Undoubtedly, a vaccine is the only long-term solution for the pandemic. And for the developing world, where more than 90 percent of HIV-infected people live, a vaccine is the only solution. In the early 1980s, after the discovery of HIV and methods to grow it in test tubes, a vaccine was expected to appear soon. In response to a critical review, the agency recently restructured its AIDS vaccine program by appointing a part-time committee of external scientists to guide the effort. Although welcome, this reform is unlikely to overcome the fundamental handicaps of the agency itself.
Several reasons account for the agencys problems.
NIH, the worlds premier biomedical research agency, is run by sincere and devoted scientists. Its ponderously slow bureaucracy hinders efforts to respond quickly to epidemics. In addition, despite the planned revamping, there still will be no senior, full-time official whose sole responsibility is to produce an AIDS vaccine as soon as possible and who has the vaccinology background, budgetary resources, and contracting authority to do so. History teaches us that a different kind of entity would be better suited to manage an expedited vaccine program in the face of a public health emergency. To illuminate the current dilemma, it may help to recall Jonas Salks struggle to develop a polio vaccine in the early 1950s, when frightening epidemics were sweeping the United States, each year killing up to 3,000 victims and crippling 20,000 more.