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

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When HIV became cultivable a decade ago the systematic thing to try
first would have been to apply established technology for a killed wholevirus vaccine for AIDS -- as used in the modern version of Salk's vaccine
and current vaccines for rabies, influenza, and veterinary retrovirus
diseases. But this has never been done. Why? Off the record, "We don't
do product development." NIH insiders point out that such a proposal to
apply old-fashioned methods would not be intellectually exciting. It
would rank poorly compared to grant applications more likely to discover
state-of-the-art scientific truths. Public health emergencies do not
fare well in the researcher-initiated, peer-reviewed funding mechanisms of
basic science.
What is needed to resolve this impasse? NIH should continue to
support the basic science and clinical research which it does so well, and
from which the resulting knowledge improves new vaccine designs. But we
should learn from organizational structures with proven track records in
producing successful products: The March of Dimes gave us Dr. Salk's
polio vaccine. Our military medical research system fostered vaccines for
anthrax, encephalitis, hepatitis, meningitis, plague, pneumonia, typhoid,
and yellow fever, among others. NASA met President Kennedy's target date
for the Apollo program.
Responsibility for developing an AIDS vaccine needs to be placed in
a goal-driven, public-health-oriented, semi-independent entity with
scientific oversight by experienced vaccinologists. Such an entity must
be free of other competing missions and political constituencies in order
to weigh carefully the risks and benefits in making difficult decisions.
Ongoing private-sector initiatives by the Rockefeller and Albert B. Sabin