Immunization against AIDS?

It’s been almost five years since posters appeared around Church and Wellesley seeking volunteers for an AIDS vaccine trial. The disappointing results from that clinical trial of a preventative vaccine from California-based VaxGen were reported last year.

Since those recruitment posters were mounted, the AIDS vaccine issue hasn’t exactly been high profile. But the Canadian HIV/AIDS Legal Network and the Canadian AIDS Society have been working, against considerable odds, to bring AIDS vaccines onto the political agenda.

“Vaccines just haven’t been on the radar,” admits Marc-Andre LeBlanc of the Canadian AIDS Society (CAS). “They are so far in the future, and the movement has not been conditioned to think long term. There is always so much to do right now… and our capacity to do everything is decreased, because funding is effectively decreased.”

Combine that with the fact that AIDS vaccine development is a complicated business – the scientific challenges alone are enormous – and you don’t have an easily discussed topic.

But this spring a new, small Canadian trial of a therapeutic vaccine was announced. The trial is a hopeful event, because it is the product of a new cooperative spirit among academics, government and the private sector.

Participants in Ottawa and Montreal will be HIV-positive people who have been successfully treated with highly active retroviral therapy. For the trial, they will go off their drug therapy to determine the effect of the vaccine – actually a combination of two different vaccines – on viral rebound, explains principal investigator Jonathan Angel of Ottawa.

“Now, most people experience a virus rebound in a couple of weeks after going off drugs,” says Angel.

Most AIDS vaccine research is into a preventive vaccine, he says, but a therapeutic vaccine that could prolong drug holidays would of course also be beneficial.

The $1.5-million trial involving just 60 participants is led by academics, approved by the Canadian HIV Trials Network and financed by the Canadian Network For Vaccines And Immunotherapeutics (CANVAC), the Canadian Institutes For Health Research and the two companies that produced and donated the vaccines, Aventis Pasteur and The Immune Response Corporation.

It is exactly the kind of initiative envisioned by the Canadian HIV Vaccines Plan, a fledgling effort that the legal network and CAS prodded Health Canada into establishing. The plan’s aim is to accelerate progress in developing vaccines, ensure that safe vaccines will be accessible to those most in need domestically and internationally, and to engage those living with and at risk of HIV/AIDS in developing and monitoring a plan.

It is estimated that 14,000 people a day are infected with HIV worldwide and a vaccine remains the world’s best hope to slow or stop AIDS. The failure to invest in research and trials for an AIDS vaccine “is really a human rights failure,” argues Ralf Jurgens, executive director of the legal network.

Jurgens says Canada is the first developed nation to work on such an encompassing vaccine plan – one that is based on human rights principles. But hold the champagne: The federal government has not funded the initiative. A draft of the Canadian HIV Vaccine Plan was to have been presented this July at the Inter- national AIDS conference in Bangkok, but Health Canada recently turned down a request for project funding. To date all that exists is nine pages of point-form notes drawn together from conference telephone calls.

“You can’t just work on a plan with no funding,” says Jurgens. And if a plan is developed, it will need funding to be acted on – “otherwise, it’s just paper.”

Meanwhile, the federal gov-ernment recently announced an increase to the budget for Canada’s AIDS strategy, which funds both research and service organizations and has been frozen at $42.2-million a year for 11 years. The increase phases in over five years, at the end of which the budget will be $84.4-million. The hike will be only $5-million in the first year, despite a recommendation from the federal Standing Committee On Health that the strategy more than double to $100-million immediately.

CANVAC, one of Canada’s Networks Of Centres Of Excellence, which is internationally acknowledged for vaccine work, receives just $700,000 a year in public money to work on AIDS vaccines, says Michel Klein, the chief executive officer. “We should not live on false ideas, like saying Canada is doing its best, that it is an international player [in AIDS research]… there is no leadership in Canada.”

With the AIDS pie being of limited size, the legal network recognized the risk that activists might work at cross-purposes. Last November it convened a meeting of international AIDS treatment, vaccine and microbicide activists.

“We realized that we had to support each other and find common ground,” says Jurgens. There was a period in 2000/2001, he says, when an emerging message was that “treatment will never work for everyone. We need to work on vaccines… but now we are preparing a document to sign off on common goals. We need to work on all fronts.”

In 1984, Robert Gallo – co- discoverer of HIV – predicted that an AIDS vaccine was just a couple of years away. Today, most scientists say it will be at least a decade until a vaccine is available to the public.

“What we need is a vaccine that elicits antibodies that neutralize the virus – but we don’t have that yet. So research is important,” says Klein of CANVAC.

Until recently, the large phar-maceutical companies have not been interested in supporting costly vaccine research and trials in a significant or consistent way, and promising research has not always been followed up. Governments, meanwhile, have not launched organized and focussed efforts.

*For more information see Iavi.org (the International AIDS Vaccine Initiative), Avac.org (AIDS Vaccine Advocacy Coalition), Aidslaw.ca (the Canadian HIV/AIDS Legal Network) and the book Shots In The Dark: The Wayward Search For An AIDS Vaccine, by John Cohen.