Rethinking Is Urged on a Vaccine for AIDS

Rethinking Is Urged on a Vaccine for AIDS By LAWRENCE K. ALTMAN WASHINGTON -- Researchers must go back to the drawing board before they can develop an effective vaccine against H.I.V., AIDS experts said at a scientific meeting on Tuesday. And Dr. Anthony S. Fauci, the top federal official responsible for AIDS research, agreed that more fundamental knowledge is needed about H.I.V. and the way the body and experimental vaccines respond to it before the goal of a licensed H.I.V. vaccine can be reached. Dr. Fauci, the director of the National Institute of Allergy and Infectious Diseases, pledged to re-evaluate the use of all $1.5 billion his agency spends on AIDS research to come up with the necessary money. "Everything is on the table," Dr. Fauci said at the one-day meeting, a Town Hall-type discussion for vaccine researchers on how best to spend federal H.I.V. vaccine money in light of a budget that has been flat for several years. "There is not an immediate solution to the problem," Dr. Fauci said in an interview. But, he also said, the budgetary constraints mean that "we are going to have to justify what we are doing" and determine what steps to take after further discussions in smaller meetings with researchers. The reassessment comes after last September's widely publicized failure of what had been the most promising candidate for an H.I.V. vaccine. Many health officials believe that an effective vaccine would be the most crucial weapon in stopping the H.I.V. pandemic. Scientists do not have a full understanding of why the vaccine failed, or why it was possibly harmful, in two large trials in the United States and South Africa. Dr. Fauci's institute helped pay for the trials of the vaccine, which was made by Merck. Such failures have led a number of scientists to challenge the direction of federal H.I.V. research. On Tuesday, the AIDS Health Care Foundation called for the suspension of money for H.I.V. vaccine research and reallocating resources into effective H.I.V./AIDS prevention, testing and treatment strategies. But Dr. Fauci strongly rejected the proposal. "Under no circumstances will we stop AIDS vaccine research," Dr. Fauci said at the conclusion of the meeting. Dr. James Hoxie of the University of Pennsylvania echoed the belief of many other participants by saying, "we are not close to having a vaccine" and "there is a tremendous need for innovation" in developing one. Experts at the meeting also said that Dr. Fauci's agency needed to support efforts to further develop animal models of human H.I.V. The experts also urged greater cooperation between AIDS scientists who work on such animal models and those who are trying to develop an H.I.V. vaccine for humans. A crucial issue is supporting younger researchers to replace the cadre of veteran AIDS scientists, many of whom are working beyond traditional retirement age. Dr. Fauci said a first step would be to pare existing projects to immediately provide $10 million to $15 million for about 30 grants to be awarded to scientists who propose novel ideas. Some of the grants would be used to support young researchers, he said. Some scientists support conducting large vaccine trials in humans before all the fine points of the vaccine research are complete in animals because of the urgency of the pandemic. Others urge caution out of fear that failures could destroy confidence among uninfected people most at risk who would be needed as volunteers in future trials. Equally vocal groups call for testing everything as soon as the research shows promise because of the urgent need for a vaccine. Nature who is Dr. Warner C. Greene, a co-chairman of the meeting and director of the Gladstone Institute of Virology and Immunology in San Francisco, said he hoped that a century from now, historians looking back on the AIDS pandemic would view Tuesday's meeting as a turning point.