Diary Prequel Package — page 174

"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.