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HIV vaccine initiative still on drawing board

Plan is diverting money from local AIDS groups

The federal government’s $139-million AIDS vaccine program is still in the planning stages, says a senior public health official.

The program — officially known as the Canadian HIV Vaccine Initiative (CHVI) — was announced in February of last year. The Bill and Melinda Gates Foundation is contributing $28 million and the federal government is putting in $111 million, which health minister Tony Clement promised at the time would be new money.

Since then, however, the government has announced a funding cut of $1 million to local AIDS programs in Ontario and has said that it plans to cut funding in other areas of the country as well. Part of those funding cuts will be directed into the CHVI.

Steven Sternthal, the special advisor for HIV vaccines in the Public Health Agency of Canada, which will run the CHVI, says the program wants to work with local organizations.

“Under the vaccine initiative we need to work with communities,” he says. “That’s a critical part of how the initiative needs to be implemented.

“It’s a tough situation in government where you have to balance short-term and long-term goals.”

Funding for the CHVI is to be distributed over five years, in five different areas.

The plan assigns $3.4 million to cover the administrative costs of establishing and running CHVI.

There will be $22 million to augment existing vaccine research in Canada and to promote international cooperation.

“We’re hoping there will be new ideas, new teams, new concepts that will be more successful,” says Sternthal. “This work cannot be done in isolation. The Swiss recently launched a vaccine initiative. There’s a network of African researchers. This kind of work needs to be done much more collaboratively than other areas of research.”

The CHVI will give $16 million towards establishing clinical trials and expanding the capacity for such trials. Most of that work will centre around helping to establish procedures for safe clinical trials in developing countries. Sternthal says much of the work will build on that already being done by the Canadian International Development Agency.

“You have to be in countries where infection rates are high,” says Sternthal. “It would take years in Canada to get sufficient numbers. You don’t want to subject people to procedures that could harm them and particularly in developing countries there’s not sufficient infrastructure.”

The largest chunk of the money — $61.1 million from the government and all of the Gates Foundation’s $28 million — will go into a project that will establish a facility in Canada capable of manufacturing potential vaccines for clinical tests.

“Clinical trial lots need to be manufactured in a way that meets all the standards,” says Sternthal. “One of the things that’s difficult to do is to manufacture on a small scale, say 50 doses, of a vaccine that may not succeed and may never be used again.”

Sternthal says the CHVI will be seeking proposals from a nonprofit corporation to build the facility.

“We decided that because of the global nature and the common good approach that a not-for-profit corporation should receive the money,” says Sternthal. “We’re looking for a novel partnership with the private sector.

“The facility should be located in an environment where manufacturing is taking place. It can’t be done in an apartment building and it should be well-connected to efforts going on in other countries.”

The CHVI will also be designating $8.5 million to dealing with policy, community and social issues. Sternthal says this money will be spent on community involvement and information.

“HIV infection doesn’t occur in a vacuum,” he says. “HIV vaccine work shouldn’t take place in a vacuum. You need to promote dialogue, get Canadian communities more involved in vaccine work. Where they interact is with a clinical trial. It involves members of the community and people hear about it.”

Sternthal says community involvement is even more essential in clinical trials in developing countries.

“There may be more targetted campaigns with prevention workers in areas where there are clinical trials,” he says. “In Africa it can be so hard to recruit people. They’re literally losing people all the time to AIDS.”