Yesterday saw the release of the paper published in the New England Journal of Medicine containing the hotly awaited data concerning the RV144 HIV vaccine trial that took place in Thailand. There was already some discussion of the initial results, which were reported in September and discussed by Colin and Martin. As has already been discussed, there is a very cautious consensus due to the statistical analysis of the trial only *just* falling on the side of significant. Click here to read this post in its native environment, on Blue-Genes.net.
Also there were the issues that the efficacy (capacity to provoke an effect, in this case protection from HIV infection) was only calculated as 31.2% overall, and the non-intuitive fact that each of the two components of this vaccine – ALVAC (which contains a modified canarypox virus) and AIDSVAX – have been shown to offer no significant protection when administered alone.
Commentary on the full report is already being written of course (by people paid to do it, unlike me…) with the interesting points that vaccine efficacy may not only fall after the first year following inoculation but also seems to have a higher efficacy in trial members who are in low risk groups. The point is an obvious one – a whole bucket more questions have been raised by this trial than have been answered. Even if we cautiously accept the significance of the findings and that the vaccine’s efficacy is real, we have sod all idea why or how, other than vague speculations about a temporarily stimulated innate immune response (see ViroBlogy).
But, as disheartening as this may sound, particularly to those people who have watched every other HIV vaccine project attempted over the years fail, this is certainly a positive finding. The reason for this is that in terms of how science is done and applied, the methodology doesn’t exist in a bubble. When important things like vaccine work get noticed, they also get noticed by activists, journalists, politicians. Policy can be affected, along with public opinion which can have more affect on an academic enterprise than may be obvious. Funding into HIV vaccine research has been dropping which obviously has not been helped by all round economic belt-tightening at the moment, so this study may provide a much needed boost to a previously bleak field. Awareness is also raised amongst those people who sign the cheques. The global vaccine market is big money whichever way you look at it, though obviously investing in 16,000 strong trials that span years with no product to show at the end of it makes a sad face for any investor who might think it purely profitable. Big cash source, big cash sink. This study is the first indication that work on an HIV vaccine might not just be the latter. Many HIV activists are likely to want to push this too, as the head of IAVI Seth Berkley says:
“Years of investment and dogged science are providing leads for solving one of today’s most pressing research challenges. Some 7,400 new H.I.V. infections occur daily throughout the world. Clearly we need better methods of preventing the spread of H.I.V., and no public health intervention is more powerful or cost-effective against infectious disease than a vaccine.”
Though cautious optimism should be present for communicators and advocates this is definite justification that HIV vaccine research is not flushing cash down some impossible non-route. it is a long and tricky path…but finally, a little evidence that it is a path. Paths have ends!