‘I don’t know how long it will take, but I believe eventually we will find an effective vaccine.’ — Dr. Mark Mulligan, director of Emory’s Hope Clinic.
Long shot Emory's 'Week of Hope' raises funds for HIV vaccine research after year of setbacks
After the highly publicized failure of an HIV vaccine trial last fall, Dr. Mark Mulligan keeps returning to one word when defending his clinic’s work: Hope.
“We have to believe that it is possible, or why would we go to work every day?” said Mulligan, director of Emory University’s Hope Clinic, one of the sites where the failed vaccine by Merck & Co. was tested.
The Hope Clinic raises awareness and funds for its efforts this week with the “Week of Hope,” a series of sports, theater and educational events leading up to HIV Vaccine Awareness Day on May 18.
“I do believe there is possible vaccine. I do believe there are clues, and new developments, and with careful selection of the path forward a vaccine will be successful,” Mulligan said. “I don’t know how to do it right now. I don’t know what the time frame will be. I don’t know how long it will take, but I believe eventually we will find an effective vaccine.”
Approximately 130 people took part in the Merck HIV vaccine research study at the Hope Clinic. Globally, some 3,000 volunteers participated in the vaccine research, all of whom were HIV negative when the Phase II clinical trial began. Most volunteers, including those at the Hope Clinic, were gay men because they are at a higher risk of contracting HIV.
The vaccine trial, funded by the National Institute of Allergy & Infectious Diseases, was stopped Sept. 21 after the independent Data Safety Monitoring Board determined the vaccine “did not prevent infection.” Concerns were later raised the vaccine may have increased susceptibility to HIV infection among some study participants.
A public cry to re-channel funding from HIV vaccine research to other efforts followed. The president and the chief of medicine for the AIDS Healthcare Foundation co-wrote a guest editorial for the Los Angeles Times calling AIDS vaccine research a “self serving quest.”
“To date, there has been no evidence that there will ever be an AIDS vaccine. It is time for an honest reassessment of funding priorities and a redeployment of resources into delivering antiretroviral medications to the people who need it. It is time to pull the plug on U.S. public funding for HIV vaccine research,” they wrote.
The editorial followed a poll by the United Kingdom’s Independent newspaper that surveyed 35 HIV/AIDS researchers in England and the United States and found “nearly two-thirds believed that an HIV vaccine will not be developed within the next 10 years” and “a substantial minority of the scientists admitted that an HIV vaccine may never be developed.”
NOT GIVING UP
But setbacks and public frustration are not going to deter the researchers at the Emory Vaccine Center, which includes the Hope Clinic. They continue to expand their efforts.
A team led by Dr. Rama Amara is working on a therapeutic vaccine to teach the immune system to control HIV naturally, without drugs.
Husband and wife team Dr. Susan Allen and Dr. Eric Hunter work with HIV positive people in Africa while testing potential new vaccines through the International AIDS Vaccine Initiative. Emory’s Dr. Richard Compans is working to develop vaccines based on virus-like particles that can stimulate protective immune responses against viral infection like HIV.
The highest profile effort is a vaccine Dr. Harriett Robinson spent 16 years developing. The vaccine shows 96 percent effectiveness in preventing HIV infections in primates. Her two-step vaccine strategy uses a DNA vaccine priming approach as well as a weakened pox virus to deliver the vaccinating HIV-1 proteins to stimulate an effective immune response.
“Our product is very different than the Merck product. We use a different vaccine strategy and we use raise antibodies and T-Cells, and the Merck product only raised T-Cells,” Robinson said.
Phase One clinical trials examine the safety of the vaccine in humans. Phase Two continues to study safety while examining viral response in a low-risk population. Phase Three researches the vaccine’s effectiveness in a high-risk population.
“We’re planning for Phase Two, and if things move through the last two committees and everything goes smoothly we should start Phase Two in August,” Robinson said.
Robinson said calls to end funding for research like hers are misguided, but not uncommon. She said at an international conference in the early days of the AIDS outbreak there was a call to stop giving patients the drug AZT as it did not reduce viral loads.
“That was before they developed the multi-drug treatment that has been so effective,” Robinson said.
While Robinson is confident her vaccine will work, she warned against expecting results quickly.
“Drugs can be developed quickly because you test them in people who are already infected,” Robinson said. “With vaccines we have to start with a group of people who are not infected, educate them on safety, and wait. It takes a lot longer to develop a vaccine.”
Breakthroughs don’t fit prescribed timetables. The ultimate finding that will lead to a cure for HIV/AIDS may be out there somewhere, waiting to be discovered.
“Part of the scientific process is discovery and that often lies in unexpected places,” Mulligan said. “The key to an HIV vaccine might lie in something that has not been discussed yet.”
As HIV infection rates continuing to climb worldwide, Mulligan said a vaccine is the best weapon against the global spread of AIDS.
“Our best hope is a vaccine,” he said.
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