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VaxGen's AidsVax

The Sunday Times

AidsVax: the long shot

And the Band Played On was a monster hit in America, and Shilts, the author, makes two observations about Francis from before the vaccine race. Noting his early career in medicine, virology and diseases such as ebola, Shilts notes that when Aids first appeared "Don Francis viewed his life as an accumulation of chance decisions that had put him in the right place" to respond. "Francis had a penchant for quick conclusions stated in the most dramatic terms," he adds, with "a reputation for singular brilliance." Like teachers' praise or schoolyard snubs, people soak up their own publicity. And as I skimmed the book's index in a Motel 6 before the first of two interviews with Francis, I couldn't help thinking that, whether this penchant and reputation were real before the book, they would have been after the movie.

I was startled, even so, by the confidence of his performance, in his office overlooking the bay. There was a Japanese poster for the movie on one wall. On another was a mounted Philadelphia Inquirer report in which he featured as an angry young man. He'd a red-framed sign above his desk for reporters to note. It said: "Joyful participation in the sorrows of the world."

In our first encounter, he fed me his experiment in digestible, barbecue chunks. Wearing jeans, baggy shirt and loose-fitting waistcoat, he paced and waved his arms. There were "perfectly good arguments on either side," he said, "for this vaccine working or not working." Then he leant on a chair, stared moodily across the water and whispered: "I hate this bug." That was a line from Outbreak, a Dustin Hoffman movie, and he'd other such memorable nuggets. "I spend much of my time protecting myself from my concern," he told me.

I thought, Dr Francis, please.

It wasn't that I doubted his compassion. Both of his parents were doctors, in northern California; the young Donald grew up to watch flower power bloom and die. At med school in Chicago, he volunteered at free clinics. He was secretary of Physicians for Social Responsibility. He was for civil rights and against the Vietnam war. His resume was impeccable. But he admitted to never having gone to Khlong Toei, or other slums where his subjects were recruited. It was an awkward omission for the ebola-buster, now on $300,000 a year.

Success with AidsVax would make his fortune, but I didn't think that money drove him on. Chewing over old times, as veterans do, we talked about the moment in 1984 when French scientists discovered the virus. He'd set up a lab at the CDC, but told me that he'd looked for the wrong type of bug. The Americans thought it would be a leukaemia-type infection, but the French hunted for a simple cell-killer. Were it not for this bungle, he seemed to imply, he might have risen at some heady press conference to be acclaimed as the discoverer of the cause of Aids.

He didn't crave something that we all don't dream of. What he was doing seemed oddly human. He'd blown it once, I took as the lesson. He didn't plan to blow it again.

Our next interview was two days later. It was a formal tape-recorder job. After an hour in the company's data room, where modems blink and chatter, I asked him to explain the anomaly with the vaccine. The amino acid stuff. If Berman's theory about V3 loop tips was right, then surely the gp120 from the New Jersey strain wouldn't do much good in Bangkok. Francis had an answer. True, the V3 tip on the B part of the vaccine wasn't the same as the Bs in circulation. But, he said, it was the same as on the other prevalent strains - the Es. It would work on them. "It happens to be identical to the Thai E that's in that vaccine," he said.

But this wasn't right. What he said wasn't true. "No it's not," I interrupted.

"Yeah," he insisted.

"No it's not."

"It is."

I rummaged through my papers and read him the amino acid strings from the V3 tip on the gp120 blob. It was not one hundred millionth the size of the infected cell, but not totally out of sight. "Here we are: Thai E strain is GPGQVF."

"Right," he agreed.

"The Thai B strain is GPGQAW," I continued. "If you take the B vaccine sequence it's GPGRAF." The strings were all different. He was talking nonsense.

"Okay, okay," he acknowledged. "I'm sorry."

That surprised me. Lives were at stake. "But you're not giving the Bangkok junkies the most promising product, by your own reasoning."

"For the B virus?" he said. "Possibly. That possibly could be true."

"Isn't that unethical?"

"No." He paused. "No, because it would be unethical if you told them that this vaccine was going to work. We tell them to assume no efficacy."

Ah, yes.

Later I put to him the safety issue and the fact that serious opinion suggested that AidsVax could have long-term risks.

"I think you have to have a theoretical rationale why it would cause harm," he replied.

"There are theoretical rationales."

"Where?" he snapped. He was beginning to sound annoyed.

I cited the "deceptive imprinting" work of Kohler in Kentucky as one example.

"The question that you're asking is: if you get infected, subsequently to immunisation, will you have an increased disease manifestation, or harm accrue from the vaccine? And that could be. That could be."

Okay. Nobody was telling the Bangkok junkies. "Don't you think some of these doubts should be made plain in the informed consent?" I asked.

"I think it's more important to say 'we don't know'," he responded irritably. "And that's what we say. And we say: 'do not depend on this vaccine, we do not know if it has effect, if any, and that's why we are studying it'. I think that's your ethical responsibility - to really say: 'We do not know. We do not know if it will cause harm. These are the data that we have.'"

HIV was uniquely dangerous, he said, with 16,000 new infections daily. There was no way to develop the desperately-needed vaccine that didn't involve taking risks.

I said: "But the fact that this is an extremely virulent and infectious agent doesn't entitle you to be reckless."

"Agreed," he hit back. His voice was rising. "But shouldn't it stimulate society to take chances to prevent it?" He said that vaccine developers had always taken risks, sometimes proportionately even greater for less threatening parasites, such as in, say, measles or pertussis. "We have taken the potential risk to deal with diseases that have very low mortality rates," he shouted, stabbing his finger. "With HIV, at least you have the luxury that this bug is so fucking dangerous that it kills everybody - that all you can say is that I would do to these people is shorten their incubation period - which would be a tragedy." He glowered at me. Now he'd lost it. It was character revealed by stress. "But I'm not going to kill any more people than the virus has already killed."

When his rage subsided, I drove him home and we sipped a couple of beers. The view from his house should had been magnificent, but a fog had settled on the bay.

More: Tough questions for VaxGen as AidsVax trial fails

VaxGen's AidsVax
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This report is copyright, Brian Deer. No portion of this article on VaxGen's AidsVax, "the world's first HIV vaccine", may be copied, retransmitted, reposted, duplicated or otherwise used without the express permission of the author. Responses, information and other feedback are appreciated