More candidate vaccines

Vaccines are 'the most promising hope that we have to making a
meaningful impact on the epidemic' – so said Shaun Mellors today. Reflecting on the satellite meeting held yesterday, Community Matters: Preparing a vaccine to prevent AIDS, Mellors, who is the HIV, vaccine and microbicide team leader for the International Council of AIDS Service Organisations (ICASO) is passionate about HIV vaccines.

This, and his clear recommendations as to the best way of preparing communities for vaccines, makes him an important voice in this next important phase in the battle against HIV in Africa.

Asked about the way to prepare communities for vaccines, Mellors was clear - 'we need more candidate vaccines, and we need to address issues of access and availability now'.

Trial sponsors are certainly aware of this – the International AIDS Vaccine Initiative (IAVI), for example places a high priority on ensuring that the problems that beset the early (and current) distribution of anti-retrovirals (ARVs) does not happen with HIV vaccines.

But this should be done now, to ensure as many people as possible gain access to vaccines once they are available for dissemination.

It is also the responsibility of individual countries to consider issues of access, and to 'ensure community voices and community advocates are heard'. Mellors is keen to integrate community vaccine development into the infrastructure of treatment – 'we have to ensure that vaccines and microbicides are integrated more into the treatment agenda' he states: a situation that seems an especially big challenge, given the current dominance of ARVs - vaccines and microbicides have 'fallen by the wayside'.

The vaccine satellite meeting focused on community preparedness and community involvement in the use of HIV vaccines.

Mellors felt that a key element would be to track progress made since a similar meeting held prior to the 14th International AIDS Conference in Barcelona 2002.

He was not entirely positive, and whilst being pleased that the subject of community preparedness for and HIV vaccine was coming more to the fore, his unease about an apparent lack of progress (as compared to the debates around ARVs) gives him cause for concern.

A presentation from delegates from India soon to be involved in vaccine trials struck him as particularly significant, for 'some of the challenges and problems that we had to deal with in Africa [regarding community readiness] they are having to deal with in India'.

For Mellors, this highlights the need for 'south-south collaboration' where valuable lessons can be learnt from each other, particularly in welding the treatment to the vaccine agenda.

There is also a general need to raise the number of community advocates, currently limited to institutions and organizations, e.g. the African HIV Vaccine Programme.

This contrasts markedly with the high profile given to treatment advocates and activists, such as Edwin Cameron.

Mellors is confident that vaccine development can provide an
opportunity to build a bridge between science and the community – to make scientists understand 'that community involvement leads to better science'.

His confidence in the process is less sure. Following the vaccine satellite meeting, Mellors hoped for 'concrete actions and concrete steps which we ourselves are accountable for'.

He was unconvinced that this came out of the satellite meeting, and stressed the need for 'new players, new stakeholders' to take forward the preparation of communities for HIV vaccine use.

Clearly, the development and use of HIV vaccines continues to pose significant challenges to both scientists and NGOs concerned in this developing field of care.