At long last, we might have an HIV vaccine

September 16, 2022 5:01 AM

At long last, we might have an HIV vaccine HIV mutates rapidly, which has made the development of a vaccine an enormous challenge for decades. Finally, we might have one.
posted by robbyrobs (33 comments total)

Dear God: Please (a) let this work, but also (b) don't let it get tangled up in IP so that developing countries can't afford it, the way You did with the COVID vaccines.
posted by mittens at 6:16 AM on September 16, 2022 [23 favorites]

When I was 10, my parents got me a subscription to some pop-sci magazine because I was a voracious reader. Most of the issues were long since discarded, but one I am still wishing I kept was something from about 1981 - the cover piece was a deep dive into "how the CDC investigates diseases", but they chose to show you what the CDC did by letting you follow along as the CDC scientists were investigating this new disease they were seeing that seemed to affect the immune system. No one had a name for it yet, but GRID was something that had just been proposed.

I am now 52 and we have this news.

For some reason, 42 years from initial research to vaccine seems miraculously fast - although, at the same time it probably could have been much faster if the Reagans hadn't been such homophobes.
posted by EmpressCallipygos at 6:26 AM on September 16, 2022 [27 favorites]

Alas, this is science by press release rather than peer review. If you're excited about promising results in any species other than human, your excitement is premature. until this headline moves from praising promising results "in (insert non-human species)" to "in the clinic," it's not ready for primetime.

Sincerely, vaccine researcher and epidemiologist.

"In addition, the researchers’ findings will be assessed in the HIV Vaccine Trials Network (HVTN) 300 trial, providing an opportunity to determine whether this protein can induce bnAb in humans." This is good to hear, but this is the place where 99% of all vaccine candidates cease to progress. COVID was a good lesson in that governments finally treated an epidemic as a global health emergency and allowed clinical studies to proceed in parallel with these very, very old-fashioned non-human non-clinical studies (which are nevertheless still required). That's how we got good vaccines with relevant human impacts developed so quickly for COVID.
posted by late afternoon dreaming hotel at 6:28 AM on September 16, 2022 [40 favorites]

... at the same time it probably could have been much faster if the Reagans hadn't been such homophobes.

It makes me sad to read things like this.

The Reagans were all kinds of horrible, specifically including "they didn't think gay people are really people."

But look at the timeline: The first mention of the name GRID for the new disease came in Spring of 1982. It was not until June of that year that the first MMWR making a case for a STD origin of the mysterious outbreaks of KS and PC pneumonia. Slightly over 3 years later, Nancy's best buddy Rock Hudson was dead of AIDS that he admitted he had, and the Reagans were forced to acknowledge that real humans got AIDS and to stop dragging their feet.

So, Ronnie and Nancy's despicable prejudices delayed action for three years.

Three whole years. In a timeline that stretches over four decades.

So, no, it definitely could not "have been much faster" were it not for the Reagans.

The reason there is no AIDS vaccine yet is because the problem of making one is hard. For values of "hard" as used, not in common locutions, but in the language of mathematicians and scientists, where it is a euphemism for "nobody has any idea how to do that," or possibly for "not amenable to solution." Certainly for "we tried the easy straightforward approaches that you'd naively think would work, and they didn't."

Also please notice: TFA is not a scientific result. TFA is a press release. There has been no shortage of press releases about promising AIDS vaccine candidates in the last 40 years.
posted by Aardvark Cheeselog at 7:17 AM on September 16, 2022 [9 favorites]

Yeah, I do think this article understates how hard it has been to produce a sufficient immune response to protect people from HIV. HIV vaccine candidates commonly fail in human trials. And these are vaccines that have progressed beyond animal models, that have some technical data in humans, and still end up not working.
posted by BungaDunga at 7:17 AM on September 16, 2022 [4 favorites]

Three whole years. In a timeline that stretches over four decades.

So, no, it definitely could not "have been much faster" were it not for the Reagans.

1^1095 = 1
1.0001^1095 = 1.1157
1.001^1095 = 2.9875
1.01^1095 = 53,939

Math disagrees.
posted by Your Childhood Pet Rock at 7:47 AM on September 16, 2022 [11 favorites]

@ Your Childhood Pet Rock

I am completely not following that.

I get that 1095 is the number of days in 3 years.

I have no idea what the following three expressions are supposed to demonstrate, in the context of the discussion.

Three years is 7.5% of 40 years. If the Reagans had been enthusiastic supporters of AIDS research from June 1981 onwards, we could have been where we are today(1) 3 years ago. Which is not, in my book, "much faster." Over this span of time, three years is slightly faster.

(1) Which, to remind people again, is "in possession of a press release about a promising vaccine candidate." That is to say, practically speaking, exactly where we have been for something like 30 years now.
posted by Aardvark Cheeselog at 8:14 AM on September 16, 2022 [2 favorites]

The three expressions demonstrate exponential rather than linear growth. Progress isn't linear. "we could have been where we are today(1) 3 years ago" denies the possibility of the potential results of those wasted years themselves compounding over time.
posted by Earthtopus at 8:37 AM on September 16, 2022 [4 favorites]

If we're playing the blame game, let's not forget the long and infuriating history of HIV/AIDS denialism. (prev. on the blue)
posted by Halloween Jack at 8:37 AM on September 16, 2022 [2 favorites]

Oh, I agree that it's probably an over-simplification to blame the Reagans for the delay, but since I'm a Gen-X Cold War baby I have no problem using the Reagans as a scapegoat for a whole lot of stuff in general.
posted by EmpressCallipygos at 8:42 AM on September 16, 2022 [27 favorites]

"we could have been where we are today(1) 3 years ago" denies the possibility of the potential results of those wasted years themselves compounding over time.

