The mobilisation and renewal of effort which has begun at a global level with the launch of the International AIDS Vaccine Initiative needs to be matched and extended at national and community levels.

Vaccine research needs to be constructed as a partnership, including volunteer participants and their communities, researchers, governments and other funding agencies, public research teams and private companies producing vaccines.

The UK and other European governments and institutions could help by clarifying what they want to achieve through vaccine research, and how they propose to advance it. They could work to remove obstacles and create incentives for private sector involvement in vaccine development, following the lead of the US state of California which enacted laws ten years ago, limiting liability for vaccine-related injuries and committing funds for the purchase of any vaccine proven to be effective.

Community leaders and activists can help by informing themselves and those they are working with on the issues surrounding vaccine research and development, and by passing that information to policy makers in government and industry.

There is no certainty that this effort will succeed, although there is good reason to believe that it can. It is, however, completely certain that without sustained efforts now, we could easily be in the very same position in ten years' time.

The experience with hepatitis B, where technically successful vaccines have been on the market for more than two decades, yet new infections continue to occur even in wealthy countries, shows that it takes more than a vaccine to stop an epidemic.

‘An ideal HIV vaccine would be oral, inexpensive, safe, and heat stable; it would require only a single dose, last a lifetime, and be effective against all strains of the virus and all routes of exposure. Short of this ideal, practical limitation will constrain the efficacy of any vaccine ... Reaching those at greatest risk for HIV infection promises to be as complex with vaccination as it has been with behavioural interventions. Even a successful vaccine will be only one component of a broad prevention strategy aimed at reducing the number of new infections by diminishing the incidences of exposure to HIV, through reduction of risk behaviour and other means.’ (Stryker)

Nonetheless, the impact of demonstrating an effective vaccine, even an imperfect one, would be immensely positive for the global response to AIDS. It would open up a real possibility of working towards the elimination of HIV, rather than the temporary and partial control of it. Money spent on controlling and treating HIV in the meantime would become a supporting investment towards an achievable and finite end, rather than a potentially unending drain on resources. The mobilising and energising effect this could have across the whole range of HIV-related needs should not be underestimated.

Websites

• AIDS Vaccine Advocacy Coalition, http://www.avac.org/
• Bill and Melinda Gates Foundation, http://www.gatesfoundation.org/
• HIV Vaccine Trials network, http://www.hivtn.org/
• International AIDS Vaccine Initiative, http://www.iavi.org/
• International Council of AIDS Service Organisations, http://www.icaso.org/
• UNAIDS, http://www.unaids.org/
• US National Institutes of Health HIV vaccine research,  www.niaid.nih.gov/research/Daids.htm
• VaxGen, http://www.vaxgen.com/
• WHO-UNAIDS HIV Vaccine Initiative, www.who.int/HIV-vaccines/

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