Breakthroughs Blog: Vaccines

On the second day of the XIX International AIDS Conference, the need for a host of new tools to prevent and treat HIV and AIDS has already made it to the forefront of the agenda. Of particular note has been the resounding call for a vaccine to prevent HIV, with leading policymakers, scientists, and advocates saying that the world will never reach the end of AIDS without this powerful tool. In a session that focused on improving the effectiveness and efficacy in the HIV and AIDS response, Senator Lindsey Graham (R-SC) said that a vaccine is desperately needed to help make a sizable dent in the pandemic. Graham’s call for a vaccine was echoed by Bill Gates from the Bill & Melinda Gates Foundation. The “ultimate tool” in the fight against HIV and AIDS “will be a vaccine,” Gates said, adding that the US government has been the largest supporter of efforts to develop and vaccine “by far.” He also said that microbicide gels and rings will be powerful prevention products. Without a number of these new tools, the world cannot “talk seriously about moving toward the end” of the pandemic. “We will get these tools, but only if we stay the course.” Later in the afternoon, National Institutes of Health (NIH) Director Francis Collins and Jon Cohen from Science magazine chaired a panel that looked at what lies ahead in HIV and AIDS science. Gary Nabel, director of the NIH’s Vaccine Research Center, said “we’ve never been in a more exciting position” in the search for an HIV and AIDS vaccine. He added that recent discoveries related to broadly neutralizing antibodies over the past two years have made HIV vaccine research “like a phoenix rising from the ashes.” When sharing their hopes for the status of HIV and AIDS research, several panelists also stressed the urgent need to develop new HIV prevention and treatment options. Nabel said that by 2020, he expects researchers will be “in the midst of efficacy trials for an HIV vaccine candidate.” Robert Siliciano of the Johns Hopkins University School of Medicine stressed that by 2020, scientists will be leading clinical trials for new drugs that attack HIV reservoirs. And Dawn Averitt-Bridge of the Well Project said that by 2020, she hopes the world has effective microbicides to prevent HIV, a functional cure for the disease, and that “research makes it into the lives of the people and families we all care so much about.” Cohen ended the session with a call for young people to become the “next generation of scientists” leading HIV and AIDS research. “I’m looking to the young people, because that’s where the revolution is going to happen.” Kim Lufkin is the GHTC’s communications officer.

In this regular feature on Breakthroughs, we highlight some of the most interesting reads in global health research from the past week. The US Food and Drug Administration has approved the first over-the-counter, self-administered HIV test. Developed by OraSure Technologies, the test is 92 percent accurate and will cost less than $20. A recent article in IRIN News highlights the serious need for new antibiotic drugs worldwide, and discusses the potential of public-private partnerships to boost antibiotic discoveries. The United Nations (UN) is urging countries to impose various innovative financing mechanisms in an effort to raise money to offset cutbacks in development aid. The UN hopes that coordinated taxes on carbon emissions, air traffic, currency transactions, and other taxes could raise more than $400 billion a year. Global Health Initiative (GHI) leaders announced last week that the GHI office will be phased out at the State Department. According to GHI Executive Director Lois Quam, the GHI office will be replaced by the State Department’s new Office of Global Health Diplomacy.

In this regular feature on Breakthroughs, we highlight some of the most interesting reads in global health research from the past week. The Associated Press reports that “[o]ne in 10 cases of tuberculosis in China cannot be treated by the most commonly-used drugs,” due to drug-resistant strands of the epidemic. Because of this, there is an even greater need for newer or improved health technologies. Researchers at the fifth annual World Science Festival discuss the need for universal vaccines as “new diseases…continue to emerge.” Pharmaceutical company Sanofi could potentially find out in the fall of this year whether or not they can move forward in developing the most advanced vaccine to prevent dengue. Secretary of State Hillary Clinton announced a new public-private partnership initiative between the US and Norway to improve maternal health, including a partnership with drug maker Merck & Co.

