Prevention
	Asia's Quest for an AIDS Vaccine By Jim Frederick

In 1991, the chief of Thailand's Ministry of Public Health asked Dr. Supachai Rerk-ngarm to run the government's newly formed AIDS prevention and treatment division. Supachai was reluctant. After almost 20 years as a pediatrician, specialist in preventative medicine and epidemiologist, he had just applied to a master's degree program in health policy at Johns Hopkins University in the U.S. Not to worry, said the public health chief. Just head the division for a couple of years and then go get the degree. There's plenty of time.

Supachai never did get to Johns Hopkins. Fighting HIV in Thailand, a country among the hardest hit by the disease, has become his life, one he can't imagine abandoning. Having spearheaded an education and condom distribution campaign that was applauded by the World Bank as a model for developing countries—one that prevented an estimated 400,000 infections in a nation coping with 1 million cases—Supachai is already something of a luminary in AIDS prevention circles. But now he and his team of 350 are about to begin the most important project of their tenure, one that could change the course of AIDS treatment worldwide—as well as the role that developing countries play in the creation of new drugs. Beginning in December, Supachai will launch the largest HIV vaccine trial ever conducted anywhere in the world, and one of the only-AIDS trials ever to reach Phase III, the final and crucial testing that determines whether a vaccine works or not. Approximately 16,000 currently HIV-free volunteers in two AIDS-ravaged Thai provinces on the country's southeastern coast will be injected with either a combination of two vaccines or a placebo. Then their HIV infection rates will be monitored for the next five years.

Supachai is just one of a growing number of health care professionals in the developing world who are working to bring pharmaceutical trials to the countries that are suffering the worst. In Beijing, for example, at the National AIDS Research Center, Dr. Cao Yunzhen is working with famed American AIDS researcher David Ho to win governmental approval to conduct the first HIV vaccine research trials ever in China by next year. Ho believes the mainland is an ideal locale for testing some of his most promising research vaccines because it has a dramatically rising infection rate, a comparatively advanced health care infrastructure and, he hopes, the commitment of Chinese authorities. "We want to bring something positive to the community," he says. "We want to compel the government to do something. China has the resources to help people. China isn't Zimbabwe. The government can do more. In another year or two, given the current trajectory of the virus in Asia, total infections will exceed Africa's."

That gloomy forecast highlights why the race to find an AIDS vaccine has taken on a particular urgency in Asia, and why so many eyes are fixed upon Supachai's megatrial. Some critics have charged that his testing will be a waste of time, asserting that neither test drug—ALVAC HIV (developed by Aventis Pasteur of France) nor AIDSVAX B/E (made by VaxGen of the U.S.)—has proved effective in preliminary trials. But Supachai is not banking on one vaccine being better than another. He is hoping the trial will vindicate a concept he champions known as "prime boost"—the idea that you can increase the effectiveness of two vaccines that fight a virus in different ways by administering both together. Even though the makers of AIDSVAX say they would be happy with a 30% efficacy rate from their vaccine alone, Supachai is shooting for 50% as the measure of this treatment's success. That might not sound like a tremendous success rate, but for a disease that has so vigorously resisted any effective treatment thus far, 50% would be nothing short of a miracle. Even if only half of all HIV cases could be prevented, he and other researchers point out, that would mean millions of lives saved in the most AIDS-ravaged nations.

—Reported by Robert Horn/Bangkok and Anastasia Stanmeyer/Beijing

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