Abstract
When HIV was discovered and established as the cause of AIDS in 1983–1984, many people believed that a vaccine would be rapidly developed. However, 30 years have passed and we are still struggling to develop an elusive vaccine. In trying to achieve that goal, different scientific paradigms have been explored. Although major progress has been made in understanding the scientific basis for HIV vaccine development, efficacy trials have been critical in moving the field forward. Major lessons learned are: the development of an HIV vaccine is an extremely difficult challenge; the temptation of just following the fashion should be avoided; clinical trials are critical, especially large-scale efficacy trials; HIV vaccine research will require long-term commitment; and sustainable collaborations are needed to accelerate the development of an HIV vaccine. Concrete actions must be implemented with the sense of urgency imposed by the severity of the AIDS epidemic.
Highlights
The development of an HIV vaccine has been a long and tortuous process that, far, has consumed nearly 30 years of intense laboratory and clinical work
The history of HIV vaccine development has been a tour de force in trying to develop protective immune responses that nature has not learned to produce
Vaccine Advocacy Coalition (AVAC), the challenge that President Clinton posed to the scientific community in 1997 to develop an HIV vaccine within 10 years [13]; and the establishment in 1996 of the International AIDS Vaccine Initiative (IAVI)
Summary
The development of an HIV vaccine has been a long and tortuous process that, far, has consumed nearly 30 years of intense laboratory and clinical work. The paradigm that allowed the development of most existing viral vaccines, which is based on the recreation of the protective immunity that develops after natural infection, does not work in the case of HIV. The history of HIV vaccine development has been a tour de force in trying to develop protective immune responses that nature has not learned to produce. If we learn lessons from the past and, most importantly, have the wisdom to apply them, we may be able to accelerate the development of a much needed HIV preventive vaccine. It discusses the insights that have guided those efforts, and identifies lessons that can inform the path forward This discussion is based on personal experiences after more than 25 years of involvement in the global HIV vaccine effort. Nations Program on AIDS (UNAIDS) in Geneva, Switzerland (from 1986 to 2004), and more recently at the Bill & Melinda Gates Foundation in Seattle, WA, United States (since 2004)
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