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BRIAN
DEER: THE VAXGEN EXPERIMENT Page 1
The
Sunday Times Magazine (London) 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.
*****
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