HIV Vaccines - Accelerating the Development of Preventive HIV Vaccines for the World: Summary Report and Recommendations of an International Meeting

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Introduction
The continued spread of HIV-11 presents a serious threat to public health and economic
development throughout the world. The World Health Organization (WHO) estimates that 14
million people had been infected with HIV by 1993, and projects that at least another 26 million
will become infected by the year 2000. The available evidence suggests that all infected
individuals will ultimately suffer from AIDS, and that all individuals with AIDS will die within a few
years, unless much better means are found to slow disease progression. Already HIV is a leading
cause of adult and infant mortality in a number of urban centers in both developed and
developing countries, and by 1990, according to World Bank estimates, HIV was the leading
cause of disability-adjusted life years lost among young adult males living in developing countries.
The recognition of the potential impact of the epidemic led to the mobilization of financial and
human resources to slow the spread of the virus. Information and education campaigns designed
to modify practices placing individuals at risk of acquiring and transmitting infection along with the
provision of condoms and the screening of blood, have played an important role in reducing the
rate of spread of the virus. Despite these global efforts, currently estimated to cost over
US$ 1.5 billion a year (US$ 200 million [13%] of which was spent in developing countries), the
virus continues to spread - even in populations exposed to extensive prevention programs. New
prevention measures are urgently required.
Key to the successful prevention of many other infectious diseases has been the development
and distribution of safe, effective, and inexpensive vaccines. Vaccines have played a pivotal role
in eradicating smallpox worldwide, in eliminating polio from the Americas, and in controlling
measles in a number of countries. The development and distribution of a safe, effective, and
inexpensive vaccine to prevent HIV infection probably represents the best hope of controlling the
global HIV/AIDS pandemic.
There are many scientific challenges that will need to be overcome before a preventive HIV
vaccine is developed. The development of a vaccine, however, is only the first step. Experience
with drugs and vaccines for other diseases suggests that measures will need to be taken to
ensure that once a vaccine is developed that it is accessible to those at risk of infection
throughout the world with the least possible delay.
This report broadly summarizes the deliberations of an international meeting convened by the
Rockefeller Foundation in March 1994. The meeting, held in Bellagio Italy, was attended by 24
scientists, public health specialists, industry and private sector representatives serving in their
personal capacities. The document is divided into five sections: the need for and ideal
characteristics of a preventive HIV vaccine; current efforts to develop HIV vaccines; obstacles to
developing and making HIV vaccines available; accelerating the development of HIV vaccines;
and future activities.
Throughout this document the term HIV refers to HIV-1. The focus of the meeting was on
HIV-1, rather than HIV-2, as HIV-1 accounts for over 90+ % of all HIV infections, is spreading
faster, and is more easily transmitted than HIV-2.