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United States of America
The US government has funded more AIDS research than any other government in the world. Although vaccine research has received a relatively minor proportion of that funding, the US programme still exceeds those of all other countries put together. Vaccine research was given an increasing priority in terms of funding in the later years of the Clinton administration and this has continued under the Bush administration.
While a number of US federal agencies are involved in AIDS vaccine research, the lead agency is the National Institute of Allergy and Infectious Diseases (NIAID), part of the National Institutes of Health in Bethesda, Maryland. NIAID stresses the importance of having vaccines which are broadly effective against a range of HIV variants and which can be accessible to people in developing countries (Levine).
In a 1996 review of US government AIDS research, work on vaccines was given increased priority (Levine). This has led among other things to the establishment of a Vaccine Research Center within NIH, focussed initially on HIV vaccine research, headed by HIV researcher Dr Gary Nabel, with an initial annual budget of US $16.5 million. It is designing prototype HIV vaccines, the first of which has already entered a phase I clinical trial.
Where once there was a separation between a domestic NIH AIDS Vaccine Evaluation Group (AVEG) network of sites for phase I and II trials and an international network called HIVNET for phase II and III trials, there is now just one HIV Vaccines Trials Network, HVTN. This includes partnerships with researchers and clinicians in a number of other countries, notably Thailand and South Africa. A separately managed HIV Prevention Trials Network on similar principles sponsors work on microbicides to prevent sexual transmission and the use of vaccines (among other methods) to prevent mother-to-child transmission. In practice, there is overlap and coordination between the two networks.
After 1994, the leading option for Phase III trials sponsored by NIAID was a prime–boost approach, using a canarypox recombinant from Aventis Pasteur followed by a recombinant gp120. Phase II trials were conducted in the USA, Brazil, Haiti and Trinidad. In 2002 a decision was taken not to take this any further in these countries, as the cellular immune response to the canarypox vaccine was insufficient for a larger trial to be able to show if that response made a difference to the efficacy of the combined vaccines.
A trial of two similar vaccines is still planned in Thailand, although its future may be in doubt following the failure of VaxGen's initial recombinant gp120 vaccine (see below). This process was initiated as a partnership between the Thai and US military authorities, which have worked together for many years. US military HIV vaccine research was recently transferred to NIH, so this would in effect be an NIH/Thai collaboration.
The AIDS Vaccine Advocacy Coalition, AVAC, is a lobbying organisation which publishes an annual review of US government efforts towards HIV vaccine development (www.avac.org). Recent books by Cohen and Thomas also give useful accounts of US HIV vaccine research.