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“What are you doing here?” This question was posed to me at a scientific meeting by a fellow researcher about six months after I had landed at USAID following my tenure as director of nursing of the Vaccine Research Center at the National Institutes of Health. The implication of the question seemed ludicrous to me, as it seemed to presume that working with a donor agency made it somehow unnecessary to keep current regarding emerging scientific discoveries and thought. The opposite is true of course, but the notion that we at USAID randomly dole out funds is very unfortunately out there. My counterparts in development agencies for other governments, and even for large donors like the [Bill & Melinda] Gates Foundation, have shared similar experiences of such misconceptions about all that donor decision-making entails. They too, are technical experts in their respected disciplines, as are my colleagues in the Office of HIV/ AIDS. We all require regular inputs from our respective fields so that we may proficiently “husband” the precious funds for which we assume responsibility. Another common misconception is the perceived mismatch between “development” as we know it at the Agency, and the “development” of new biomedical tools like topical microbicides and vaccines. They can have a real hand-in-glove fit, as was recently seen in the news from our partner, the International AIDS Vaccine Initiative (IAVI). It has long been presumed that the ultimate tool in the fight against the AIDS pandemic is a vaccine capable of stimulating the body’s own immune system to manufacture protective proteins, known as antibodies, against the virus. IAVI scientists recently identified two unique and potent antibodies capable of blocking a wide array of HIV. These powerful naturally occurring proteins were isolated from an infected volunteer in Africa who has not as yet required anti-retroviral therapy. IAVI’s antibody discovery work, funded in part by USAID, know it at the Agency, and the “development” of new biomedical tools like topical microbicides and vaccines. They can have a real hand-in-glove fit, as was recently seen in the news from our partner, the International AIDS Vaccine Initiative (IAVI). It has long been presumed that the ultimate tool in the fight against the AIDS pandemic is a vaccine capable of stimulating the body’s own immune system to manufacture protective proteins, known as antibodies, against the virus. IAVI scientists recently identified two unique and potent antibodies capable of blocking a wide array of HIV. These powerful naturally occurring proteins were isolated from an infected volunteer in Africa who has not as yet required anti-retroviral therapy. IAVI’s antibody discovery work, funded in part by USAID, therefore, has profound implications. Their CEO, Dr. Seth Berkley, offered this perspective: “If not for USAID support for the IAVIaffiliated clinical research infrastructure in Africa, this scientific advance could not have been produced with such efficiency…This model illustrates what can be accomplished when you marry international development work with state of the art science and innovation.” Knowing that a vaccine capable of stimulating an antibody response against HIV is thought to be the holy grail of potential tools to impact the pandemic, my boss David Stanton and I agreed with IAVI’s plans to direct USAID funds to support their antibody discovery work. We are particularly happy for IAVI, for the Agency, and for the field in general, as we are all one step closer to understanding what a vaccine may need to do to stop the virus. This news, in addition to the signals of vaccine efficacy in the recent trial in Thailand, supported by the National Institutes of Health and the U.S. Department of Defense with their partners, gave HIV vaccine research some real momentum of late. “Are we there yet?” This quintessential question asked by impatient children on a long road trip comes to mind. “No, not yet, dear, but we’ll get there—don’t worry” says the reassuring mom or dad. The road to an HIV vaccine is long indeed; for the first time in 27 years of research we have reached a real milestone on our way to even more hopeful future breakthroughs. At some point, a vaccine to prevent AIDS will be a reality, as is the case with a malaria vaccine, and hopefully an improved TB vaccine. USAID will have been a deliberate part of salient discovery events, while wisely preparing to integrate these new tools with existing methods of relevant treatment and prevention. The results will be dramatic in both countless lives saved and in immeasurably improved public health—logical and worthy outcomes of development efforts. In the meantime, I’ll hold on to my dream, that a safe and effective HIV vaccine is a part of routine immunizations for generations to come. ★
FrontLines is published
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