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Q&A: The State of HIV Prevention Vaccines

Safeeyah Kharsany interviews Dr ALAN BERNSTEIN, executive director, Global HIV Vaccine Enterprise.

JOHANNESBURG, Apr 26 2010 (IPS) - An HIV vaccine is possible if the world works together as a global community with the objective of finding one, but it will take some years to develop.

This is according to Dr Alan Bernstein of the Global HIV Vaccine Enterprise.

The 2009 results of an HIV vaccine trial in Thailand showed for the first time that a vaccine could cut the risk of HIV infection. The trial vaccine was a combination of two experimental vaccines that on their own had not been able to cut the risk of infection. However, combined, the risk of infection was cut by a third.

Bernstein was in South Africa for talks with the WHO and UNAIDS to discuss the breakthrough of the experimental HIV vaccine. He believes a collaborative effort from academia, industry, public and private funders will speed up the search for a vaccine.

Excerpts of the interview follow.

Q: In 2009 the Thailand vaccine trial cut the risk of HIV infection for the first time. What is most significant about these trial results? A: The most important thing is that it has opened a door which we did not have before. It says that it is possible to get protection against HIV acquisition with a vaccine.

Q: What significance does the result of the Thai vaccine trial hold for the African strain of the HIV Virus? A: We came to a consensus that we have to do two things. We have to do more in Thailand, and, in sub-Saharan Africa, where the epidemic is. There needs to be a trial that tests other variations of what was done in Thailand.

It will take about a year or two to get a new vaccine manufactured for sub- Saharan Africa. There also needs to be regulatory approval, and a source of funding found. The trial sites also need to be geared up.

Q: Why do we still not have an effective HIV vaccine? A: HIV is not like other viruses. It has the ability to evade its host immune system, to kill the host immune system, to immigrate, go underground as it were. It is very different to Polio, Flu or Small Pox. It is a very, very challenging virus in ways we could not have anticipated when it was discovered in 1983. It is smarter, not smarter than us, but it is smarter than other viruses. I have no doubt that we will get a vaccine.

Q: When do you think we may get an effective HIV prevention vaccine? A: I do not know… It depends on that very complex relationship between academia, industry, public funders, private funders and people from different countries working together with one objective of speeding up the search for a vaccine.

However, even if we started a new trial tomorrow, it will be at least two or three years before we know if it is effective.

Q: Thus far, what are your impressions of African input in the HIV Vaccine research? A: In South Africa science is as good as anywhere in the world. No country brings together their scientists as well as South Africa does but, the bad news is, that although the new government is upfront that HIV causes AIDS and that they have lost time and which they have to make up for, at the same time, their funding for South African AIDS Vaccine Initiative has been cut. So South Africa is at a risk of losing what it has built up over the last five to 10 years.

Q: What are the biggest challenges facing the creation of an HIV prevention vaccine? A: There has never been a more exciting time in the field, scientifically, but because of the economic situation worldwide, the amount of money going to HIV vaccine research dropped by a 100 million dollars last year. This is about 10 percent.

Q: What are your thoughts on the call to prioritise the financing of therapeutic vaccine research (vaccines for HIV-positive people to improve their immune systems) over HIV prevention vaccine research (vaccines to prevent HIV)? A: It is not either or. As a world, as a premise, we have to be able to afford to pursue every possible good idea because this epidemic is literally killing us. It is out of control and it is going to get more out of control over the next three years.

I am all for good therapeutic vaccine ideas, and they should be funded. Good prevention vaccine ideas should also be funded, Pre-Exposure Prophylaxis should be funded. Can we afford it all as a planet? Yes, but it is a question again of convincing funders and governments of putting money into it. If they do not put money into it, we are going to pay 10 to 20 times more in the long term.