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AIDS: Finding a Cure - 2003-11-26

It has been more than 20 years since AIDS was identified as a deadly disease, which swiftly became a global epidemic. Today, the United Nations estimates that as many as 46 million people in the world are infected with HIV, the virus that causes AIDS. Significant progress has been made toward treatment, prolonging the lives of those who are ill. But despite billions of dollars invested in years of research, there's still no vaccine and no cure. There is no prediction as to when an AIDS vaccine might become available.

Two decades after the start of the AIDS epidemic, a preventive vaccine remains an elusive goal. A vaccine is not a cure, but it would keep HIV from spreading.

Anthony Fauci is director of the U.S. Institute for Allergy and Infectious Diseases, the lead government funding agency for AIDS vaccine development. Dr. Fauci notes it took decades to develop vaccines for common infections such as Hepatitis-B and polio. "But that's not really the issue," he says. "The issue is that it is an extremely difficult situation with an HIV vaccine, because of the nature of the body's general inability, immunologically, to handle the AIDS virus very well."

Unlike other viruses, experts say, the body's immune system is baffled by the HIV virus, because it keeps changing shape. That has made it extremely difficult for virologists to develop a vaccine that can help the body to recognize and attack HIV.

The United States out-spends the world in funding AIDS research.

Since 1996, when it started keeping records, the National Institutes of Health, which includes Dr. Fauci's agency, has spent more than $2 billion on AIDS research.

Mr. Fauci says devoting more money to the effort would not necessarily result in an AIDS vaccine. "In science, you could always do better, and money generally pushes you [that way]," he says. "But, I think, if you were to drop a billion dollars extra into [developing a] vaccine now, you would not get a billion dollars worth of advancement. It would not be a proportionate one-to-one ratio of what you put in."

Seth Berkley is president of the International Vaccine Initiative, a private, global organization with the goal of encouraging development of an AIDS vaccine. Dr. Berkley believes research is moving at a sluggish pace, in large part because too little money is devoted to the effort. "This is still much less than one percent of what the world spends on health research, despite [the fact that] this is the worst pandemic, or disease pandemic, since the 14th century."

Dr. Berkley says there is no strong advocacy for a vaccine because newer drugs to treat people are so effective in staving off the effects disease. Few have seen the benefits of anti-AIDs drugs better than Bruce Walker, who heads the Division of AIDS at Harvard Medical School in Massachusetts.

Dr. Walker says people come into his clinic everyday who are near death, and they are restored to productive lives by anti-retroviral drugs. He says that has led to a tug-of-war between drug companies and vaccine advocates over where funds should be directed. "There are problems just in terms of how much money is available to deal with both of these competing needs, says Dr. Walker. "On the one hand to treat people who are HIV-infected, and, on the other hand, to develop vaccines to try to prevent infections."

Jon Cohen, a reporter who has been covering the AIDS issue for Science magazine since 1991, is cynical about AIDS vaccine development. He says only about four pharmaceutical companies make vaccines for a variety of illnesses. "That means that every vaccine that now sells on the market totals less money than one best-selling drug. So, if you're a big pharmaceutical company, why take the risk? Why do it? It's not where the money is."

Experts agree that a revised funding system is needed to encourage risk-taking in research, and to reward those who work to develop AIDS vaccines.