KAY MARSHALL, Int'l AIDS Vaccine Initiative
Thurs., March 6, 3-4 pmEST

Chat Transcript

Moderator: Good afternoon. My name is Vicky Gou. I work as a web associate at the Feminist Majority Foundation (FMF). I will be moderating today's chat. I would like to thank Kay Marshall from the International AIDS Vaccine Initiative for joining us today.

Kay Marshall: Thanks Vicky. Thanks for inviting me. I hope I'll be able to answer people's questions about AIDS vaccines and the International AIDS Vaccine Initiative.

Jeff: Your bio says you often travel to Africa to educate local media on HIV/AIDS reporting. Could you explain a bit about what the problems are with media coverage of AIDS in Africa and in the U.S. as well if you know? Thanks.

Kay Marshall: AIDS is the single biggest health problem we face as a species and it doesn’t get nearly enough column inches or airtime in Africa, the US or anywhere else in the world. The work that I do in Africa is specifically to help local journalists understand the tough science and policy issues surrounding clinical trials of AIDS vaccines. In communities where AIDS vaccine trials are planned and are going on, we work with the media so they can better explain what the trials are and what they mean to the local community. We also work with journalists to help them find new and innovative ways of writing about AIDS. In many communities there is a great deal of stigma around AIDS--journalists have a key role to play in their communities in helping to fight the stigma and provide clear and accurate information about what AIDS is, how you can get it and how you can protect yourself, and what to do if you think you may be infected.

Billie Kim: Why do you think the Bush Administration suddenly has an interest in AIDS in Africa? Does it have to do with the war on terrorism? Traditionally Republicans have been weary in giving aid to African nations to combat HIV/AIDS!

Kay Marshall: I'm not sure why the administration has stepped up their interest in AIDS in Africa, but if the money is spent wisely, it will be a good thing. I think we all need to let the President and Congress know our thoughts on how that money should be spent and hold them accountable for spending it wisely.

Roz: Is there a new vaccine to prevent HIV?

Kay Marshall: Not yet. There are a few things in human trials now, but only one vaccine candidate has made it into Phase III trials. Unfortunately the product AIDSVAX was not proven effective. Other vaccines are in earlier trials, so we don’t yet know if they will work. Some of the candidates in early trials, including a DNA-MVA vaccine series that my organization, the International AIDS Vaccine Initiative, is testing in the UK, Kenya and Uganda, look promising in early trials, and it is important for us to fast track these vaccines into larger trials so we can find out if they will work.

Jeff: How close are we to a vaccine in years and dollars?

Kay Marshall: We hope we are 5 to 7 years away from at least a partially effective AIDS vaccine. The whole AIDS vaccine effort is still woefully underfunded—in 2000 IAVI estimated that the world needed to spend more than US$ 1 billion over 7 years on the development and testing of AIDS vaccines. A single large scale clinical trial can cost US$100 million or more and we will need multiple Phase III trials in the coming years.

Jeff: What are your thoughts on President Bush's new $15 billion AIDS plan?

Kay Marshall: We hope that the US government and other nations will provide their fair share of the funding needed and that the money will be used wisely for prevention and treatment programs where they’re most needed.

Peter: What kind of pressure can we put on corporations to help with dealing with the HIV/AIDS issue?

Kay Marshall: One of the things that can be done is to make companies that are working in areas where there’s a large epidemic to provide treatment, education, and prevention development for their workers. In terms of vaccine development, it’s also important to make sure that pharmaceutical and biotech companies are involved in developing an AIDS vaccine. The government should work to provide incentives to those companies to be involved in vaccine development.

Claire: In your opinion, how far is the medical community from developing an HIV vaccine? Are any tentative plans in the works as to how this vaccine will be distributed, if the government will subsidize the costs, and if the US and other industrialized nations will help (financially and logistically) make the vaccine available in less economically fortunate countries/continents (especially Africa)?

