May 18, 2008
|Anthony S. Fauci, M.D., NIAID Director|
The past year was a disappointing one in the search for a safe and effective HIV vaccine. The scientific concept tested in the HIV vaccine study known as the STEP trial was considered to have great promise; however, the vaccine did not have the desired beneficial effect. Although the finding was disappointing, it was not unusual given the nature of science and vaccine development. Historically, it has taken decades to find effective vaccines to combat infectious diseases. In the 89 years it took to create an effective pertussis vaccine and the 42 years it took to develop an effective measles vaccine, researchers experienced numerous setbacks and disappointments before reaching success; yet they persevered. Finding a safe and effective HIV vaccine demands an equally intense resolve.
Last year, 2.1 million people died as a result of AIDS, including 330,000 children under the age of 15. Today, 33.3 million people are living with HIV infection. Although the problem is most severe in sub-Saharan Africa, the United States also has been hard-hit: more than 565,000 people in this country have died of AIDS and an estimated 1.1 million are living with HIV infection. African-Americans and Hispanics shoulder the greatest burden, accounting for 59 percent of U.S. AIDS cases in 2006. In some urban areas, the HIV infection rates rival those of Africa. Nowhere is this more shocking than in the nation's capital, where one in 20 Washingtonians have HIV and one in 50 has AIDS.
Through important public health programs, such as the Ryan White HIV/AIDS Program, the U.S. President's Emergency Plan for AIDS Relief, the Global Fund to Fight AIDS, Tuberculosis and Malaria, the Bill and Melinda Gates Foundation and the Clinton Foundation, we have made enormous strides in making life-saving treatments accessible to HIV-infected individuals throughout the world. Despite this heroic achievement, only a fraction of those individuals in developing countries who need antiretroviral therapy are receiving it. The stark reality is that for every person with HIV who is placed on therapy, about three more individuals become newly infected with the virus. The rate of new HIV infections far outpaces our ability to supply a lifetime regimen of HIV medication to everyone who needs it.
Further scale-up of lifesaving HIV treatment programs is critical. However, treatment alone will not end the AIDS pandemic. Developing HIV prevention strategies, including a vaccine, remains an extremely important goal. A number of proven strategies to prevent HIV transmission are already available, including education and behavior modification; condom usage; medically supervised adult male circumcision; harm-reduction approaches such as needle and syringe exchanges for injection drug users; and antiretroviral drug regimens for HIV-infected pregnant women to prevent mother-to-child HIV transmission of the virus. NIAID is testing other prevention strategies, such as microbicide gels or creams that can be applied prior to sexual intercourse and preventive regimens of antiretroviral drugs, that we hope will prove successful. Ideally, a vaccine that prevents HIV infection would be a core component of our prevention program.
Recently, NIAID convened a scientific summit to examine the state of HIV vaccine research and determine how best to move the field forward. Based on that discussion, it became clear that although it is important to maintain our approach to identifying promising HIV vaccine candidates and clinically testing those candidates when appropriate, it also is imperative that we place greater emphasis on the basic research necessary to address the many unanswered questions that remain about HIV. We must understand how to create a vaccine that induces a protective immune response in people that is more effective than the immune response that results when someone is naturally infected with HIV.
By striking a better balance between fundamental HIV research and vaccine development and by fostering research across scientific disciplines, we can expand the body of knowledge needed to better understand this complex virus and develop a safe and effective HIV vaccine.
On HIV Vaccine Awareness Day, we applaud the thousands of volunteers, scientists, community members and health professionals who have been involved in HIV vaccine research and who continue to support and participate in this extremely vital area of public health research. We encourage all interested parties to join with us in our rededicated battle to find an effective HIV vaccine to end the scourge of AIDS.
Dr. Fauci is director of the National Institute of Allergy and Infectious Diseases at the National Institutes of Health in Bethesda, Maryland.