More than 1,000 people have registered to attend the AIDS Vaccine 2001 conference which opened on Wednesday 5 September, in Philadelphia.
The conference is primarily about preventive vaccines although, on Saturday 8 September, Dr Bruce Walker is due to make a plenary review of therapeutic immunisation. Most presentations are concerned with basic science and preclinical studies but there are some relating to behavioural issues, including a first report on gay men’s risk-behaviour in the course of the North American VaxGen trial, due on Friday. The main impetus for the meeting has come from the US National Institutes for Health and its AIDS Vaccine Research Committee through a new “Foundation for AIDS Vaccine Research and Development”. The meeting is cosponsored by other US Federal agencies and three international partners: WHO, UNAIDS and the French ANRS.
In the opening session, Dr William Foege, a distinguished epidemiologist who is now a senior medical adviser to the Bill and Melinda Gates Foundation, gave a spirited defence of the priority that Foundation continues to give to funding HIV and AIDS prevention.
Dr Anthony Fauci, head of NIH's National Institute for Allergy and Infectious Diseases (NIAID), reviewed progress and challenges in HIV research generally and preventive vaccines in particular. He stressed the commitment of the new Bush administration and Health and Human Services Secretary Tommy Thompson to NIH funding in general and funding for AIDS research and HIV vaccine research in particular.
The projected budget for FY 2002 increases AIDS research funding across the board to an estimated $2.501 billion. Within this, vaccine research set to expand by 24 per cent to $356.6 million: a bigger increase than for any other area of AIDS research. In another context, that of NIAID’s overall spending on vaccine research for all diseases, HIV will account for 61 per cent of the total of $450.7 million.
Dr Fauci welcomed the political interest in addressing the global impact of AIDS, symbolised by the establishment of the Global AIDS and Health Fund and the recent UN General Assembly Special Session on HIV/AIDS. He argued that the demand for action to expand access to treatment was not a threat to vaccine research but evidence of a commitment that could and should be mobilised to carry vaccine research forward.
Dr Fauci particularly stressed the importance of NIH’s international partnerships within the HIV Vaccine Trials Network and numerous other collaborations. The “Comprehensive International Program for Research on AIDS” (CIPRA) differed from NIH’s past activities in stressing the need to build sustainable scientific infrastructure within developing countries, as a basis for stronger and more equal partnerships between scientists in the US and elsewhere. Out of 24 HIV vaccine projects in NIAID’s pipeline (15 of which were “significant investments”) no less than 16 were built around non-subtype-B viruses (12 being “significant investments”).
Rwanda calls for renewed partnership
President Paul Kagame of Rwanda attributed Africa’s present problems with HIV to a combination of factors including a “lukewarm response” when the epidemic was first identified, amounting to poor leadership; a lack of openness about sexual behaviour and some cultural practices including wife inheritance that promoted its spread; and economic difficulties in managing rising external debts.
Some of these problems, especially the issues of leadership, were now being addressed at national, regional and international levels. What is now the African Union had committed itself in December last year in Addis Ababa to respond to AIDS and in Abuja, Nigeria, last April, to supporting HIV vaccine development. The UN General Assembly Special Session and the launch of the global fund were very welcome, though he expressed concern that the global fund should be brought into operation without undue delay.
President Kagame said that primary responsibility for addressing the needs of Africa had to be taken by African leaders, and that without their commitment international partnerships would have little effect. Nonetheless, he was grateful to WHO, UNAIDS, the US CDC, Bill and Melinda Gates Foundation and all others who had supported the fight against HIV and AIDS in Africa.
In Rwanda, some 400,000 people between the ages of 15 and 49 are now HIV positive, out of 4 million in that age group. Each year, 40,000 to 50,000 babies are born to HIV positive mothers. Events surrounding and following the genocide of 1994 had contributed in particular ways to their problems, including the transmission of HIV through organised rape.
In 1991, WHO’s Global Programme on AIDS had chosen to work with Rwanda towards setting up a site for Phase III vaccine trials, a project which had to be abandoned in 1994. With the reestablishment of Rwandan society, President Kagame expressed a strong wish to renew such partnerships with vaccine and other HIV and AIDS researchers.
The context in which this could now happen included:
- A national campaign to spread awareness, which had led to a ten-fold increase in HIV testing since 1997
- A national programme to prevent mother-to-child transmission, which is being put in place
- A scheme under which the government is providing subsidised access to antiretrovirals provided by Glaxo Smith Kline, Merck, Bristol-Myers and Boehringer Ingelheim - although even these subsidised drugs would, he admitted, be unaffordable by most Rwandans
- A National AIDS Committee which had been established
- Young people’s organisations, including anti-AIDS clubs in almost all secondary schools
- National Patriotic Army education programmes, which had led to a reduced incidence of HIV among service men and women and were being extended to civilians
- Finally, GRIA – the Great Lakes Initiative on AIDS, which is being hosted in Kigali and which explores cross-border HIV responses.
Further information about the meeting, including all conference abstracts, is available on the AIDS Vaccine 2001 website, which is also due to have webcasts of speaker sessions including the session discussed here.