June 21, 2004
Jackie Judd: I'm Jackie Judd with the Kaiser Family Foundation. July 11th marks the opening of the 15th International AIDS Conference, this one being held in Bangkok, Thailand. We have with us today, a leading expert on AIDS, Dr. Anthony Fauci is the Director of the Institute of Allergy and Infectious Diseases at the National Institutes of Health. Dr. Fauci, thanks for joining us.
Anthony Fauci: Good to be here.
Jackie Judd: What is your expectation, what would your definition of success be at the conference?
Anthony Fauci: Well, when you have a conference as large as the International Conferences that occur every couple of years, what you really expect and would like to see happen and would essentially be the signature of a success, is to get people from different parts of the world to be able to exchange information and network with each other, develop collaborations, strengthen relationships that would bring the group of not only investigators, scientists, but also the people involved in the other aspects of HIV, health providers, social workers, community people. It serves as an excellent vehicle for forging relationships, reaffirming old relationships and developing better interactions. When you have such a large meeting, it is unlikely that there's gonna to be a knockout of brand new scientific finding because those things usually get exchanged among investigators as they are evolving. The meeting of getting together is really the whole ambience of being able to interact with your international colleagues.
Jackie Judd: Is it the kind of event where a controversial issue such as the purchase of generic drugs before the brand name drugs have run out of patent, is that the kind of controversy that could reach some kind of resolution? Or not?
Anthony Fauci: Well, unlikely reach a resolution, but likely be aired out in a way in which you're going to get multiple sides of the story. One of the hallmarks of the international meetings over the past several years have been to have issues that are in fact, controversial, contentious, unresolved issues and have the pros and the cons discussion in front of a large audience where the audience can hear the differences of opinion and also be able to comment on them. So I would think we're going to see some of that, there'll be areas, particularly areas that we lay to international HIV, that has always been one of the major features of these meetings and is not provincial at all. How does HIV relate to the whole global problem of this disease?
Jackie Judd: And the conference being held in Thailand will put the spotlight on AIDS in Asia.
Anthony Fauci: Certainly.
Jackie Judd: Is Asia destined to be an Africa or is it off of that track?
Anthony Fauci: No, I don't think so. I think there are serious difficulties in Asia from the standpoint of where this epidemic is going, this pandemic. We are seeing now, the signs that we saw years and years ago in Subsahara in Africa, when we would talk to our colleagues and say there is a problem here, although you're seeing maybe the tip of the iceberg, there will be an explosion, but that's the nature of HIV. HIV does not attack a population like a very acute respiratory infection, where within weeks you know what the extent of your problem is. With HIV it's very, very subtle, because people can go years without knowing they're infected and then they only wind up getting sick and you see that you actually were looking at the tip of an iceberg. I fear that that's what's going on in several Asian countries, is that there's a gross underestimate, not only of what is actually going on, but what the potential is of exploding and when you have countries like India, which has a billion people, even though they're the relatively small percentage of people who are infected, the potential for just doubling or tripling that very small amount, you're talking tens of millions of additional infections. Same holds true in China and some of the southeast Asian countries, the same thing. You have the potential for an explosion, that given the numbers of people who live in Asia, that could potentially dwarf what we're seeing in Africa.
Jackie Judd: Let's step back for a moment from the conference itself. I've heard you say that a vaccine is the last great stumbling block. There are human trials going on now, some in Thailand itself, what is your expectation for success in that area?
Anthony Fauci: I think that ultimately we will see first partial success and then with different iterations of trials over the years, it will get better.
Jackie Judd: What does partial success mean?
Anthony Fauci: Partial success means that you have a percentage of people who are protected, but the percentage is low enough that you cannot count on that vaccine of being a substantive preventive modality.
Jackie Judd: So it works for some people, but not the entire population.
Anthony Fauci: Well, no vaccine is ever going to be 100%, but the good vaccines, prevent infection 90%-95% of the people, some maybe a little bit less, but you're way up there approaching 100%. It could be 85%, it could be 95%, it could be 90%. We're expecting that we'll see, in the multi-step process to getting to an HIV infection, I hope we hit a home run, but it's unlikely that it will be a home run, it is likely that it we'll see a degree of protection, 30%, 35%, 40%, that is not the goal, the ultimate goal, but tells you that you're onto something, you're learning from that trial and you say, this particular response is correlated with protection in people, so now we're going to aim the next iteration of the vaccine, we're going to aim to boost that particular component of the immune system.
Jackie Judd: And how many years out do you see, being at 30% to 35%.
Anthony Fauci: Well, right now, there is a clinical trial going on, in Thailand, it may or may not be successful. I think that we would feel good if we got over 30% to 40% of the people protected because that would not be the perfect vaccine, but it would at least tell us that you're on the right track. If you get less than that, 5% or 10%, that's almost low enough that you can't even statistically analyze whether or not it was effective or not. You have to get over a certain percent and that's generally between 30% and 40%.
Jackie Judd: Thank you so much, see you in Bangkok.
Anthony Fauci: Yes, indeed.
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