HIV vaccine partners strengthen collaboration

As new developments in the search for an HIV vaccine take place, vaccine researchers from around the world are joining forces to accelerate progress towards an effective and safe HIV vaccine, with the full and equal involvement of countries most affected by the AIDS epidemic.

'With so many HIV vaccine clinical trials testing novel products ongoing and planned by a wide variety of investigators, it is time to intensify global collaboration. Lessons learned must benefit all working in this challenging, but advancing, field,' said Dr Marie-Paule Kieny, director, Initiative for Vaccine Research, World Health Organisation (WHO).

About 50 experts from developing and industrialised countries presented and discussed their HIV vaccine research and development efforts at the first WHO-UNAIDS Meeting of Global Partners Promoting HIV Vaccine Research and Development, which took place in Montreux, Switzerland, on 2-3 February. The participating vaccine experts are from governments, academia, industry, public-private partnerships and non-governmental organisations throughout the world.

Recent progress in the HIV vaccine area includes the completion of several phase I and II trials of candidate vaccines. The publication last month of the Global HIV/AIDS vaccine enterprise scientific strategic plan has also set a number of important milestones to be reached by all global partners.

But challenges remain. They include the need to increase clinical trial capacity worldwide and conduct trials at multiple sites against different globally prevalent HIV strains in populations with different transmission patterns; the appropriate use of trial sites for other HIV preventive research; the interface between HIV vaccine trials and increased access to anti-retroviral treatment; and the need to ensure that the most appropriate candidate vaccines are tested at the most appropriate sites regardless of who developed the product or strengthened the site.

'Overcoming these challenges will require intense international collaboration and coordination,' said Dr Saladin Osmanov, acting coordinator, WHO-UNAIDS HIV Vaccine Initiative.

Twenty-five million people in sub-Saharan Africa are currently living with HIV, accounting for over 65% of all infections worldwide. Developing countries must be involved as equal partners in the development of HIV vaccines. An increasing number of trials are planned in African countries. This has not always been the case. Although the first clinical trial of an HIV vaccine took place in 1987 and more than 70 phase I HIV vaccine trials have since taken place, by 2003 only four phase I/II trials had been conducted on the African continent.

'Africa must participate in HIV vaccine development,' said Dr Pascoal Mocumbi, High Representative, European and Developing Countries Clinical Trials Partnership and former Prime Minister of Mozambique. He added that the majority of African countries are more focused on disease control and very few have provisions for HIV vaccine research and development in their national AIDS programmes.

It is important to conduct vaccine trials in developing countries because the genetic variability of HIV may require testing of vaccine candidates in different areas of the world, where different strains are prevalent. It may also be necessary to evaluate how different infection routes, cofactors for HIV transmission, such as other sexually transmitted infections, and host genetic backgrounds influence vaccine-induced protection. Finally, licensing of a successful vaccine by regulatory bodies may require prior trials in countries with similar epidemiological settings.

Participants at the vaccine meeting addressed a number of policy issues including: the essential involvement of women and adolescents in clinical trials; ethics; access to and use of a future HIV vaccine; advocacy for increased vaccine science, education and funding; and broadening the involvement of the private sector in developing HIV vaccines. They recommended that a WHO-UNAIDS guidance document be developed, explaining how best to include women and adolescents in clinical trials of HIV vaccines.