The AIDS Vaccine Impasse: Lessons from Jonas Salk and the March of Dimes (Draft)

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Draft 9 Jan 96 (Jonas5.doc) CONFIDENTIAL - PLEASE DO NOT CIRCULATE
THE AIDS VACCINE IMPASSE: LESSONS FROM JONAS SALK AND THE MARCH OF DIMES
A vaccine for AIDS represents the principal long-term and most costeffective solution for the AIDS pandemic, given the limits of reducing
risky human behaviors and the expense of treatment after infection occurs.
Current lifetime medical costs for HIV-infected patients exceed $100,000,
and increasing as new drugs are added to treatment regimens extending
life. After the discovery in the mid-1980s of HIV and methods to grow it
in the laboratory, a vaccine was expected within a few years. Yet now a
decade later, the first generation of candidate AIDS vaccines are in limbo
while arguments rage whether or not to test them for efficacy in field
trials in the population.
To understand the debate, it helps to recall the struggle to conquer
polio, and its heroes who were two of the greatest rivals in the history
of medicine: Jonas Salk and Albert B. Sabin. Their competing vaccine
designs and distinct personal and professional styles explain the clash of
egos they sustained until their recent deaths. But on another level,
their rivalry illustrated the differing approach between empirical public
health practice and theoretical science which remains today an impediment
in developing a vaccine for AIDS.
In the early 1950s, epidemics of polio were sweeping the U.S. and
each year killing two to five thousand victims and crippling 20 to 50

thousand more. Virtually all polio research at that time, including
Salk's and Sabin's work, was funded by the remarkable March of Dimes
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