In this guest post, Jamie Elizabeth Rosen—media & communications manager at Aeras—discusses a new effort to develop a novel tuberculosis (TB) vaccine candidate. Dr. Steven Reed is the founder, president, and chief scientific officer of the Infectious Disease Research Institute (IDRI), located in Seattle, Washington. IDRI is a 120-person nonprofit biotech committed to applying innovative science to the research and development of products to prevent, detect, and treat infectious diseases of poverty. My organization—Aeras, a nonprofit biotech focused on developing vaccines against TB—recently announced with IDRI a collaboration to conduct joint development activities with respect to IDRI’s novel TB vaccine candidate, called ID93 + GLA-SE. The collaboration was formed to accelerate the development of ID93 + GLA-SE by combining resources and expertise. IDRI’s internal development programs focus on three neglected infectious diseases—leishmaniasis, TB, and leprosy. But the organization has also collaborated or provided access to its vaccine technologies for a much wider range of infectious diseases and conditions, including malaria, pandemic influenza, HIV, hookworm, and Chagas. I asked Dr. Reed why IDRI got involved in TB. “IDRI started working on tuberculosis vaccines 20 years ago as an unmet need, and I have been working on TB since graduate school,” he said. “So we had knowledge of the disease and this question, and nobody else was addressing it.” Dr. Steven Reed, founder, president, and chief scientific officer at IDRI Although TB continues to claim the lives of more men, women, and children than any other infectious disease except HIV and AIDS, efforts to develop TB vaccines in clinical trials stalled for nearly 80 years. Part of the reason is that a vaccine against TB was invented and rolled out in 1921. But Bacille Calmette-Guerin (BCG), the most widely used vaccine in the world, has done little to stem the TB epidemic globally. While it helps prevent severe forms of TB in children, it is not very effective against adult pulmonary TB, the most common and contagious form of the disease. Only in the past decade has momentum in clinical development of new vaccines accelerated its pace. ID93 + GLA-SE is designed to boost protection afforded by BCG. It is slated to join a dozen vaccine candidates that are now undergoing clinical trials to test their safety and efficacy in protecting people from TB. Vaccine development is particularly complex for TB, so scientists are testing multiple candidates simultaneously so they can deliver new vaccines to protect the people who are most at risk for TB as soon as possible. I asked Dr. Reed why this vaccine candidate holds promise. “The main thing is that ID93 + GLA-SE is designed to boost the current vaccine, BCG. Secondly, the intellectual property for this vaccine candidate is held by IDRI and available for developing country manufacturers. Thirdly, it’s easily scaled and can be affordable. It has to be. So there’s no question in terms of making enough doses at an affordable price, which is not true for most live vaccines. Fourthly, it has a very extensive safety and efficacy data package and TB models.” The vaccine candidate contains four proteins recognized in both latent and active TB. One of every three people worldwide is already infected with latent TB, a dormant state of the disease that can reside in the body for years and will ultimately make about 10 percent of people who have it sick. The vaccine also contains the GLA adjuvant to enhance immune response. ID93 + GLA-SE has already been tested pre-clinically and, pending approval, will enter its first Phase I clinical trial in the United States this year. “We funded this program with over $35 million dollars from NIH [the National Institutes of Health] over the last 15 years,” said Dr. Reed. “All of the preclinical development is done with federal funds, with some industry support. We think working with Aeras will speed the process and integrate us a little more into the community of other vaccines that are in development.” Dr. Reed has a PhD in microbiology and immunology from the University of Montana, which served as a reference lab for BCG—the current TB vaccine—in the 1970s. He started working in global health as a Cornell University Medical College faculty member, and he worked in Brazil for five years in the 1980s. He developed the first recombinant TB vaccine to enter clinical trials, M72, which is now licensed to GlaxoSmithKline. In addition to vaccines, IDRI is working on other new tools to combat TB. “We’re working very closely with some excellent diagnostic manufacturers to make TB diagnostic tests, as well as with the Lilly TB Drug Discovery Initiative and the TB Drug Accelerator to identify and develop new TB drug targets,” Dr. Reed said.