Kay Marshall: That’s a great question. Most researchers working on AIDS vaccines think we will have at least a partially effective vaccine in the next 5 to 7 years. While that is in many ways a long way away, there is much to be done now to ensure that once we have a vaccine it will be made available to the people who need it the most as quickly as possibly. Since most of the people who desperately need a vaccine to prevent AIDS can’t afford it, we must also work now to ensure that funding mechanisms are in place. A vaccine against AIDS will also need to be given to adolescents and adults, rather than infants and children. So at the same time that research and development is going on, IAVI and other groups are working to ensure that manufacturing, distribution and financing plans for developing countries will be in place when we do have a vaccine.

Jeff: Back to the issue of corporations and their role in fighting AIDS. Many people argue that when corporations create programs for their workers (like Coke and certain mining companies in S. Africa have begun to do), governments don't feel the same pressure to tackle AIDS because they believe the private sector is taking care of it, but really it's just a tiny sector of the population--the elites who work for major multinational firms--who get treatment. Also, corporations are afraid that many HIV-positive people will apply to work for them to get access to their programs, driving up their costs and down their productivity. Do you think it would be wiser for corporations to simply give money to The Global Fund to Fight AIDS, Tuberculosis and Malaria and let them get the money out to effective programs?

Kay Marshall: This is a difficult question. I think that all sectors of society -- private and governments have a responsibility to provide adequate treatment and prevention. Companies providing care shouldn't let the governments off the hook or vice versa. We need well-organized multi-sector approaches in all countries. When we have a vaccine or other new preventive technologies, like microbicides, those should be a part of that response.

Mary: What are some of the main challenges in terms of vaccine development?

Kay Marshall: There are scientific challenges to making an AIDS vaccine - there is still a lot scientists don't know about HIV, so we need to try many different approaches in candidate AIDS vaccines. For example, we don't know if we need neutralizing antibodies or cell-mediated immunity or a combination of both. We learn from the laboratory work and from each trial we do, but there are still many unanswered questions. There are also non-scientific challenges to AIDS vaccine development -- we need governments in both the developed and developing world to provide more political and financial support to AIDS vaccine development.

Maya: What are some important issues dealing with HIV/AIDS that you don't hear about in the mainstream media?

Kay Marshall: I think in the US and Europe the media sometimes suffers from AIDS fatigue and doesn't cover the issues around AIDS nearly as much as in the past. That contributes to the impression that many people have that AIDS is a manageable disease. But infection rates in the US are on the rise again. In developing countries the issue is often that the stigma and politics surrounding AIDS may mean that the best information about AIDS is not published.

Isabel: What do you think about the potential of a vaccine being developed using traditional medicine or herbs developed using local traditional knowledge from an African country, India or China?

Kay Marshall: Most vaccines are made by using a weakened or killed version of the pathogens they are meant to protect against. So, for example, the oral polio vaccine is made from a weakened form of poliomyelitis, the virus that causes polio. For AIDS vaccines, researchers don’t use whole-killed or live-attenuated HIV, but rather very small parts of HIV to make vaccines. It is not likely that a vaccine could be made without using at least a part of the pathogen, so traditional and herbal medicines would probably not play a major part in developing an AIDS vaccine. But these methods are very important in the treatment of many diseases, including opportunistic infections often associated with AIDS.

James M. Nordlund: If the roots of lack of compassion for the diseased and the en vogue economic tool war, one being psycho-pathic greed, aren't addressed in Western societies 'sociological programming of their populaces, won't the corporate structure's convolution's devolutionary direction eventually determine more apathy and social pathos in global society; ergo less funding for prevention, treatment, and research into curing AIDS, in the long run?

Kay Marshall: I think we face a lot of apathy NOW in terms of funding for existing prevention and treatment programs for AIDS, as well as for research into new technologies including vaccines, microbicides and new kinds of treatments. In the last couple of years more people have begun to pay attention to the global AIDS epidemic and more funding has been allocated for programs, but not nearly enough. We hope to have at least a partially effective vaccine in the next 5-7 years.

Jeff: Aren't different vaccines needed to combat different strains of HIV? Is it true that many more resources are being devoted to finding a vaccine for the strains common in the developed world than for those common in Africa and other developing regions?

