I SPENT the whole of last week in Barcelona attending the 13th (and last) AIDS Vaccine Conference - listening to very complex cutting edge research papers, and thinking about my six grandchildren whose ages range from eighteen months to 18 years. I was among over one thousand conference participants drawn from all six continents - HIV research scientists, immunologists, virologists, public health practitioners, HIV and AIDS activists, AIDS clinicians, health communications specialists, community workers, health/science journalists, research funders and policy makers. Quite a formidable gathering of people of all races - speaking in a dialect of English and in acronyms even I had never heard before and had difficulties comprehending. They spoke familiarly of "low entropy viral epitopes", "broadly neutralising VRC01-class antibodies or BnAbs", "trimers" and "homing markers," "CD4 liganded envelope glycoproteins", and "immune-correlates analysis".
But even all the highest high level science of the human immune system was not itself immune to the science of the inner workings of politics and governments - the complex innate and cognate immune systems that run our world. Because of the US government shutdown, several scientists including key speakers, from US state run institutions like the National Institutes of Health (NIH), were not able to travel from the US to Barcelona. Most prominent of these was veteran inspiring speaker at AIDS Conferences, Dr Anthony. He is the director of the National Institute of Allergy and Infectious Diseases (NIAID) at the NIH and a leading respected HIV and AIDS scientist.
Dr Fauci was however 'present' on the opening day - by telephone during the Opening Press Conference (which started at 04:30 am in the time zone he was in); and via video gave his presentation at the official Opening Session on Monday afternoon. His presentation was entitled "Toward Ending the HIV/AIDS Pandemic: Synergy between Vaccine and Non-Vaccine Interventions". (I could not help thinking how someone somewhere should be presenting: "Toward ending the shutdown: Synergy between US political parties, or between politics and the presidency"! Maybe Dr Fauci might have been in Barcelona? But then I understand these sciences of the politics even less than I understand how 'BnAbs and their unmutated common ancestors' complicate HIV vaccine development!)
Still at the official opening, my thoughts were brought back to reality and to thoughts of my grandchildren, with the soft spoken words of South African Ntando Yola's presentation. Ntando is a Community Engagement Coordinator from Cape Town, who has worked with the Desmond Tutu HIV Foundation (DTHF). For me, his presentation brought home to the packed auditorium the reality that at the end of all the high powered new language, this "science-speak" of vaccine research science, there are ordinary people from communities around the world waiting patiently for the last three decades for something tangible. He told the story of Grace, an HIV positive community worker in HIV prevention in Cape Town. Grace's expressed concern was that an HIV Vaccine be made available soon so that her son, who is HIV negative, can be prevented from HIV infection. Ntando Yola's presentation was titled "Partnership towards a tough target: Communities are an essential ingredient, not a cherry on top".
My grandchildren and Grace's son are not cherries on top of the cake.
I have attended several world AIDS conferences since the ICASA meeting held in Zambia in 1999. At each single one of them, when the subject of when the world can expect to have an HIV or AIDS vaccine researched, developed, manufactured, distributed and available, the answer has always seemed to be the same - in about ten years' time. At every conference it seemed that the estimation by researchers and others was that it would take another ten years before a vaccine could be available.
During pre-conference training for journalists at last week's Barcelona conference, I asked again how long we should expect to wait for a HIV vaccine, in view of all the exciting and promising research going on in several parts of the world. One researcher told me plainly and simply, "I am afraid we do not give time lines any longer".
Another official, the head of a leading global HIV prevention advocacy organisation said something to the effect that a vaccine could be available in ten years - depending on when you start the clock! He then as an example looked at one of the most promising vaccine trials so far - the RV144 study done in Thailand and soon to be started in South Africa. All things being equal, and all the stars being well aligned, and RV144 trails prove successful - we are still looking at 2023 or thereabouts for the vaccine to be available. So the 10 years they would predict in those days has not changed - even if the clock started now.
At a press conference in the course of last week's Barcelona Conference, Dr Louis Picker, whose team recently announced the results of successful vaccine trials in rhesus monkeys, said his team feels that they have "a very good shot" at proceeding to developing a successful vaccine for use in humans. He said however that it will be at least another two years before Phase 1 Clinical Trials can be started in human beings. That will be followed by a sequence of other phases whose successful completion will then be followed by several other steps, before their vaccine available (perhaps in another 10 years from now?) for general use.
I am a great believer that in HIV and AIDS we owe it to future generations to bequeath them a world free of HIV. Hence the thoughts of my grandchildren while learning about the nuances and complexities of HIV and why a vaccine is not ready yet. For the oldest grandchild, if clocks starting ticking now, he will be 28 years old by the time a vaccine is available. The others will be between 11 and 15 years old and could be living at the beginning of a world where an HIV vaccine is available. It cannot come soon enough.
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