With AIDS vaccine plans in disarray after trials of the most promising candidate collapsed, the head of the federal agency that oversees AIDS research renewed the government's commitment to the development of a drug to prevent the wasting disease.
"We will not discontinue research, period. Not only will we not decrease it, we will in fact try to increase it," Dr. Anthony S. Fauci, director of the National Institute of Allergy and Infectious Diseases, said at a summit of top HIV/AIDS researchers in Bethesda.
The agency organized the gathering to help scientists regroup after Merck & Co. announced that it had halted tests of a prominent vaccine candidate in September. After 10 years and millions of dollars in development, two clinical trials determined that the drug not only failed to protect people against AIDS - but might actually have increased their risk of infection.
"Despite hundreds and hundreds of millions of dollars, the reality in 2008 is that an HIV vaccine clearly remains beyond our grasp," Dr. Warner C. Greene, a professor at the University of California, San Francisco and co-chair of the summit, told the attendees. "The HIV vaccine field is clearly at a critical crossroads, and decisions about our future course will affect the lives of billions of individuals in both research-rich and resource-poor settings for years to come."
As the scientists discussed the future of HIV vaccine research, others argued that the field has no future. Officials of the AIDS Healthcare Foundation, which bills itself as the largest AIDS organization in the United States, called yesterday for the end of government funding for HIV vaccine research.
They said the money should instead be spent on effective and proven strategies for HIV prevention. On Sunday, the group published an op-ed piece in The Sun, laying out its argument.
"Twenty-five years into the epidemic and 20-plus years of vaccine research and we are no closer to a vaccine," said Ged Kenslea, spokesman for the Los Angeles-based foundation. "We just don't think our tax dollars should be going to something that doesn't have much hope, especially with science as it is today."
Although health-care providers have made great strides in treating AIDS and turning it from a death sentence into a chronic disease for many patients, there is no question among scientists that recent failures have shaken confidence in the underlying approach to developing vaccines that would prevent HIV/AIDS in the first place.
That approach was based on using a cold virus to deliver the anti-AIDS payload to those inoculated with the vaccine.
Still, Fauci characterized the AIDS Healthcare Foundation's position as "radical" and said that the Merck vaccine was only one of many promising avenues of research.
He acknowledged, however, that his agency might have to shift emphasis from large clinical trials on humans to more basic research on monkeys into the mechanisms by which HIV infects the body and overwhelms the immune system.
A number of other studies on vaccine candidates similar to Merck's have been halted or postponed, including PAVE 100, a large federal trial that has been put off until at least midyear. Fauci said his agency had not decided on that trial's future.
Earlier this week, Robert Gallo, director of the University of Maryland's Institute of Human Virology and co-discoverer of the virus that causes AIDS, compared the outcome of the Merck studies to the space shuttle Challenger disaster.
Gallo defended his comments yesterday, saying that he made the comparison because both situations involved huge sums of government funding and major failures.
"I wanted to foster this kind of discussion because I knew we were going to be attacked, and sure enough we're getting attacked," he said, referring to calls for an end to vaccine research.
The meeting in Bethesda was a soul-searching exercise for the AIDS research community and a way for the federal agency that funds the research to solicit suggestions for the future.
"With as much disappointment as we have ... the path forward is the focus," said Dr. Adel Mahmoud, a professor at Princeton University and co-chair of the summit. "The status quo and finger-pointing isn't going to take us anywhere."
A common sentiment: The discipline needs a booster shot of young scientists with new ideas.
Fauci said his agency would try to set aside an additional $10 million to $20 million next year to fund grants to look into new ideas. About one-third of the NIAID's $2.9 billion budget goes to HIV vaccine research.
Others cautioned against overreacting to the failure of Merck's experimental vaccine, noting that scientific inquiry often leads to dead ends before it leads to fruitful discoveries.
Hamilton Richardson, a West Baltimore man who is HIV-negative but has participated in vaccine research, said he attended the summit to urge the gathered researchers to continue their search for a vaccine.
"When Challenger blew up, did we stop going into space?" he said, referring to Gallo's remarks. "No, we're in space right now."