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The Search for an AIDs Vaccine: A review of the literature on vaccine development

Cacciatori, E   Hanlin, R   Lasio, L   Orsenigo, L

April 2012

Innogen working paper no. 102

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Introduction

After a period of neglect, vaccines have in recent years become the object of the increasing attention of policy makers, academics and pharmaceutical firms. There are several reasons for this renewed interest. First, there seems to be a widespread recognition of the importance of vaccines in preventing the spread of infectious diseases and of the threats that infectious diseases both known and (as yet) unknown once more pose to the industrialized world. The cases of HIV/AIDS, SARS, but also the resurgence of diseases believed to have been eradicated (e.g. polio) have renewed attention given to vaccines by the general public as well as among social scientists and medical doctors. Current fears of bioterrorist attack have further added to these worries. Second, in the Developing World, preoccupations about the failure to find satisfactory remedies for “old” diseases like malaria which are increasingly becoming drug resistant have been compounded by the appearance of new tremendously dangerous infections – e.g. Ebola - and of course by the explosion of the HIV pandemics, especially in Africa but also in large emerging countries like China. Third, conversely, advances in scientific knowledge and understanding have raised expectations about the ability of research to deliver new vaccines. For example, the sequencing of the human genome and that of animals and other disease carriers (such as the mosquito) where heralded as creating opportunities for fast, modern solutions to a variety of prevailing diseases. Fourth, more generally, the debate about vaccines is at the same time one of the main causes of, and a chapter in, the broader discussion about the evolution of the health care systems, facing at the same time major scientific and technological revolutions, binding budget constraints for the public programs, increasing demand for healthcare by the people. Within this context, the pharmaceutical industry is undergoing profound transformations and it is currently facing difficult challenges.

The combination of all these factors has led to a deep feeling of dissatisfaction among the medical community, researchers and the general public. Either the discovery of new vaccines appears to lag behind expectations (especially where diseases affecting the Developing World are concerned) or, when a vaccine is discovered and access is restricted because of cost (as initially happened with the hepatitis B vaccine). The debate on the inadequacies of the system of vaccine development has been framed as an issue of limited involvement of the private sector due to market failures. However, recently increasing interest has been devoted to the scientific, social and organizational challenges that surround vaccine development. This paper provides a review of the current debate in these areas, focusing in particular on the search for a HIV vaccine. The case of the search for an HIV vaccine is particularly important for two reasons. The first is the huge impact of AIDS. Current estimates place the total number of people infected with HIV at about 40 million, with 4.3 million people newly infected and 3 million deaths in 2006 (UNAIDS/WHO 2006). Despite the fact that AIDS is a global epidemic, much of the burden of the disease is carried by poor countries, and in particular sub-Saharan Africa, where 2.1 million people died of AIDS in 2006. The second reason for the selection of the HIV vaccine is that it is in this field that some of the more imaginative efforts to redesign the system of vaccine development, understood as the whole process from discovery to delivery, are carried out.

This review is organized as follows. Section 2 reviews the market failure argument and the current policy recommendations, which are overwhelmingly based on it. Section 3 examines the scientific, technical and social challenges of developing a vaccine for AIDS. Section 4 examines the organizational challenges of AIDS vaccine development, while the Conclusions summarize the main findings of the review.