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HIV Vaccine to be Tested in Botswana, US - 2003-08-26

The southern African nation of Botswana has one of the highest rates of AIDS in the world. Health officials there are working with the School of Public Health at Harvard University to test a vaccine against HIV, the virus that causes AIDS. It is the first time a vaccine is being tested at the early stages simultaneously in Africa and the United States.

The AIDS epidemic in Africa has a significant biological difference from that in the United States and Europe. Africa has a different HIV strain.

The head of the Botswana-Harvard partnership, Max Essex, says this variation has led researchers to begin testing a vaccine on both continents, in a study funded by the U.S. National Institute of Health.

"For some time, we have been interested in having vaccines made that would incorporate some of the antigens for viruses that are more prevalent in Africa than in the United States," said Mr. Essex. "And also, I think, a lot of groups [around the world], including U.S. NIH, [are] interested in testing vaccines in Africa, especially southern Africa, because this is the area with highest prevalence in the world. So, you can get results faster, so to speak."

The vaccine trial is at its earliest stage. In June, 42 adults, equally divided between Botswana and the U.S. cities of Boston, and Saint Louis, received low doses of the vaccine, known as EP, HIV-10-90, to determine its safety. As a control, some of the participants are being given a placebo.

Researchers say it is not possible to contract HIV from the vaccine. California-based pharmaceutical company Epimmune developed the drug from synthetically produced HIV genes. The intent is for the vaccine to prompt the body to produce a protein, so the immune system can recognize and fight HIV infection.

This is not the first vaccine trial. The California drug company VaxGen earlier this year concluded that a three-year vaccine trial in industrialized countries did not show a statistically significant reduction in HIV infection. But the company has other vaccine trials in the works in Asia and Africa.

Botswana's ambassador to the United States, Caesar Lekoa, says it was easy to find volunteers for the study in his country, where people are desperate for a cure.

"Botswana, like many other countries, remains in a situation where the population is being decimated by the pandemic," explained Ambassador Lekoa. "We have seen a reduction in life expectancy from 70 years to around 45 years. And we are losing labor productivity as a result of people dying from HIV-AIDS, and so forth. So, a cure really will make all the difference for Botswana. For Botswana, this is really a catastrophe that really came from nowhere and visited our country."

Mr. Lekoa says he is encouraged by President Bush's pledge of $15 billion to fight HIV/AIDS in Africa and the Caribbean over the next five years, a commitment the president underscored during a recent trip to Botswana and other African countries.

Botswana is one of the most economically successful nations in sub-Saharan Africa. It was one of the first to offer a government drug-treatment program for AIDS.

But Ambassador Lekoa says Botswana needs guidance and resources from developed nations.

"We need first and foremost human capital, the manpower to implement the national response to the HIV/AIDS scourge," he said. "Secondly, we need to expand our medical facilities and related resources to deal with the heavier burden, or the additional burden that HIV has brought on to the capacity of existing facilities."

The independent Bill and Melinda Gates Foundation has dedicated $50 million to Botswana to fight AIDS. The country is also working closely with Harvard University on AIDS and HIV drug programs, and to prevent mother-to-infant infection.

Harvard School of Public Health Professor Max Essex says education and behavioral change are needed. But he says even a vaccine with a relatively low level of success would help reduce the deadly disease that has infected an estimated 42 million people around the world. "It would have tremendous impact in the long run, if we get a vaccine that has even 50 percent protection, which is, in the eyes of most vaccinologists who are more familiar with traditional vaccines, mumps, measles, rubella, polio, hepatitis etc., is a horrible vaccine," said Professor Essex. "But even one that only worked at that level in Botswana, in South Africa, in all of that region, would have tremendous value by reducing the number of new infections."

Researchers will study the vaccine's safety in Botswana and the United States for 18 months. Then, if it is not harmful, thousands of volunteers will test the vaccine's protective response. It could take at least five years to test and many more to produce and market a working vaccine against HIV/AIDS, which takes the lives of about 8,500 people a day worldwide.