The vaccine hunt on the fast track

International statistics on AIDS make for grim reading but this is not the only side to the story

International statistics on AIDS make for grim reading but this is not the only side to the story. A fight-back is underway, an initiative with the single mission: to bring about a working vaccine against the disease.

The International AIDS vaccine Initiative (IAVI) was established in 1996 in an effort to fast-track work towards a vaccine for HIV. It is a remarkable endeavour driven forward by an individual, De Seth Berkley, who has managed to overcome traditional impediments to research, explains Prof John Kevany, an international health specialist based in the Department of Community Health and General Practice at Trinity College Dublin.

The IAVI campaign is led by its president and chief executive, Dr Berkley. "What can be credited to him is the first attempt to put together what we now call public private partnerships," Prof Kevany explains.

"He got together public sector people, vaccine manufacturers and drug companies and also solicited funds from national governments."

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He was here last April looking for support from the Government. He briefed the Minister of State for Foreign Affairs, Ms Liz O'Donnell, and she in turn presented him with a cheque for £2.25m in support of the IAVI's work.

The international, not-for-profit body has so far raised funding worth $230 million and Dr Berkley's goal is to put $550 million together by 2007.

Dr Berkley has no difficulty with motivation given the statistics associated with the disease. Before this day ends 15,000 more people worldwide will have become infected the HIV, joining the estimated 60 million who already have it or have died from it.

He founded the body to push along efforts towards a working vaccine. Most of the drug companies put money into pharmaceutical therapies and $3,000 million is spent annually in drug development. By comparison just $100 million worldwide is invested in vaccine studies.

Yet vaccine development is a slow and difficult business, Prof Kevany says. "The fastest ever was to market in 15 years. He (Dr Berkley) has set a goal for himself of seven years."

Dr Berkley's efforts at partnership building is central to his plans if he is to achieve this goal. Dr Berkley describes it himself as raising "social venture capital". The idea is not to retain profits for IAVI or hold on to intellectual property. Instead the body brings the various players together to hasten research and then trials of promising HIV vaccines.

"His aim is to broaden the pipeline for candidate vaccines for AIDS," Prof Kevany says and to accelerate new trials through the pipeline. Dr Berkley does this in a "push-pull" fashion, Prof Kevany adds.

He pushes things along by funding the clearing of bottlenecks in the way of research and manufacturing For example IAVI will help fund "pilot lot" vaccine manufacturer. It is uneconomic for vaccine producers to prepare small amounts of vaccine, so IAVI provides the financial resources to make this happen.

He pulls things along for example by guaranteeing manufacturers that they will have markets for working vaccines in the most affected countries. He does this by enlisting bodies such as the World Health Organisation to back vaccine distribution.

Prof Kevany was struck with the "comprehensiveness" of Dr Berkley's work. He looked at regulatory requirements for trials both in countries developing vaccines but also in recipient countries. He studied ethical issues: for example, the response should a vaccine work in just 60 per cent of individuals, and how trials can be conducted without turning people into guinea pigs.

He even undertook what is known as "field trial preparedness", Prof Kevany adds. This is promotional work necessary to win public support for a trial in a candidate country to ensure a good level of involvement.

The IAVI now has six candidate vaccines in development. One done in conjunction with Oxford University is undergoing Phase I studies in Nairobi. It may take a few years to get a working vaccine in place but at least this work will have a powerful advocate in the IAVI.