Failure of Vaccine Test is Setback in AIDS Fight

By: Jillian Casey
October 4th, 2007


This article came as old news to me as word around the office was already buzzing about the cancellation of Merck’s vaccine trials. The only piece that was new was the aura of an overwhelming loss that I have not perceived here in the HIV-fighting community of South Africa. The Desmond Tutu HIV Foundation was already almost a year into the vaccine trials when the plug was pulled and defeat admitted by Merck and infectious disease experts alike. To my amazement, I have yet to witness any surprise or disappointment from my colleagues at work. There are no gray clouds over anyone’s heads, no gloomy faces, and not even a whisper of acknowledgement of the loss this community has just incurred. It makes me wonder: What faith does the developing world, and concomitantly, the populations most ravaged by HIV/AIDS, instill in vaccine trials as the potential knight in shining armor to slay this human predator? I can’t help but suspect that defeat was actually expected at the DTHF, and for that reason, the news was not received as defeat at all. What I really want to know is why.

The New York Times article, Failure of Vaccine Test is Setback in AIDS Fight, embodies the disappointment and frustration of the Western World in the war on AIDS. I have to wonder why American journalists, multinational Big Pharma executives, and western medical culture as a whole, are more distraught over the failure of Merck’s drug than are the very people who witness the devastation of HIV/AIDS on a daily basis. Granted, I have not had the opportunity to pay a return visit to the DTHF’s vaccine trial center since the cancellation of the trial, but I would still anticipate a more heartfelt reaction from those in the head office (who are running the show) than I have thus far observed. In fact, upon questioning a few coworkers, I have even discovered that many of them are not aware of the response or the impact this has had on the organization or the HIV community at all.

So how can this be? The best answer that I can come up with is that on the ground in South Africa, where almost a quarter of the population is infected with HIV, there is no time to waste hoping for a successful vaccine. The doctors and medical professionals here cannot wait years for the approval of a vaccine because people are dying by the day. Parallel to the argument that those who live in poverty can only afford to think of today, so too must the doctors who work for the impoverished focus their efforts on the present. To expend energy on vaccine trials, and therefore divert energy away from ARV treatment by impact of opportunity cost, one is jeopardizing the lives of those already infected. In the developing world, where resources are stretched to exhaustion, the dream of an HIV vaccine can only be entertained with promise of outside funding and staff so as not to pinch the pockets of the already under-funded treatment programs in existence.

Even still, when funding is provided by the NHVTN (National HIV Vaccine Trial Network) from the States, and PEPFAR has leant money for the staffing and supervision, how then can the doctors closest to the cause not feel a surge of distress when they learn that another effort has failed? Perhaps it’s because it is the very doctors who are so involved who can understand and appreciate the gap between our understanding of and our ability to eradicate this virus. Doctors know that HIV is a biologically simple virus; they know that it can be prevented and even treated. But they respect that we are a long way from grasping how to vaccinate against it, and so they leave that task to those with the time and money to take on such a challenge. They let those who do not have to listen to the coughs of dying parents and look into the faces of children who are soon to be orphans on a daily basis worry about the long-term struggle.

Perhaps these assumptions are entirely inaccurate. Perhaps I am just struggling with my own romantic hopes of a vaccine versus my practical plans for life-saving today. I can say that being in South Africa, and working for an organization participating in the trials when a promising vaccine is pulled, has not at all produced the response I would have expected. As time goes on, I suspect I will find a greater understanding of why such setbacks are received so differently across cultures. I often feel as if I am just an outsider here, window-shopping through the confusing streets of South Africa’s public health network. But this lens lends me the benefit of seeing things from a more patient eye, one that can project into the future because my today is not so desperate. In talking to the doctors at the DTHV, I see in their eyes that nothing has changed since the cancellation of the trials. Tomorrow, like today, they will again face patients whose CD4 counts are plummeting and whose T cells are being assassinated by opportunistic infections. Either way you like to look at it, they are either not as fortunate, or not as naïve as me and my western counterparts in their investments in an HIV vaccine initiative.

I can only hope that these seemingly separate communities can merge at some point and the vision of tomorrow can be reconciled with the reality of today. Because even though a vaccine would undoubtedly be the most valuable development in the global campaign against AIDS, it is important to remember that treatment and education cannot suffer in the name of a prospective solution.