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Promises, promises
t is no longer a question of whether we can
develop an AIDS vaccine, it is simply a
question of when,” said President Clinton.
He committed the nation to developing an
Clinton’s initiative to secure an AIDS vaccine within 10years
HIV vaccine within 10 years, comparing
his challenge to John F. Kennedy’s pledge to put
draws responses from encouragement to derision
a man on the moon in the 1960s. The long-
anticipated initiative made up about 15 percent of
his commencement address at the historically
by Bob Roehr
African American Morgan State University in
Baltimore on May 18.
Many leading
Most of those with knowledge of HIV ap­
scientists do not
plauded the president’s intent but were skeptical
of the outcome. Perhaps they remembered the
share Clinton’s
prediction that Ronald Reagan’s secretary of health
and human services, Margaret Heckler, made in
certitude that an
April 1984. She said they would have a vaccine in
HIV vaccine can
trial within two years. It did not happen.
Many leading scientists do not share Clinton’s
be developed
certitude that an HIV vaccine can be developed
within 10 years,
within that time frame, and some doubt that a
vaccine is even possible. AIDS activists, mean­
and some doubt
while, question whether his commitment is any­
that a vaccine is
thing more than rhetoric. The president has pro­
posed no new money; his initiative consists largely
even possible.
of reorganizing 30 to 50 existing employees at the
The president has
National Institutes of Health into a vaccine re­
search center.
proposed no new
This year Clinton has sought to make vaccines
his signature mark on the epidemic. “With new
money; his
resources NIH will now become the most power­
initiative consists
ful discovery engine for an AIDS vaccine, work­
ing with other scientists to Finally end the threat of
largely o f reorga­
AIDS,” he said in his February State of the Union cr >
nizing 30 to 50
address. “We must reinforce our commitment to 1
medical science.” His subsequent budget for NIH
existing employees
offered an increase in funding that would not keep =
)
x
at the National
0
pace with the rate of inflation for medical care.
Vaccines were a high priority at a meeting of 1
Institutes o f Health
the Presidential Advisory Council on HIV/AIDS S
into a vaccine
in early April. Dr. David Baltimore, chair of the 0
1
AIDS Vaccine Research Committee at NIH. told
research center.
the council it was “not possible to put a date” on
Bill Clinton
developing a vaccine, saying there are “too many
uncertainties.” Others expressed little need for a
research. Each will contribute its own resources,
searchers are taking as to where and how to
restructuring of research. “I flinch at the concept
with supplemental funding from OAR’s discre­
intervene to prevent infection. It indicates how
of more coordination,” said Anthony Fauci, di­
tionary account.
little consensus there is and how much basic study
rector of the National Institute of Allergy and
of HIV remains to be done.
Paul called the president’s challenge “a formi­
Infectious Diseases.
dable undertaking.... One which 1 am confident
There are six known strains of HIV, and the
But council chairman Scott Hitt, in his most
we can achieve, though not quite in 10 years.” But
highly unstable virus is constantly mutating, cre­
political comments of the meeting, told the body
he said he believes “a challenge is the right way to
ating variations within each strain. Such is the
that the president wants to do “the man on the
put it. We didn’t want to trivialize it.”
varied, evolving foe that a vaccine must protect
moon” analogy in moving this as a priority of the
Clinton’s analogy to the moon project may be
against. Right now we simply don’t know how a
administration. He recommended they support
a good sound bite, but it is not an accurate com­
vaccine can work under these conditions, which
the effort. The final document urged development
parison. In that instance we already possessed the
has led some scientists to fear a vaccine is impos­
of “a vaccine to prevent HIV/AIDS within a
scientific and mechanical knowledge necessary
sible. It has led many pharmaceutical companies
decade,” with “a significant and sustained in­ to accomplish the task. Kennedy’s challenge was
to drop their efforts toward developing a vaccine,
crease in funds...from new sources.”
to summon the political and economic will of the
as they see foresee no profit coming from their
nation to do so.
In a private conversation. Dr. William Paul,
investment.
director of the Office of AIDS Research at NIH,
Developing an AIDS vaccine is quite differ­
Then there is the slippery slope of definition.
described the new lab as an intramural effort
ent: We are taking a leap of discovery, not one of
How does one define "success”? The model most
jointly sponsored by NIAID and the National
implementation. The uncertainty is apparent in
people in this country know is that of the polio
Cancer Institute, the two major players in vaccine
the handful of radically different approaches re­
vaccine, where children are inoculated, protec­
I
m
m
m
k m
tion is 99.9 percent effective, and side effects are
minuscule.
Some researchers believe that vaccines cur­
rently in development may offer 30 percent pro­
tection for HIV. That is clearly not acceptable in
the United States, where the prevalence of the
virus is relatively low ( I million infected people in
a population of 270 million), the ability to reduce
new infections is relatively easy and inexpensive,
and the current standard of protection for vaccines
is very high.
But a vaccine of such limited effectiveness
might be acceptable in those Third World coun­
tries where HIV infects close to half the popula­
tion and sheer poverty precludes massive spend­
ing on health care. From a strictly public health
perspective, such a vaccine might save thousands
of lives and begin to limit the spread of the
epidemic.
There is also the dilemma of not knowing the
long-term consequences of such a vaccine. They
include the very real possibility that a vaccine
could result in the infection of individuals with
HIV, not their protection from it.
Researchers and the Advisory Council sug­
gested the creation of a body to look at the moral,
ethical and legal questions embedded in a possible
vaccine for HIV. The president has yet to move on
that proposal.
Noted AIDS researcher Dr. Robert Gallo ques­
tioned the extent of Clinton’s commitment. He
told USA Today, “If you really wanted a crash
program, you’d have to have five or six centers
focusing on nothing else.”
The always acerbic playwright/activist Larry
Kramer told the Washington Post the president’s
speech was “more cheap talk.... It’s an easy
promise. He’s just switching NIH funds from
Column A to Column B.”
“Show me the money,” said Steve Michael of
ACT UP Washington. He echoed the sentiment
expressed more diplomatically by every other
AIDS organization. There is an underlying fear
that increased funding for vaccine research might
come at the expense of funding for research on
treatment and for care for those already infected.
The Human Rights Campaign applauded the
initiative and called on the president to support a
supplemental appropriation now before Congress
that would add $68 million for AIDS drug assis­
tance programs. The White House has not pub­
licly indicated its support of that effort.
Meanwhile, Clinton continues to drag his feet
on things that could be done right now to prevent
new infections in this country. They include lift­
ing the federal funding ban on needle exchange
programs and more effective prevention efforts.
It is statistically likely that some of the gradu­
ating seniors and their family members in the
Morgan State audience listening to his speech
could have been spared their HIV infection had
the president implemented those changes at the
start of his administration.
.
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y o u n g m e n ’s pro gra m , spe ak to y o u r brothers at cascade A I D S p ro je ct