Why don't we have an HIV/AIDS vaccine? When will we have one?

A c c o r d i n g to the latest surveillance reports from the United Nations AIDS (UNAIDS) and the World Health Organization (WHO), there has been a significant underestimation and reporting of HIV infection and cases of AIDS worldwide. Currently, there are 30.6 million people living with HIV/AIDS, 88% of these people do not know that they are infected; additionally, almost 12 million people have died from AIDS. There were approximately 6 million people infected in 1997 (16,000 new infections every day), 90% of these new infections occurred in developing countries, and the majority of these infections were heterosexually transmitted. More than 8 million children have lost their mothers to AIDS, and most of these orphans are living in sub-Saharan Africa, which has an unprecedented seroprevalence rate of 7.4% of all those between ages 15 through 49. Southern Africa also has a raging epidemic. In some of these southern African communities, there are infection rates of 32% and 43 % among pregnant women. There is also a raging epidemic in Asia. It is anticipated that Asia will surpass Africa in numbers of Human Immunodeficiency Virus/Aquired Immunodeficiency Syndrome (HIV/AIDS) cases in the near future. At the present time, Asia has more than 6 million cases of HIV infection (UNAIDS/WHO, 1997). In the United States, our death rate has recently dropped due to the new therapeutic regimens, but we are also seeing an ever-increasing wave of risk behaviors among some populations (Perlman, 1997; Petit, 1997; Peyser, 1997; Price, 1997). In developing countries, antiretroviral medications and prophylactic medications for prevention of opportunistic infections are not available. With statistics as mentioned above, a rational assumption would be that extensive vaccine research would be taking place and that the identification and production of a safe and effective vaccine candidate would be the first priority on the HIV/AIDS agenda. But that assumption proves to be incorrect. Vaccine research at the National Institutes of Health (NIH) has not been the first priority, and until this last fiscal year, only about 7% of the NIH AIDS research budget was designated to vaccine research (Rockefeller Foundation, 1995). Recent changes in fund allocation at NIH into innovative vaccine grants have increased the allocation to approximately 12% to 13% (NIH, NIAID, 1997). The Centers for Disease Control and Prevention (CDC) has very little activity in AIDS-vaccine development. Much of the military (Army and Navy) AIDS research is in the area of vaccines, but their AIDSresearch budgets are much smaller than NIH's (personal communication, D. Burke, November 17, 1997). The "AIDS vaccine development pipeline" is a misnomer. The "pipeline" is really a "pipette." Since HIV was identified 17 years ago, only 40 Phase-I trims and one Phase-II trial have been conducted, and no PhaseIII trials have been conducted (Heyward, MacQueen, & Jaffe, 1997). There has been and continues to be significant controversy between the theorists and the empiricists. The theorists argue that we do not have sufficient information to move from basic research into targeted product development. Lacking knowledge about the "corre-