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BRIAN
DEER: THE VAXGEN EXPERIMENT Page 1
The
Sunday Times Magazine, October 3 1999
By
Brian Deer
Once
a month, at around 3pm, Dr Donald Francis,
president of the VaxGen corporation, boards a 747
at San Francisco airport for an 18-hour flight to
Bangkok. The route is unpopular - with maddening
stops in Seoul, Hong Kong or Taipei - and he
insulates himself in a business class window seat
with earplugs, eye-mask and face-cream. The
tedium drives him crazy, but he doesn't sleep
much. His adrenaline levels stay high.
Speculations loop like a tape through his head:
"What if I do? Supposing I don't?"
He's
57, but looks ten years younger, with blue eyes
and an animated style that makes people think
that he's gay. When they grasp that he's not
(married twice, two sons) the next thing they
guess is that he works in show business; say,
music or motion pictures. Boyish, fit,
articulate, charismatic; he's a person you'd
choose to sit next to. But he's a doctor and
scientist in the gruesome field of Aids, so
demons lurk behind the mask.
I
couldn't wait to meet him. We've something in
common: we've followed the epidemic since the
start. I reported on the first known death in
Britain, in December 1981. He was the first to
alert America's blood banks, arguing that a virus
was to blame. In Randy Shilts's 1987 Aids
history, And The Band Played On, Francis storms
across 76 pages, warning, demanding, lambasting.
In the movie of the book, starring Richard Gere
and Anjelica Huston, he's played by Full Metal
Jacket's Matthew Modine. He's ER meets JFK.
A
man with his record might have taken it easy,
sure he'd done enough. In the 1960s, as a young
MD with the American government's epidemiology
service, the Centers for Disease Control (CDC),
based in Atlanta, he was dispatched to India to
help eradicate smallpox: a triumph against
infectious illness. In the 1970s, while studying
virology at Harvard, he was rushed to Sudan by
the World Health Organisation - the WHO - to
investigate the first outbreak of ebola. In the
1980s, he led trials in Phoenix of a successful
vaccine against another killer, hepatitis B.
But
for him these achievements merely judder like
turbulence; they remind him of what's still to be
done. When he slips into Bangkok the following
morning, his destination is Taksin Hospital, by
the Chao Phraya river, a corroded-concrete and
grimy-glass hulk full of poor people patiently
waiting. He goes to the second floor and through
a pair of glass doors, where the atmosphere
transforms. There are maroon carpets, soft
furnishings and secretaries in beautiful dresses.
A sign inside says: "Bangkok Aids Vaccine
Evaluation Group". The VaxGen experiment.
People
laughed when he declared - seven years ago - that
he would be first with a shot against Aids. After
20 years as a fireman with the CDC, everybody
said that he couldn't focus on such an intricate
project. Although he'd set-up an Aids lab back in
1983, ten minutes at a bench would have him
yawning and twitching. He preferred khaki shorts
to white coats.
Since
the human immune deficiency virus was discovered
in 1984, moreover, it has been the definitive
white coat challenge - and quite different from
his previous foes. Unlike smallpox - an easy
target- HIV kills some of the very cells
(so-called T-helper cells) which are fundamental
to our immune system defences. Unlike ebola, a
rare disease, HIV has slayed 14m people and
infected another 35m. And unlike hepatitis B
virus, which is quite stable, HIV is a so-called
"retrovirus", with its genes coded in
ribonucleic acid (RNA), and changes so much with
each replication that it breeds an infinity of
strains.
When
Francis was at medical school in the 1960s, a
virus was a virus, with maybe three strains, like
polio. Vaccines were easy. But such is HIV's
frenetic shape-shifting that each infected person
harbours an astonishing swarm of strains,
totalling about 1 billion, all
slightly-different, virions. Scientists lump them
into two types (HIV-1 and HIV-2), three groups
and ten subtypes. Thousands of strains are
studied. At med school he learnt that parasites
evolve to live in harmony with their hosts. But
HIV is so new and unstable in humans that it may
evolve to become a quicker killer, or be more
infectious. The truth is, nobody knows.
Cleverer
doctors and scientists than him have got lost in
this terrain. So far, some three dozen would-be
vaccines have been tested in labs, animals or a
few individuals, but none has done any good.
Vaccines work by priming our immune systems -
including antibodies and T-cells - so that they
will be ready for action if a bug comes along.
But so far every attempt to accomplish this with
HIV has either proven dangerous or to have no
effect. Some experts say that nothing will work.
Francis
crosses the Pacific with an approach to the
problem that sounds beguilingly simple. The
VaxGen experiment is with a product - brand-named
AidsVax - that mimics part of the viruses skin,
or envelope. By inoculating healthy people with a
manufactured clone of this part - a sugary
"glycoprotein" called "gp120"
- antibodies are supposed to be primed to protect
in the event that sex, blood or drug misuse
causes the virus to later intrude.
At
Taksin Hospital he fine-tunes the experiment - a
"placebo-controlled double-blind trial"
- so far the only full-scale Aids vaccine trial
ever. On 24 March, the first of 1,250
HIV-negative Thai volunteers started on a course
of seven six-monthly shots. Another 1,250 are
getting an inactive placebo. Who is getting what
is concealed in codes, and any difference in the
numbers who later become HIV-positive should
reveal if the product works.
Francis
meets with Dr Kachit Choopanya, his principal
investigator. In silk suits and gold-rimmed
glasses, Kachit, 65, controls 17 Bangkok drug
dependency clinics, chosen to take part by
Francis's old friends at the CDC and WHO. Heroin
misusers are top of the HIV risk-list, due to
poverty-driven needle-sharing. If they can be
protected, the agencies reason, then you, I, or
anyone can. "If the VaxGen vaccine can
create immunity in humans, then we can solve the
whole problem," Kachit declared on the day
of the first jab. A 27-year-old heroin addict was
equally upbeat. He said: "I believe the
trial could bring great benefit to mankind."
There's
a similar impression at a high level in America
that history may be about to be made. The US
government's National Institutes of Health and
its Food and Drug Administration, both in
Maryland, are backing the experiment. So are
officials of the World Bank in Washington and
United Nations agencies. And so is the principle
lobby group: the International Aids Vaccine
Initiative. The group's president, Dr Seth
Berkley, said: "We applaud VaxGen."
Francis
basks in these endorsements. He settles on the
thought that he'll do it. VaxGen is one quarter
owned by Genentech Inc, a medical biotechnology
leader. Genentech is a subsidiary of Hoffman-La
Roche, the Swiss pharmaceutical colossus. All are
poised for full-scale production. When shares in
the company were launched on the New York Nasdaq
market at the end of July, they jumped from $13
to $26. He banks on a license for a crash
programme of inoculations like the world has
never seen.
But
when he flies in from San Francisco, he can never
quite quell his anxieties. In his files are
papers which suggest that AidsVax can't really
work. And he's familiar with scientists who warn
of possible hazards on a globally catastrophic
scale. His vaccine may make it into millions of
people. The profits could buy Bangkok. But the
momentum behind the experiment could turn out to
be one of medicine's greatest mistakes.
*****
This
report is copyright, Brian Deer. Responses,
information and other feedback concerning this
resource on VaxGen and AidsVax and the
"world's first Aids vaccine" are
appreciated - via the briandeer.com homepage.
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