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An Abidjan comedy troupe headed by Adama Dolo, and Abidjan radio personality, performs at an anti-AIDS rally in Abidjan. The troupe is doing a sketch lampooning discrimination against people with the AIDS virus. Photo by Jim Ruppert/The Washington Post The Series Part 1: Hope and Disappointment Part 2: On the Front Line Part 3: Stopping the Virus Part 4: The Hunt for a Vaccine Part 5: Third World Despair Today's Articles Help Least Likely Where Most Needed Vaccine for Developing Nations Faces Scientific, Financial and Ethical Hurdles

Vaccine for Developing Nations Faces Scientific, Financial and Ethical Hurdles

By Rick Weiss
Washington Post Staff Writer
Thursday, September 3, 1997;
Page A14

With the new generation of AIDS drugs unavailable or unaffordable for the vast majority of people in developing countries, some experts believe that a cheap and effective preventive vaccine is the only plausible means of stemming the global pandemic.

So as scientists move closer to large-scale tests of the most promising experimental AIDS vaccines, public health officials in the United States and abroad are focusing increasingly on how best to share with the developing world the benefits — and risks — of these emerging vaccines. That task, they are finding, is fraught with enormous scientific, economic, logistical and ethical difficulties.

Scientifically, the task is difficult because there are at least 10 different families, or clades, of HIV around the world, and researchers are uncertain whether any single vaccine will prove effective against them all. Recent studies suggest that at least one promising vaccine, made from live canarypox viruses, is effective against several HIV clades, a relief to scientists, who do not want to have to develop several different vaccines for people living in different regions of the world.

But new studies also suggest that the effectiveness of this vaccine may vary substantially depending on genetic variations in an individual's immune systems. If true, then a variety of vaccines may have to be developed after all then matched to individuals or ethnic groups according to the immune system genes they carry.

The economics of vaccines are a double-edged sword. The generally low cost of vaccines makes them attractive to the poverty stricken countries that need them most, but the promise of low profits undercuts companies' incentives to develop and test vaccines for these countries. Even in richer countries, vaccines traditionally have not been big money makers for drug companies because profits are consumed largely by losses from unsuccessful efforts and liability costs. In developing countries, profit margins are even thinner because the product is often bought by international or national public health organizations at big discounts.

The International AIDS Vaccine Initiative, a 1-year-old, global, nonprofit nongovernmental organization funded by philanthropic groups, is trying to put together an international vaccine purchase fund — perhaps to be administered by the World Bank — that would help offset expenses for individual countries and make development of an AIDS vaccine more economically attractive to the handful of companies that have the expertise.

Logistics are a problem because many of the most needy countries do not have the public health infrastructure to coordinate distribution of a vaccine, or to educate people about its potential risks and benefits. Moreover, most AIDS vaccines under development need to be refrigerated until they are used, which is impractical in many countries.

Perhaps most daunting have been the ethical questions about AIDS vaccine testing and marketing in developing countries. The high rates of new infections in these countries make them ideal testing grounds for vaccines because efficacy is easiest to prove in areas where new infections are common. Yet some wonder whether the countries where trials are being planned, such as Thailand and Uganda, will benefit from their cooperation.