Kay Marshall: There are a number of different strains, or subtypes, of HIV. Researchers don’t yet know if vaccines will only work against the subtype from which they are made, so it is important to test vaccines for the subtypes most common in regions where the need for a vaccine is the greatest. My organization, IAVI, was founded in 1996 because no one was working on AIDS vaccines for developing countries --the only vaccines being tested at that time were for subtype B, the most common in North America and Europe. Since that time a number of vaccine candidates have been developed, and some are already being tested in humans, for the subtypes most common in Africa and Asia.

Jalana: What repercussions will the most recent "failed" vaccine trials, which were so widely publicized, have on future research and funding for a vaccine? There were reports of some success among non-Hispanic minorities in the latest trials. What are the implications of that research? There are some rumors of commercial sex workers exhibiting continual immunity to HIV upon repeat exposure-- are these women being included in any sort of vaccine-linked study?

Kay Marshall: Science is often a trial and error process–sometimes you have to try many different approaches before you find the one that works. The news on VaxGen's AIDSVAX is disappointing, but we are not discouraged. The search for an AIDS vaccine will—and must—go on. Scientists remain confident that an AIDS vaccine is possible. Alternative AIDS vaccines, employing different design strategies, are now in development, and some have already entered human trials. These must move forward through further study, without delay. Because the numbers of blacks and Asians in the trial was very small it is difficult to draw conclusions about what this means (VaxGen's analysis is based on just 13 infections among black volunteers, 4 in the vaccine group and 9 in the placebo group). Finally, there are groups of commercial sex workers who have remained uninfected despite repeated exposure to the virus. Studies involving some of these women are the basis for IAVI’s DNA-MVA vaccine now being tested in the UK, Kenya and Uganda.

Carol: At the end of the Clinton administration several years back, an article appeared in our local newspaper, for all accounts reputable, showing an article on research done at the University of Michigan by, I think his name was Brown. In this article it specifically stated that they HAD THE CURE for AIDS, smallpox, and all deadly viruses by using what what termed a nanobomb, which was supposed to attach itself to any virus, etc. and destroy it. It was made of some kind of substance not harmful to the body. Since that time, I read that the US government went there and took over the whole operation...and the news itself, and knowledge is being suppressed. I sent a copy of the article to Oprah and several news channels, who only could come up with the distraction of nanotechnology as in computers...nothing else mentioned the research regarding the rest. What do you know of this, and have you heard of it? I have no further info on the subject, except that it was reported out of one of the big meetings they held in Washington state.

Kay Marshall: I haven’t heard of this research. It would be wonderful if it were true, but unfortunately, science usually doesn’t work that way. You can easily destroy HIV or other pathogens in a test tube, using any number of substances, but these things don’t usually work as vaccines or treatment, so we still need to continue our research for better treatments and preventive vaccines for HIV.

Jackie: You mentioned earlier that if the Bush administration spent the HIV/AIDS money wisely, it would be beneficial. Can you expound on what you consider "wise" spending?

Kay Marshall: I think that the money could be spent wisely if it is part of a balanced and comprehensive response. By that I mean, it needs to include treatment for all members of a family, not just babies, and prevention and education programs. It should also include funding for research and development for new treatment and prevention technology such as microbicides and vaccines that are geared specifically for Africa and other parts of the developing world where AIDS is devastating families, communities and nations.

Jim: Which vaccine has the most potential in terms of AIDS prevention and why?

Kay Marshall: We don’t really know. The only way to know if a vaccine is effective is to test it in a Phase III efficacy trial in thousands of people. So far only one AIDS vaccine has reached Phase III testing. You may have heard last month about AIDSVAX, a vaccine developed by VaxGen a US biotech company. In a Phase III trial in North America and Europe, the vaccine did prove effective. Other vaccines in human testing are farther behind-– most in Phase I or early Phase II testing. Some of these vaccines like IAVI’s DNA-MVA being tested in the UK, Kenya and Uganda and Merck’s DNA-- Adeno vaccine being tested in the US look promising in early trials.

Kelly: What are some ways to help facilitate and speed up the process of vaccine development?

Kay Marshall: A key to ensuring that AIDS vaccine development continues at the fastest pace possible is to make sure that there is adequate funding for all stages of research and development. Political will is also important. For example, in countries where vaccine trials are planned it is important for legislators and policy makers to understand how they can help foster an environment conducive to the conduct of ethical trials. It is also important for local regulatory agencies to understand how trials work and be able to make informed and timely decisions about approving trials.

