In the final pages of And the Band Played On, Randy Shilts' epic exposé of the politics and people behind the AIDS epidemic, a teary-eyed Ugandan man with two dying sons asked a question that has lingered ever since: "When will it come? When will there be the cure?"Almost a decade and a half later, this query remains tragically relevant. High-priced treatments might prolong the lives of wealthy Americans with AIDS, but the outlook for most of the world's citizens is bleaker than ever with the continuing absence of a vaccine -- the only real hope for eradicating the plague. Sixteen years after the date that former Health and Human Services Secretary Margaret Heckler once set for the start of testing, only one vaccine has ever been evaluated widely -- and even this happened despite the government, not because of it.
In Big Shot: Passion, Politics, and the Struggle for an AIDS Vaccine, Patricia Thomas sets out to chronicle the search for a cure in much the same way that Shilts once chronicled the epidemic's onset. Thomas has borrowed heavily from that earlier work, from its brief, chronological vignettes to its cast of characters and bureaucracies. Like Shilts, Thomas doesn't follow a central character but an occasionally dizzying number of scientists, and the government officials who helped or, in fact, too often hindered them. That this book is not quite the equal of its predecessor -- which stands as one of the most compelling and heroic journalistic works of our times -- nevertheless does not diminish its own importance or timeliness.
Big Shot chronicles the period from the earliest days of AIDS-vaccine research to the time, nearly two decades later, when it finally became clear how much time had been wasted. Science journalist Thomas writes that, at the outset, she expected to document "a classic struggle between scientific ingenuity and an exceptionally wily microbe." Yet while the scientific hurdles were certainly formidable, what ultimately emerged was a larger battle involving "social attitudes toward AIDS, careerism and timidity among bureaucrats, and corporate anxieties about profits and liability." This interplay is the best part of her book.
Thomas identifies several reasons why vaccine research has not been a high priority either for industry or for government. Money tops the list. A company must spend as much as $100 million just to develop a potential vaccine, and then the formal process of measuring its effectiveness can add another $100 million.
Also to be considered is that greater profits stand to be made from treating disease than from preventing it. At the drug company Merck, for instance, the highly profitable AIDS drug Crixivan consumed resources that might instead have been allocated to the company's equally promising vaccine research. "Ironically, a product that aimed to prevent AIDS in millions of people took a backseat to a drug that would treat the disease in thousands," Thomas observes.
The most ironic aspect of the sad state of vaccine development is that this reflected the priorities of the once-powerless gay community. In the years after Shilts published his landmark history of the disease, the gay community became a potent lobby for AIDS spending -- but once again the priority was treatment, not prevention. "No organized groups of healthy people prowled the corridors of power on Capitol Hill ... demanding a vaccine that would protect them against AIDS," Thomas notes. Consequently, long after government AIDS spending topped $1 billion a year, less than ten percent of this money was devoted to vaccines.
Still, the reason no AIDS vaccine exists today is not because science has not developed one. As long ago as the late 1980s, more than half a dozen companies had produced possible vaccines. By early 1994, Emeryville's own Chiron Corporation and South San Francisco's Genentech, Inc. possessed the formulas most deserving of widespread efficacy testing. And so the companies prepared for a meeting of the federal advisory panel that would decide whether to throw government financial support behind either of them.
In the weeks leading up to the decision, several factors conspired against the growing momentum to embark on widespread vaccine trials. Scientists worried that government-backed trials would seriously reduce the amount of money available for basic research launched a publicity campaign to attack funding. Other opponents were sneakier -- leaking to the media preliminary research results that erroneously made it appear as if one of the companies' vaccines had actually given some test subjects AIDS, which wasn't even scientifically possible. Finally, there was a vocal attack on vaccine testing from radical gay activists, in a tragic foreshadowing of the way that part of the gay anti-AIDS lobby would devolve into conspiratorial nonsense. And so, on the same June night when OJ Simpson cruised the freeways of Los Angeles in his white Ford Bronco, federal AIDS bureaucrats essentially killed government-backed vaccine trials.
As predicted by Genentech's Don Francis, the withdrawal of government funding had an immediate chilling effect upon the whole field. Promising approaches developed by researchers over more than a decade were soon abandoned without ever being formally tested. Two years later, there were fewer potential vaccines under development than at any point in the past decade. "The current status was a depressing litany," Thomas writes: "development stopped, plans dropped, no longer available for trials, doubtful that this will be pursued, uncertain when available, timeline unknown, development halted, no plans for clinical development."
Chiron temporarily abandoned its efforts following the tragic cancer death of pioneering researcher Kathy Steimer and the odd discouragement it received from federal AIDS czar David Baltimore. Genentech, mean- while, reassigned or laid off everyone on its staff who was devoted to vaccine research except Francis, the retrovirologist who had become politically untouchable due to And the Band Played On's highly visible coverage of his heroic work on AIDS at the Centers for Disease Control. And when Francis realized that Genentech was now reluctant to spend even $30,000 to keep alive a vaccine effort that had already cost it $50 million, he too knew the end was near.
But as Randy Shilts observed, Don Francis does not give up. He and entrepreneur Bob Nowinski would go on to convince Genentech to license its vaccines to a new company they founded, VaxGen of Brisbane. Through sheer perseverance, VaxGen would go on to do what the government itself was unwilling to do: stage the world's first widespread efficacy trials of an AIDS vaccine. In June 1997, VaxGen received permission from the U.S. Food and Drug Administration to begin widespread vaccine testing programs in the United States and Thailand. These became the first-ever domestic or international clinical trials large enough to demonstrate whether a vaccine could actually interfere with the spread of AIDS. Final results of those efforts are expected later this year.
In the end, this effort was made possible by a handful of courageous and dedicated researchers, entrepreneurs, and investors. But Thomas points out one other person to whom significant credit is due -- Shilts. Francis and Nowinski secured a huge portion of their $27 million in private funding based on the reputation that Shilts created for Francis. And even if Thomas' book never achieves the same impact, the attention it draws to the need for additional vaccine research will have been well worth its author's efforts.
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