Southern Illinois University associate professor William Halford administered the shots himself at a Holiday Inn Express and a Crowne Plaza Hotel that were a 15-minute drive from the researcher's SIU lab. Halford injected at least eight herpes patients on four separate occasions in the summer and fall of 2013 with a virus that he created, according to emails from seven participants and interviews with one participant.
The 2013 experiments raise further questions of misconduct by Halford, who pursued a herpes vaccine for years while working at Southern Illinois University, which claims to have been unaware of his unorthodox research practices.
Halford, who died this summer from cancer, ran a clinical trial out of a house on St. Kitts in 2016 to test the experimental vaccine and did not alert U.S. or St. Kitts and Nevis authorities.
Following a KHN report that Halford completed the 2016 trial with no independent safety oversight, the Department of Health and Human Services demanded the university account for the research.
SIU, in an initial response to U.S. authorities, said the university's institutional review board found "serious noncompliance with regulatory requirements and institutional policies and procedures."
SIU, like many universities receiving federal research funds, pledged to follow U.S. standards for all clinical trials.
In 2013, Halford, who was a microbiologist not a physician, noted a need for secrecy in one email to a participant, writing that it would be "suicide" if he became too public about how he was conducting his research.
Many email exchanges with participants in 2013 — asking them to send photographs of rashes, blisters and other reactions — were sent from Halford's university email account. He used the university phone for communication and he referred to a graduate student as assisting in the experiment and to using the lab.
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"Furtive unregulated live virus vaccine injections in a Holiday Inn? This is really, really out there," said Jonathan Zenilman, a doctor and an expert on sexually transmitted diseases at Johns Hopkins University. "Someone in the university had to know that this stuff was going on. If they didn't, they should have."
According to the emails between Halford and the patients and extensive interviews with the participant, Halford did not procure written informed consent as required by federal law when testing a live virus on humans. Medical researchers, such as Halford, may not inject patients without oversight by a physician or a nurse practitioner, Zenilman said.
SIU refused to comment on revelations about Halford's 2013 experiments.
It has previously said it had no role or responsibility for Halford's work in 2016 in the Caribbean. The university has maintained it didn't know about the offshore trial because he pursued that through Rational Vaccines, a company the professor co-founded in 2015.
But criticism has been raised about the university's ties to Halford's commercial venture.
SIU, based in Springfield, Ill., shared in a patent on the prospective vaccine with Rational Vaccines, which was formed to market and research the product. The university promoted Halford's vaccine research on its website. And when a company owned by Peter Thiel, a supporter of President Donald Trump's, invested millions of dollars into the research this April, SIU publicly trumpeted Halford and Rational Vaccines.
— SIU Medicine (@siusom) February 18, 2017
The Food and Drug Administration, which oversees the safety of vaccine research in the U.S., declined to comment on the 2013 experiments. It previously declined comment on the 2016 trial.
Since Halford's death in June, several participants who received the vaccine in 2013 and 2016 have told KHN they have informed the university about what they fear may be side effects from the vaccine.
One participant who says he received the injections in Illinois fears that the vaccine, which contains a live virus, may have given him a new and different type of herpes he did not have, a scenario that experts who reviewed his medical details for KHN said was possible.
In recent weeks, that participant from Texas and a woman from Colorado who took part in the St. Kitts trial have separately electronically reported to the FDA their possible side effects, also known as "adverse events."
They said SIU and the FDA have not adequately addressed their inquiries.
"It makes me angry that Halford went ahead with the offshore trial anyway," said the man from Texas who did not want to be publicly identified because of the sensitive nature of his disease. "I hope more people weren't hurt."
Rational Vaccines has vowed to proceed with the research. The company, founded by Halford and Hollywood filmmaker Agustín Fernández III, has said it considers the 2016 trial a success — though it is unclear what data it used to support that claim. In a statement, Rational Vaccines said that Fernández was not involved with Halford's work before the company was formed but that Fernández was aware of "individuals who experienced positive outcomes from the vaccine."
"Their stories are what sparked Mr. [Fernández'] future involvement," the company stated. It did not address specific questions from KHN about the 2013 injections.
A representative for billionaire PayPal co-founder Thiel did not respond to questions about his investment in the vaccine. Thiel and other backers share libertarian political views that are critical of the FDA's regulations.
The 2013 emails and interview with a participant show Halford began unregulated human experiments while working as an associate professor in the medical school's department of microbiology.
