Still waiting for the HIV vaccine By: Seth Berkley and Alan Bernstein

With the XVIII International AIDS Conference under way in Vienna, it is time to face some difficult realities about the global response to HIV and AIDS.

More than 2.7 million people worldwide are newly infected with HIV every year. Current HIV drugs are not cures. Every person infected with HIV will require expensive and often complex antiretroviral treatment for life.

The US government, the Clinton Foundation, the Global Fund to Fight HIV, Tuberculosis and Malaria and others are leading efforts to provide treatment to the ever-increasing millions of people in need. New United Nations data shows, however, that the 5 million people now receiving HIV drugs in developing countries are still just one-third of the number in need. For each person who receives treatment, 2.5 more are infected. Simply put, we cannot treat ourselves out of this pandemic. This pandemic needs a vaccine.

Multiple approaches to stopping HIV, including condoms, circumcision and widespread promotion of monogamy and safer sex, along with new approaches in development, are all important to slowing this epidemic.

Historically, however, vaccines are the best tool to limit or stop the spread of a virus. Smallpox and polio are examples of global killers that have been completely or nearly eliminated with a vaccine.

So why don’t we have an HIV vaccine yet, and what can we do to get one?

The development of an HIV vaccine is slowed by the complexity of the challenge — HIV is the most elusive virus ever targeted for a vaccine — but also by inadequate support for research.

Consider that the global economic impact of AIDS is estimated between $20 and $50 billion every year. The cost of providing treatment to even the one-third of people who need it today is more than $10 billion per year. But the amount spent on the entire global effort to develop and test HIV vaccines was only about $800 million last year — 12 per cent less than 2007 funding. That’s not enough to get the job done. Only four major trials of HIV vaccine candidates have been conducted in 27 years of research — not nearly enough to gather critical scientific information. We are poised to take major steps forward in HIV vaccine research if the effort receives the support it needs. Recently, a vaccine trial in Thailand reduced HIV infection risk by 31 per cent — a major advance and the first demonstration that a vaccine can prevent HIV infection. While 31 per cent protection is too low for a useable vaccine, it shows that a vaccine is possible.

In other advances, scientists have discovered a number of antibodies that neutralise different variations of HIV found around the world. Combining two or more of these antibodies in the laboratory provides protection against most strains of HIV. Other innovative vaccine strategies aimed at controlling HIV infection have tested well in animals. Without a truly global effort to act on that promise, however, we may find ourselves asking the same question after 25 more years of this pandemic: Where is the HIV vaccine?

Seth Berkley is president and CEO of the International AIDS Vaccine Initiative. Alan Bernstein is executive director of the Global HIV Vaccine Enterprise