BRIAN
DEER: THE VAXGEN EXPERIMENT Page 2
At
first glance, Thailand is a strange location to
carry out medical trials. The CIA rates the
country as merely an "emergent
democracy"; the last military coup was only
eight years ago; and there were Bangkok riots in
1992, when 91 died or went "missing".
Corruption is de rigeueur, while police are
accused by Amnesty International of
"extra-judicial killings". Much of its
profile relies on sex: first with young women and
later with children.
Since
the coup, however, quick cheap, experiments on
the Thai population have been added to the
country's attractions. Dozens of projects are
currently in progress, run by foreign
pharmaceutical companies and sponsored by the CDC
and WHO. With an estimated 800,000 Thais infected
with HIV, Aids is the big one, with tests of
drugs, immune-system stimulants, and top of the
list Francis's AidsVax trial.
It
makes sense to test products where the risk of
Aids is greatest, but my attention was drawn to
potential problems during a conference in a
Bangkok hotel. The topic was Aids vaccines.
Francis spoke. And a doctor pointed out that some
volunteers in an AZT trial were mothers from
remote hill tribes. "They come across the
border from Burma." he said. "They
don't speak Thai, so there is the question of
whether they can understand enough to give
informed consent."
The
question was brushed aside ("They keep
coming back.") and might not have meant much
if I hadn't also met an activist from the
northern town of Chiang Mai. Despite grilling 11
people who swallowed tablets daily, he complained
that he couldn't discover even the name of the
product or the pharmaceutical company involved.
This man was a former heroin user, so I asked him
where VaxGen was recruiting. "Go to Khlong
Toei," he said. "By Port Authority
Building. That's where they'll get people for the
trial."
Khlong
Toei is a slum; a sewage-stinking wasteland; a
cauldron of disease and drug use. The better-off
live in concrete hutches, with wire-fenced
windows and balconies. Next down in the social
scale are wooden-shack coops on plots of
flood-prone ground. Then there are kennels:
festering shantytown alleys of plank, sheet-iron
and debris sheds. The "streets" are dim
corridors, with boardwalk floors, cluttered with
children and dogs. At night frail figures shuffle
around, suffering from Aids, tuberculosis or
both.
Thailand
was once praised for anti-HIV efforts in disease
hot zones such as this. But evidence suggests
that since the 1992 coup priorities have changed.
In 1992, a health minister complained that talk
about the virus had "seriously affected
tourism". And now, official figures show
that Aids prevention has been slashed by one
third against comparable public health
programmes.
The
biggest cuts have been in initiatives aimed
specifically at drug misusers. "There used
to be a project for clean needles in the early
90s, but now it's gone" a spokeswoman for a
Khlong Toei charity, the Duang Prateep
Foundation, told me. A health department official
said the same thing. His time-frame: "about
seven years ago". Targeted education, known
to be most effective, has also been axed, he
said.
Nobody
could explain the thinking, but the effect on the
junkies can be measured. Blood tests reveal that
HIV prevalence peaked among female prostitutes in
1993 - when 30% were positive - and has since
fallen back to 21%. Among rent boys, prevalence
peaked in the following year at 18%, and is now
half that figure. But prevalence among
heroin-injectors has leapt from 31% in 1994 to a
staggering 47% now.
Were
these changes evidence that the government were
allowing the junkies to be put at greater risk to
make them useful for experiments? (Health
department officials told me that if AidsVax is
marketed, they expect a billion-dollar
manufacturing plant.) I couldn't find out. People
wouldn't talk when I raised such contentious
concerns. Even Bangkok's Medicines Sans
Frontieres staff went silent when asked about the
trial.
Francis
is convinced that nothing is amiss, and his
collaborators voice no worries. "All have
assured me that this has been done
ethically," he told me, when eventually we
met. "We are going out of our way not to
increase the vulnerability of an already
vulnerable population." The trial was
conducted in Thailand, he said, for scientific
reasons. Different parts of the world are linked
with different HIV subtypes, with their myriad
subsidiary strains. B subtype strains, for
instance, are most common in North America,
Europe and Australasia; A, C and D in Africa. In
Thailand, there's a mix of B and E strains and,
for technical reasons to do with E strains, the
company argues that success is more likely there
"than anywhere else in the world."
But
there are aspects of the project which suggest
that the junkies may be involved in an unusual
way. A parallel trial among gay men at American
clinics is having problems finding and keeping
volunteers, due to scepticism towards the
venture. But at Kachit's clinics the programme
has features which may help to avoid these snags.
The junkies get methadone, an oral heroin
substitute, plus $10 expenses for each of up to
17 visits. The risk is the appearance of offering
drugs and money as inducements to this desperate
group.
There's
also a feature of the experiment's design that
seems self-contradictory. If the methadone liquid
got people off injecting heroin, the volunteers'
risk of infection would slump and they would be
of little use to the vaccine trial. In fact,
documents drawn up with the CDC and WHO show that
that 7% of clinic users are expected to become
HIV-infected each year. So, despite the oral
methadone, they keep injecting heroin. They may
even buy it with VaxGen's money and have an
increased risk of getting Aids.
The
logic of the trial creates a dilemma for Francis.
The moral uncertainties about using junkies as
guinea pigs might be offset by humanity's greater
needs. But there would need to be plausible
scientific grounds to think that AidsVax might
work. And on that the VaxGen experiment is open
to even greater doubts.
*****
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.
|
