In an Unpredictable HIV Vaccine Search, Hope Still Reigns

Nothing about AIDS vaccine research and development has ever been easy or straightforward except for one simple truth: to end the AIDS epidemic we will ultimately need an effective vaccine. This is as true on this year's HIV Vaccine Awareness Day, observed annually on May 18, as it has ever been. In a year that has seen both highs and lows in news from the field, it is essential to keep our sights, funding and commitment aligned with that enduring need.

HIV Vaccine Awareness Day 2013 comes just weeks after immunizations in a major vaccine trial--HVTN 505--were stopped early when an independent scientific review board determined it became clear that the vaccine being tested was not effective. Vaccine research is rarely linear and often unpredictable, and even disappointing results like those of 505 are critical to refine future vaccine strategies. This result, while not the one we'd hoped for, nonetheless provides a clear answer to the question the trial was investigating, and must now be used to inform selection and evaluation of other candidates.

Meanwhile, we are witnessing exciting scientific breakthroughs in other areas. Just last week, the US National Institutes of Health announced the development of a new tool that will speed up the process of identifying potent broadly neutralizing antibodies found in the blood of some people living with HIV. These antibodies are capable of blocking many different strains of HIV, and it is hoped that a vaccine that induces them would prevent or greatly reduce the risk of infection. This new tool is just one of the recent incremental but essential steps towards the long-term goal of developing such a vaccine.

On a separate track, the field continues toward building on the RV144 trial in Thailand, which in 2009 provided the first proof in that a vaccine can, indeed, prevent infection. The science is difficult, and taking longer than hoped, but hopefully the follow-up trials to confirm and improve upon the result will start in the next two to three years.

In short, there are promising pathways today that could ultimately lead to a safe, effective and accessible AIDS vaccine. To keep the pace, researchers need sustained funding, and increased industry, political and community support. In fact, we should be striving to step up the pace further. That means swift, well-designed research into the reasons certain vaccine candidates haven't worked; continued, broad-based support (including from the pharmaceutical industry) for trials that build on the RV144 result; and unstinting stakeholder engagement in potential trials of antibody-based vaccine approaches.

The AIDS vaccine field has been tackling one of science's toughest challenges for three decades. There will undoubtedly be more disappointments along the way, but until there is an approved preventive vaccine, we know that no single result will make or break the field.

Vaccines are wonders of modern medicine. Vaccines for smallpox, polio, measles and many other diseases have saved millions of lives around the world. But most vaccines have taken decades to develop and an AIDS vaccine is also taking time. Just as Jonas Salk, Albert Sabin, Hilary Koprowski, Maurice Hilleman and countless other vaccine researchers persevered until the polio and other vaccines were developed, HIV vaccine researchers will persevere, following up on promising findings and learning from disappointing ones.

As HIV prevention research advocates, AVAC urges continued focus on and funding for AIDS vaccine, microbicide and other new prevention research, just as we add our voices to the global chorus demanding clear plans, ambitious action and wise investments to begin to end the epidemic using tools available to us today. A safe, effective and accessible AIDS vaccine is still many years off, and its greatest impact will be on an epidemic that is already waning due to sustained and expanded implementation of HIV treatment, voluntary medical male circumcision, PrEP, male and female condoms, along with behavioral and structural interventions that are currently available but not being used to their fullest potential.

With some 2.5 million people newly infected with HIV every year, we can't afford to slash funding for research or for rollout of treatment and prevention options. While there are encouraging signs that US-funded vaccine research will remain a priority, it is equally critical to maintain funding for the US PEPFAR program and the Global Fund to Fight AIDS, Tuberculosis and Malaria, the two major funding streams available to support implementation of combination HIV prevention using proven strategies.

The road to an effective AIDS vaccine remains a long one, but we can reach that goal. For more than a decade, we've set aside May 18 to honor the thousands of men and women around the world who have contributed to HIV vaccine research as trial participants, researchers and community supporters.

This year, in the midst of both disappointments and successes, we are reminded that the contribution of trial participants is the most essential element of HIV vaccine research and development. Their shared commitments and sacrifices demand that we continue working toward the breakthroughs that will ultimately bring the epidemic to an end.

Check out AVAC's HVAD 2013: The Countdown Continues, which includes snapshots of AIDS vaccine research, trials, concepts, volunteers, sites and funding, along with a timeline of key milestones over the past 25 years.