2007 AVAC Report Resetting the Clock
Resetting the clock,
this year's AVAC Report title, is inspired by
the anniversary of US President Bill Clinton's
1997 speech calling for an AIDS vaccine in ten
years' time. Many organizations, including
AVAC, marked this anniversary, and the expiry
of the original deadline, with reflection and
tempered optimism on May 18 of this
year.
We recognize that the title could
just as easily be the punch line of a joke
about the AIDS vaccine field. Here at AVAC we
frequently hear, and remark, that the timeline
for finding an AIDS vaccine has been "5 to 10
years" for, well, 5 to 10 years. It seems that
we are always resetting the clock.
Today
we argue in all seriousness that it is time to
reset the clock. We are within two to three
years of data from three test-of-concept
studies of AIDS vaccines, including the ongoing
Thai prime-boost study and two trials of
Merck's adenovirus-based candidate. And so now
is the time to set new, ambitious deadlines for
developing the novel vaccine concepts and
candidates that will be needed whether or not
there is evidence of benefit from these first
test-of-concept trials.
The three
sections of this year's report outline some
specific deadlines and challenges in AIDS
vaccine scientific strategy, clinical trials,
and the broader realm of HIV prevention. These
arenas mesh like watch gears, and must function
just as smoothly if the field is to
proceed.
Resetting the Clock
- click to download the full
PDF
Low-resolution (3MB)
High-resolution
(7MB)
Table of
Contents
Executive Summary
Letter from the Executive
Director
- Figure 1. Global Coverage for
Select HIV Prevention Strategies in
2005
- Figure 2. Global HIV
Incidence With and Without Comprehensive
Prevention Package
Key Recommendations
AVAC's Status Report - An
Update on Last Year's
Recommendations
Section 1: New
Countdowns
In this section we
explore progress and barriers in funding and
strategy-setting for the field. As we wait for
the results from upcoming trials, what else do
we need to be doing? What are the
responsibilities of key institutions at this
critical time? We've addressed these questions
and returned to industry for an updated survey
of private-sector work. This section also
discusses progress and challenges of the
Global HIV Vaccine Enterprise.
- Figure 7. Anticipated Data
Milestones and Proposed Needs for the
Future
- Figure 8. Non-commercial
Funding Allocations for Preventive HIV Vaccine
R&D by Category in 2000-06
- Table 1. Test-of-Concept
Versus Phase III: A Comparison
- Table 3. Industry HIV Vaccine
Involvement 2007
- Figure 9. Global HIV Vaccine
Enterprise Timeline 2003-07
Section 2: Racing Against
Time
In this section we turn to
clinical trial issues. Here we argue that the
field is already in danger of slipping behind.
We mean this in several senses, including
anticipating and keeping pace with clinical
trial capacity needs, reaching consensus on
standards of prevention and levels of care, and
solidifying communications strategies for
conveying information about trial outcomes.
There are also open questions about the new US
approach to funding its trial networks. In the
spirit of thinking globally and acting locally,
we've highlighted specific examples from work
around the world as a way of emphasizing issues
that affect all prevention research.
- HIV Prevention
Roadmap
- Figure 11. Countries with
AIDS Vaccine Trials (August 2007)
- Table 4. Trials of New
Prevention Options Worldwide
- Table 5. Trials of Preventive
HIV/AIDS Vaccine Worldwide (August
2007)
Section 3: Wake Up
Call
In this section we explore
the critical lessons to be learned from
responses to data on new approaches which could
have some benefit in out-of-control epidemics.
The clock is already running when it comes to
implementing existing prevention approaches
like male and female condoms, as well as
emerging prevention strategies like male
circumcision. HPV vaccine, while not an HIV
prevention tool, is still an important case
study. We also listen hard to what advocates
from other areas of the AIDS response have to
say about prevention research, since collective
action is essential for improved prevention
overall.
- Figure 12. Coverage of
Essential Prevention Services
- Figure 13. HIV Prevention
Research: A Comprehensive Timeline of Efficacy
Trials