By Gustavo Capdevila
GENEVA, Nov 25 2003 (IPS)

Two centuries ago, the Spanish monarchy sent a group of orphans on a ship to its colonies in the Americas. The children served as living vessels for the vaccine against smallpox, the equivalent at the time of today’s HIV, or AIDS virus.

Two children were vaccinated shortly before departure, and when pustules developed on their arms, the ship’s doctor would use some of the pus to inoculate two more children, roughly every nine days.

There was no system of refrigeration to preserve the live vaccine during the long voyage across the ocean, to Spain’s colonies. The experiment is considered the first international public health operation.

Today smallpox has been eradicated. But researchers are working hard to come up with a vaccine of similar importance: one that will fight HIV, the AIDS virus, the worst scourge in a century, which claimed three million lives a year, the highest rate ever.

The number of people living with HIV/AIDS – over 40 million today – is steadily climbing, as is the number of deaths the virus causes, said Marika Fahlen, director of social mobilisation and information for the United Nations Joint HIV/AIDS Programme (UNAIDS).

Some five million people have been infected with HIV this year, said Fahlen at Tuesday’s release of the annual report ”AIDS Epidemic Update 2003” in London.

But the biggest hope lies in the discovery of a vaccine. Efforts towards that goal have been underway since 1985, said José Esparza, a World Health Organisation (WHO) AIDS vaccine expert.

The provision of pharmaceuticals to people living with HIV/AIDS took on renewed momentum through the WHO/UNAIDS strategy known as ”3×5”, shorthand for making the antiretroviral “cocktail” therapy available to three million people in 2005.

Today, only 400,000 people receive the drugs, said WHO official Donald Sutherland. Of that total, a relatively large proportion, around 70,000 live in South America, mainly Brazil.

Esparza noted that, years ago, the Brazilian government began to furnish people living with HIV/AIDS with antiretroviral drugs free of charge.

The big challenge now is to make these drugs available to patients in Africa, a moral commitment that the world must assume, he said.

Science cannot continue producing wonder drugs that radically change the prognosis for people living with HIV/AIDS in the United States and Europe, while the developing world has virtually no access to those drugs, he argued.

Catherine Hankins, UNAIDS chief scientific adviser, points to the situation in sub-Saharan Africa, which is dominated by a cycle of disease and death largely due to the total lack of far-reaching prevention programmes and antiretroviral treatment.

Of the 40 million people living with the disease worldwide, nearly 27 million are in sub-Saharan Africa, amounting to between 7.5 and 8.5 percent of the adult population on that continent.

Prevalence of the disease in that region ranges from less than one percent in Mauritania to nearly 40 percent in hard-hit Botswana and Swaziland.

But Esparza says the application of the “3×5” strategy would renew hopes in Africa about the availability of antiretroviral drugs and would revitalise programmes for fighting HIV/AIDS in all developing countries.

The price of these medicines today has dropped to the point that, with less than a dollar a day, a person with AIDS can be treated with the least expensive yet appropriate drug cocktail that the WHO recommends.

That sum is around 300 dollars a year, which is still considered high, but is a tiny portion of the 10,000 to 15,000 dollars per person that the drugs cost just a few years ago.

However, Esparza notes that the problem is not limited to prices, but also involves the infrastructure needed to distribute the medicines. The treatments are complex and require strict medical follow-up. There are many who say the African optimism is a bit premature, he adds.

The big pharmaceutical transnationals used the same arguments in 2001 when debate began on authorising developing countries to produce generic versions of the drugs in order to treat their ill, as Brazil, South Africa and India have done since.

With this panorama, Esparza says a vaccine to prevent AIDS is the best hope for definitively controlling the epidemic.

But he admits that “it is not easy,” nor will a vaccine be available soon, as indicated by the outcomes of two trials published this year.

In February, encouraging results were announced for tests involving 5,400 people in the United States, using the first generation of what are known as the GP120 vaccines.

And a few weeks ago, reports were released for a similar trial conducted in Bangkok, with 2,500 young men who use intravenous drugs. But the vaccine did not provide much protection for high-risk populations.

Nevertheless, the experiments with vaccines have provided important lessons. For one thing, they have shown that it is possible to follow the individuals taking part in the trials for three years, even though they often live in difficult situations.

We now know that the tests can be conducted with the highest ethical and scientific standards, says Esparza.

But another issue is that the antibody induced by this type of vaccine does not protect people who already have HIV, at least not for the majority of the test population.

A different kind of antibody is needed, and scientists are already trying to identify one, said the WHO expert.

Another lesson is that in future experiments, variables of gender and race need to be taken into account. Esparza admits that tests should include more women and more people representing different ethnic groups.

On another front, some unpublished studies conducted in the United States show that people of African descent produce higher levels of antibodies than people of European descent. This phenomenon was unknown until just a year ago.

The relatively poor results of the two vaccines developed in the past three years have prompted members of the scientific community to seek a different route.

In June, AIDS researchers proposed creating a global enterprise for a vaccine, based on the model that was used to decipher the human genome.

The enterprise will be an alliance of research institutions, independent agencies from developing and industrialised countries alike, both public and private sector – and would include the WHO and UNAIDS.

The alliance, which is sponsored by the U.S.-based Bill and Melinda Gates Foundation, is founded on the principle of a common scientific plan, says Esparza, who will leave the WHO in the next few months to join the new project.

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