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Journalism of Courage
India is siting atop not one but two lethal A-bombs. One is the all too familiar atom bomb, signals from which shook the globe this May. The other A-bomb is a silent killer stealthily lurking in the corners of our bedrooms. And this latent AIDS bomb might be potentially much more devastating than the Pokharan bomb.
While the public has heard enough and more about America8217;s keenness to defuse India8217;s atom bomb, not many know that it is probably the AIDS bomb which is giving Uncle Sam more sleepless nights. For, even as the AIDS epidemic plateaus in America, there is every possibility that HIV could re-enter the country in the distant future unless simultaneously contained all over the globe, a fact that worries many health experts.
At the end of the brainstorming, the two countries decided that the road ahead should be a 8220;collaborative one8221;. As a consequence, talk of intense cooperation is thick in the air between America 8212; the nation with the deepest pocket on AIDS research 8212; and India 8212; the nation that is likely to be carrying the largest burden of AIDS in the next century.
According to a recent WHO estimate, India is already carrying an immense load of three-five million HIV-positive individuals. Further, based on sentinel surveys, even the Government of India now admits that about one in every 200 Indians is likely to be carrying the AIDS virus. The country is hurtling towards becoming the AIDS capital of the world. 8220;Vaccines are absolutely essential to interrupt this epidemic in developing countries and it is for that reason that the US is involved8230;andIndia should definitely take a leadership role in the development of a vaccine,8221; says Anthony Fauci, a leading researcher on AIDS and director of the famous American laboratory the National Institute of Allergy and Infectious Diseases.
Till date, only about 25 candidate vaccines have moved into clinical trials, of which only three have advanced into clinical testing and only one has moved to large-scale human trials. This most advanced candidate vaccine has been developed by Vaxgen, a San Francisco-based private company. Two other candidate vaccines, also developed in the West, are going to be tested soon in Thailand and Uganda.
A strong feeling among experts is that the world needs more candidate vaccines and that other hot spots should be used to test these new vaccines as and when they are developed. India has all this while resisted all attempts made by developed countries to test an AIDS vaccine, citing ethical reasons for not allowing its population to be used as guinea pigs. But this hardlinepolicy is likely to be changed, with India now embarking on the development of an AIDS vaccine on its own, either fully indigenously or in collaboration.
At the end of the meeting that was attended by over 80 scientists, India decided to prepare a national HIV vaccine development programme which would juxtapose well with ongoing international efforts. India stands to gain strongly by participating in this international effort, for according to J. V.R. Prasad Rao, project director of the National AIDS Control Organisation NACO of India, 8220;we can take advantage by learning from the failures of others8221;.
On his part, Fauci 8212; who was leading the American delegation 8212; also seems keen on a joint effort in the search for an AIDS vaccine. 8220;Collaboration with India is an excellent idea and we are willing about accepting Indian collaborations in vaccine development8230;as it might lead to a quicker solution,8221; he said. He also added that as and when a new candidate vaccine comes up which may take anywhere upto three-five years we can plan for testing it in India, but for that to happen, steps have to be initiated today in India and 8220;now the ball was in India8217;s court8221;.
Since these are very early days, none of the participating parties was willing to speculate on the exact nature of the collaboration. Whether it would remain a scientist-to-scientist affair, a bilateral or a multilateral initiative or probably a mix-and-match collaboration. Seth Berkley, president of the non-profit scientific organisation the International Aids Vaccine Initiative IAVI, New York, says a good collaboration will 8220;really cut time8221;, as there is a 8220;real emergency in India8221;. He adds that among the developing countries, apart from Brazil and China, India is the only one that has both the scientific base and the technological capability to commercially produce vaccines and India8217;s non-participation 8220;will surely slow down8221; the global effort to control AIDS.
The scientists may be in agreement, but finally it is the IndianGovernment that has to be first convinced, and that still seemed a little far way. 8220;Unless India is made a full and equal partner in the development of a vaccine and unless the candidate vaccine has been developed collaboratively, India will never allow the testing of a vaccine,8221; says Manju Sharma, secretary of the Department of Biotechnology, Government of India. She adds this word of caution even while she admits that the only viable solution for India today is a vaccine, as the drug therapy is far too expensive, at around 18,000 a year. Sharma emphasises that India really needs a vaccine against the most prevalent strain C of the AIDS virus while most of the vaccines developed so far have been against the strain B of the virus, which is the most prevalent HIV strain in America and Europe. This is likely to change, with the IAVI announcing this week that it is investing 9.1 million for the development of vaccines for the strains most prevalent in developing countries.
There are other important issuesthat need to be resolved before an effective collaboration can get going and that includes touchy ethical problems like who is going to bear the exorbitant cost of treatment if some of the participants in the course of the trial were to contract AIDS. Ways of sharing the spoils and issues of intellectual property still pose a major stumbling block.
In conclusion, the Indian Council of Medical Research 8220;pledged support8221; of its extensive resources and the NACO expressed its 8220;deep commitment8221; towards the development of an AIDS vaccine. Predictably, the Americans were delighted. Expressing happiness over the deliberations, Carole Heilman, Deputy Director, Division of AIDS, NIAID, Bethesda, said she was 8220;very hopeful8221; that an Indo-US collaboration may now really come through and was 8220;very thrilled8221; that commitment for this new AIDS vaccine initiative had come from a 8220;high level8221; in India.
Pallava Bagla is India correspondent of Science
