Millions still suffer, caught in the middle of an Aids turf war

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An unseemly "turf war" has broken out between the main organisations responsible for developing a vaccine for Aids – a disease fast producing the worst pandemic in history.

Rivalry and backbiting between two arms of the United States government with hundreds of millions of dollars to spend on vaccine development is hampering the global effort against the virus that causes Aids. The conflict is critical because many doctors identify an effective vaccine as the single most important health issue in the world today.

Over the past 20 years, HIV has spread alarmingly to a point where the pandemic will soon become worse than the Black Death of the 14th century. A vaccine is seen as the only effective way of stemming the tide.

The existence of the dispute in the US has been made public by a British-born Aids researcher who condemns the rivalry in an excoriating article published yesterday in the journal Nature. He calls on President George Bush to resolve the impasse.

John Moore, an Aids specialist and vaccine researcher at Cornell University in New York state, said wasteful duplication of research was seriously hampering attempts to deal with a problem whose most glaring statistic is the 14,000 people who become infected with HIV every day.

Dr Moore accused the US National Institutes of Health (NIH) and the Department of Defence (DoD) of replicating their efforts in the fear that one of them will be left behind in the race to be first to produce a vaccine against the main Aids virus, HIV1.

"It has long been known in the HIV1 vaccine field that the NIH and the DoD regard each other as rivals, not collaborators," Dr Moore said.

"It has seemed as if each agency has felt compelled to 'shadow' the other, to insure against the embarrassing outcome of a working vaccine candidate emerging that was sponsored by the other agency."

The situation had led to a "massive waste of money", which had been made worse by the appearance of a third organisation in the field, the International Aids Vaccine Initiative (IAVI), a private organisation that had received $100m (£71m) in funding from the Bill and Melinda Gates Foundation.

"Whatever is said in public, the rivalry between the NIH, the DoD and the IAVI is an open secret among scientists working on HIV1 vaccine development," Dr Moore said.

"This state of affairs should not be allowed to continue. A coordinated effort could make so much more progress than one that is fractured by institutional rivalries. There will be more than enough credit shared out if an effective vaccine is eventually made.

"If this particular turf war cannot be resolved by the agencies involved, perhaps the White House should take action. There are several possible options, but duplication is the least palatable."

Almost since the first time that the Aids virus was isolated in 1983, scientists have been working on ways of developing an effective vaccine that would protect people against infection.

However, despite the catastrophic spread of the virus around the world, especially in Africa but also in Russia, south-east Asia and South America, vaccine attempts have run into one brick wall after another.

Unlike many other viruses that affect humans, such as polio and measles, HIV mutates rapidly and presents a constantly moving target for a vaccine. The virus also integrates its genetic material into the DNA of an infected person, in effect making it almost impossible for HIV to be eradicated fully from the body.

Professor Andrew McMich-ael, director of the Institute of Molecular Medicine at Oxford University, said: "The problem has turned out to be far harder than people predicted at the very beginning," said

By the end of last year an estimated 64 million people worldwide had been infected with HIV, of whom 25 million had died and almost 40 million were living with HIV or Aids.

Peter Lamptey, the president of the Family Health International Aids Institute, based in Arlington, Virginia, wrote in a recent issue of the British Medical Journal that the situation was as dire as any medical crisis on record.

"In the 14th century the Black Death, the most severe pandemic in history, ravaged Asia and Europe, leaving more than 40 million people dead and making a profound social and economic impact," Dr Lamptey wrote. "Despite the impressive advances in medicine since then, HIV-Aids is likely to surpass the Black Death as the worst pandemic ever. We urgently need an effective and safe vaccine."

Dr Moore echoed the sentiment, saying it was imperative that the vaccine initiative succeeded if the growing pandemic was ever to be controlled in the developing world.

"The need to develop an effective vaccine against HIV1 is now probably the world's greatest single public-health problem," he said.

For 15 years the effort has been dominated by the NIH and the DoD, the two biggest spenders on Aids vaccines. Both are now planning huge, phase-three clinical trials, but testing what is essentially the same candidate vaccine.

The NIH will be spending between $60m and $80m on a trial involving more than 11,000 volunteers in the US, the Caribbean and South America whereas the DoD will spend up to $40m on a similar trial involving nearly 16,000 volunteers in Thailand.

Both vaccines are based on a product made from combining the canary pox virus with a HIV protein labelled gp120. Dr Moore said the differences between the two approaches were too slight to warrant separate trials.

He also believes that the canary pox-gp120 vaccine is deeply flawed and will probably not be effective. If both sides had waited until the results of a smaller trial on the same type of vaccine, many millions of dollars might have been saved.

Dr Moore asks why the DoD and NIH are so enthusiastic about the canary pox-gp120 vaccine. He suggests the main reason is that it is regarded as a "practice run" for when a better vaccine comes along.

He said that would also turn out to be flawed if the vaccine failed to work properly. "The fear of failure should never dominate decision-taking, but when failure is probable, it is prudent to examine the likely consequences," Dr Moore said.

Failure on such a scale runs the risk of undermining public confidence in science being able to deliver a vaccine, he says. And "if multiple vaccine-efficacy trials all fail, the loss of confidence in the West's ability to stem the pandemic could have tragic consequences for the developing world," he concludes.