The Texas patient said he first learned of Halford's work through a members-only Facebook account. According to the emails, one woman helped Halford recruit patients and organize injections. This woman identified herself to KHN in an email as a herpes patient who was injected with Halford's vaccine. She claims she was cured as a result.
KHN attempted to contact the other participants who received injections in 2013. They either declined to comment or did not respond.
In the emails, Halford describes some of his methods, including that he was varying the doses — as well as the number of shots. He communicated regularly with participants using a familiar tone.
"Just wanted to pass along that I immunized someone with the higher dose of the HSV-2 vaccine on Monday, and I attach the photos of the injection site at 48 hours to give you and everyone else an idea of what to expect …" he wrote on Sept. 19, 2013. "This individual requested that I give him two immunizations to double the effect … one immunization per leg."
"Everyone's vaccines contained ~150 million infectious units of the HSV-2 vaccine strain …" Halford wrote four days later, on Sept. 23, saying the first injection of the group represented about a thirty- to fortyfold increase over what others had received in August 2013.
In the same email, Halford said he believed the experiments were important to demonstrating that his vaccine worked.
"Saturday Sept. 21 definitely represents a milestone in my career," he wrote. "Don't know how it will turn out, but I undoubtedly feel like this was a real test of the (a) safety / tolerability of the HSV-2 vaccine and (b) an opportunity to see if it has any therapeutic potential.
"I am indebted to all of you."
Halford also refers to using his university's resources in the emails.
"My lab currently consists of myself and 1 graduate student and anything I do with you guys or your blood is extra and on top of what I get paid to do …," he wrote in a Nov. 3, 2013 email. "If my graduate student gets to it before I do, I will pass along the results." Attempts by KHN to reach the graduate student, who was not named in the email, were unsuccessful.
When discussing the possible effects of the vaccine in emails dated Oct. 2, 2013, Halford openly speculated about possible results, calling his analysis "nothing more than an educated guess."
"The proof is in the pudding … let's see if your problems with outbreaks dial back or not."
The participants treated Halford with deference and were eager to receive the injections, the emails show.
The Texas man said he did not know how the trial was financially supported, adding that Halford wouldn't accept money from participants because, as he told them, "it would get him in more trouble if he was ever caught."
But Halford told participants they could donate money to SIU for his research, the Texas man said. SIU has confirmed that it set up a business account for donations to Halford, but the university has refused to say how the money was used.
When Halford invited them for dinner and drinks at his house, they agreed. "I'll do whatever he wants," the Dallas man wrote about the dinner.
In the emails, the participants, who ranged in age from their 20s to 50s, were enthusiastic about the potential for the vaccine and freedom from often excruciating chronic symptoms. "I do believe [it's] safe," the Texas man wrote Halford on Sept. 15.
But months later, on Feb. 24, 2014, he said, he was frightened by a reaction to the vaccine, after his second shot. "I got a large rash on my leg and it burned and swelled," he wrote to Halford. "… then a blister popped up."
The Texas man has HSV-1, which usually emerges in sores on the face. Halford's vaccine was a weakened version of HSV-2, which is genital herpes, according to descriptions he uses in the emails. "I did not think the HSV-2 vaccine strain would be capable of reactivation, but perhaps I will have to reconsider that," Halford wrote in response in an email.
Anna Wald, a leading herpes expert at the University of Washington, said Halford should have informed the Texas man before testing that he was vulnerable to having side effects because he had a different herpes virus type than the vaccine Halford prepared.
Wald said Halford's research — without oversight — jeopardized the patients.
"We're not allowed to do this to guinea pigs in this country let alone human subjects," Wald said.
But Wald said she could understand the participants' desire for a chance at a cure. "People underestimate how desperate people with genital HSV are," she said. "This is what drives even the possibility of a study such as Halford's."
SIU continues to be under scrutiny. Jerry Kruse, the dean of SIU's medical school, responded to the HHS inquiry into the 2016 trial on Oct. 6 and indicated that the university has more to discover.
In his letter, obtained by KHN under the Freedom of Information Act, the dean said "if deemed necessary, SIU will develop an effective corrective action plan." Some of the letter is redacted.
Several participants from both trials told KHN they have asked SIU for help.
The Colorado woman from the 2016 trial who reported a possible side effect from the vaccine to the FDA said she found university officials "dismissive."
One participant, a Californian in his 30s, said he wanted the university to continue the vaccine work with safety oversight while "taking responsibility" for any improprieties.
SIU did not adequately address his questions, and he said: "It was obvious they want nothing to do with us."