Dina: Your job is clearly very meaningful. What gripes do you have about the work you do?

Kay Marshall: I think I have a great job. I get to work on a project that means a lot to me personally and that will, I hope one day, help save the lives of millions of people. But because all of us at IAVI feel the pressure to make sure a successful vaccine is developed as quickly as possible, the workload and hours can sometimes be tough. I also get to spend a lot of time in Africa, which is so wonderful -- a beautiful continent with amazing people. But there you can't escape seeing firsthand the ravages of AIDS and that can be emotionally difficult. But I wouldn't trade my job for any other.

Jeff: Could you explain microbicides, please. I've heard the word tossed around a lot but I don't really understand the science of AIDS and AIDS prevention/treatment very well.

Kay Marshall: Microbicides are substances that could be used to prevent the sexual transmission of HIV. They would be used in the vagina or anus before sex to kill the virus. Like vaccines, microbicides are still in testing and so are not yet available. Microbicides, like vaccines, will be important to women, because they will give them more control over their own protection against HIV.

Jay: What are the different types of vaccines that are being developed--treatment, prevention, etc.?

Kay Marshall: Most candidate AIDS vaccines that are being developed are designed to prevent HIV infection. A number of candidates being tested as preventive vaccines in people who are not HIV-infected are also being tested as potential therapeutic vaccines in trials with people who are HIV-infected. But, since almost all vaccines for other diseases are for prevention, rather than treatment, this is a new concept.

Jeff: Could you explain IAVI too? Is it an independent NGO? Where does your funding come from? Thanks.

Kay Marshall: We are an NGO -- a scientific research and advocacy organization working to ensure the development and eventual access to AIDS vaccines for developing countries. Our funding comes primarily from governments and private foundations.

Jeff: What are the various phases of trials? How does a potential vaccine get from one to the next, and how long does that generally take?

Kay Marshall: There are 3 phases. Phase I tests for safety and has 20 - 50 volunteers at low risk of HIV infection. Phase II tests safety and doses (how many shots will be needed and what the timing will be) in 100-200 volunteers, some at high risk of infection, some at low risk. Phase III is an efficacy trial in thousands of volunteers at higher risk of HIV infection. A Phase III trial will tell us if the vaccine works.

Julie Mikalson: Can you identify which countries are most amenable now to moving forward trials, and to bringing in more test/research facilities? I am excited about the possibility to evaluate a new Chinese medicine, and hope to reduce some of the hurdles.

Kay Marshall: IAVI is working in Kenya, Uganda and the UK right now. Other groups have trials ongoing or pending in Brazil, the US and several European countries. India and China are working towards having AIDS vaccine trials. Many countries are very motivated to work on real answers to the epidemic.

Vinny: There is so much publicity about AIDS in Africa. What's your take on the epidemic in Asia, particularly China? How would the strategy for dealing with AIDS in China differ from that in Africa?

Kay Marshall: That's a good question. The epidemic in China and the rest of Asia is not as advanced as the one in Africa, but is every bit as serious. I think there are a lot of lessons that we can take from Africa -- both about what was done and what was not done -- and apply them to dealing with the epidemic in Asia. In terms of vaccines for Asia, IAVI is working with both the Indian and Chinese government. We hope to have a trial going on in India in the next year or so and a bit later in China. If we are lucky and treatment and prevention plans are stepped up in Asia, the epidemic won't become as severe as it is in many African countries.

kathy: How are you combating the "virgin" cure problem that is so rampant in Africa (men thinking they must sleep with a young virgin to rid themselves of disease)?

Kay Marshall: Most of IAVI's work is focused on preparing for vaccine trials, but we all have a responsibility to help overcome the stigma and misinformation that leads to such actions. Some of the work we do with the media in Africa helps to spread correct information about treatment and prevention. But we all need to do more.

Moderator: Thanks Kay for taking the time to share your thoughts with us today. Good luck in your work. Thanks also to all those who joined in the chat.

Kay Marshall: Thanks for having me. These were great questions. If you want more info about vaccines, go to IAVI's website.