Over the past week, scientists and advocates around the world refocused their attention on the search for an HIV vaccine. Fittingly the observance stems from a long ago speech by President Bill Clinton. On May 18, 1997, Mr. Clinton delivered an inspiring commencement address at Morgan State University in Baltimore, Maryland. In the speech, the president challenged the scientific community and the graduating class from one of America’s foremost historically black universities to invest their talents in the discovery of an HIV vaccine. Mr. Clinton also called for a worldwide commitment to develop an “AIDS vaccine within the next decade.” Since that commencement, May 18 has been marked by scientists, advocates and governments as HIV Vaccine Awareness Day.
In the years following Mr. Clinton’s bold challenge, there have been gains and setbacks in our quest to find an HIV vaccine.
In 2009, the world applauded when the U.S. Army’s research program and the Thai Ministry of Health announced the first HIV vaccine trial to show efficacy. The trial results showed that the candidate vaccines in the RV144 study worked in 31 percent of the people who were vaccinated. Although this level of efficacy is not sufficient to bring a product to market, it is a promising sign that a vaccine is indeed possible.
Progress in science is also accompanied by setbacks. This past month, despite the success of having enrolled 2,504 volunteers at 21 sites in 19 cities in the United States, the HIV Vaccine Trials Network (HVTN) study 505 was found not to be an effective vaccine. The data safety monitoring board for the study, which protects trial participants, and the National Institute of Allergy and Infectious Disease (NIAID) recommended that injections be stopped as a result.
The 505 and other recent vaccine study results are depressing for all of us who each day work and hope for a vaccine or cure. While the news was not good, the data safety review board, NIAID and the scientists conducting the research all acted in the best interest of the study volunteers and efforts to move research forward. Much will be learned from the heroic efforts of all involved.
In three decades we have made tremendous progress in the battle against the HIV epidemic. There are now over three dozen approved drugs and combination regimens that, when taken correctly, can extend life for decades. We have also seen behavior change result in decreased HIV transmission from what occurred in the early 1980s. In the United States, community-led efforts have resulted in a decrease of the U.S. Centers for Disease Control and Prevention’s (CDC) estimated annual HIV infections from a high of 130,000 a year to the current estimate of about 48,000. While this is progress, it is still simply not good enough. The Joint United Nations Programme on HIV/AIDS (UNAIDS) estimates that globally 2.5 million people will be infected with HIV this year. And despite our great success in preventing mother-to-child transmission, UNAIDS reports 330,000 children are still infected with HIV annually.
These dire statistics highlight why our investment in HIV vaccine research is critical to our efforts to end the HIV epidemic. We can be grateful to the 16,000 people in Thailand who volunteered for the RV144 study. Their contribution was essential to providing new hope that finding a vaccine is possible. The HVTN will continue to follow the 505 study participants to learn more about why the vaccine did not work. The ongoing commitment of the scientists and volunteers will be essential in our effort to learn from the trial. The effort will also continue to move forward through a public-private collaborative team, called the Pox-Protein Public-Private Partnership (P5), which is planning a new round of studies using a similar vaccine regimen to RV144 beginning in 2015 in Southern Africa and Thailand. The quest continues.
In his 1997 address at Morgan State University, President Clinton declared, “Here at home, we are grateful that new and effective anti-HIV strategies are available and bringing longer and better lives to those who are infected, but we dare not be complacent. HIV is capable of mutating and becoming resistant to therapies and could well become even more dangerous. Only a truly effective, preventive HIV vaccine can limit and eventually eliminate the threat of AIDS.”
Mr. Clinton’s words ring as true and relevant today as they were 16 years ago. This is especially so for African Americans, who the CDC reports now comprise 44 percent of all new HIV infections in the U.S., and have the most severe burden of HIV of all racial or ethnic groups in the United States. Since that long ago commencement, we’ve discovered the power of science as the drugs used to treat AIDS can also be used as an effective tool to prevent HIV transmission. Indeed, the inspired call for an “AIDS-free generation” from former Secretary of State Hillary Clinton and President Obama reminds us that, in the absence of a vaccine, it is even more urgent that we rapidly implement every available strategy to reverse the course of this epidemic.
This year, Morgan State University again held its commencement ceremony on May 18. U.S. Secretary of Education Arne Duncan was the keynote speaker as more than 900 students celebrated their academic accomplishments and look to the future. Few of those graduating will have known of a world without AIDS or lacked an experience of its impact in their lives.
On Memorial Day, as we recognize the sacrifice of our military men and women in defending our freedom in selfless ways every day, it seems appropriate to honor the U.S. Army scientists for their contributions and willingness to answer “the call” from President Clinton’s 1997 address. By showing the scientific community — and indeed, the world — that an HIV vaccine is possible, their patriotism inspires the hope that one day, young men and women who stand in their caps and gowns looking toward their own futures, will see a world untouched by HIV.