It does?

The horse may have already taken a sufficient beating, and I'm confused by what those equations mean and why you're varying the base of the exponent (which appears to be the daily rate of compounding of something?). But, anyway, if you're assuming progress, measured in some units, can be modeled by an exponential function of time, then delaying the start by 3 years does in fact shift the whole graph right by 3 years, and "we could have been where we are today 3 years ago" is exactly right.

No excuse for Reagan being terrible. And no opinion about what exactly the next 3 years (which could've been the last 3 years) could hold.

Just giving side eye to mathematical handwaving here.
posted by bfields at 9:18 AM on September 16, 2022 [2 favorites]

May I gently suggest that we not quickly succumb to the (very agreeable) temptation to beat the dead horse of Reagan, and/or each other for not rushing into the horse-corpse fracas.

Upon reading TFA it does seem that this website is fond of credulous and hopeful medicine press releases; the Related links at the bottom of this page promise "Researchers may have created a universal coronavirus vaccine," "An Alzheimer’s vaccine might be possible," and yet another "We May Soon See the End of HIV." So take with a grain of salt.

Also check out this Twitter I enjoy that points out when medical study saw results merely within mice.
posted by panhopticon at 9:24 AM on September 16, 2022 [3 favorites]

So, no, it definitely could not "have been much faster" were it not for the Reagans.

Except for years of literal fag jokes in the White House hallways and in press conferences, Reagan and his administration slow-walked their response. The virus spread in the US and worldwide. 35 million people are ultimately dead, largely as a consequence of the initial choices to do nothing. I'm too exhausted to even go into this further. We can and should do better than defend that trash here.
posted by They sucked his brains out! at 9:27 AM on September 16, 2022 [25 favorites]

Political will drives the resources spent on this sort of thing, and there was very little political will under the Reagan admin. Regardless of actual timeline for getting workable treatments, I don't think it's up for debate that they stood by and did nothing for at least 3 years and doing so undoubtedly led directly to the preventable deaths of at least thousands if not millions of people. Even if we don't have a cure in hand even today, HIV was and is much more treatable and preventable now that we have that better understanding, and moving that timeline ahead by a few years would have saved many, many lives and improved the conditions for those that did survive much sooner.

Arguing that the timeline wouldn't have mattered that much is frankly infuriating and insulting.
posted by Aleyn at 9:34 AM on September 16, 2022 [14 favorites]

Regardless of the haggling over bases and exponents, writing off '81 to '84 as "oh well, we'll make that up in the next three years, all we lost was the time" is, bafflingly, both naively charitable to the Reagans and callous towards the victims of the early pandemic and their advocates fighting upstream against delieberate government apathy.
posted by Earthtopus at 9:35 AM on September 16, 2022 [10 favorites]

Having a vaccine would be wonderful and I hope trials proceed with encouraging results. Today, we also have TasP and PrEP medications that can to some extent stop HIV-1 transmission altogether, where used. This strategy can have a better chance at success where we push public health authorities to make it freely and widely available. Pushing our respective governments to change patent laws can also go a long way to help make these drugs available to all.
posted by They sucked his brains out! at 9:39 AM on September 16, 2022 [3 favorites]

I'll take "science press releases that are modernity's answer to liturgical prayer" for 400, Alex
posted by eustatic at 9:41 AM on September 16, 2022 [4 favorites]

If anyone needs a modern-day example of what happens when you give a deadly virus a years-long headstart, look at Trump and Covid.

Or if that isn't convincing, while governor of Ohio, Trump's second Pence tried to pray HIV away, which lead directly to 215 new cases. Many of those infections should have never happened:

Using a mathematical model of epidemic dynamics, we estimated that up to 127 HIV infections could have been averted if Pence had implemented public health measures like HIV testing and needle exchange proactively in 2013, when he had been urged to do so by experts in his state.

Choosing to do nothing sickens and kills people. Don't let anyone tell you different.
posted by They sucked his brains out! at 9:50 AM on September 16, 2022 [5 favorites]

The Reagans were all kinds of horrible, specifically including "they didn't think gay people are really people."

This is a little deraily, but... it's worse than that. The Reagans were friends with a lot of gay people while they were in Hollywood, and then decided that they weren't people when it was politically convenient to think that. They weren't just bigots; they enthusiastically embraced bigotry for political points.
posted by GenjiandProust at 10:33 AM on September 16, 2022 [9 favorites]

Agree, as an epidemiologist who works on TB, a "partner" disease to HIV which has also suffered its own very lengthy search for a new vaccine over the last many decades, the path to an effective vaccine is a long one, requiring long collaborative clinical trials enrolling many participants over years and following them for a year or more in order to ascertain the protective effect of a candidate vaccine. These are long, laborious and costly ways to learn that a vaccine doesn't work and by necessity require an iterative approach--this didn't work as we thought it might- can we tweak or change this approach to improve it? As previous commenters have noted, most vaccines fail AFTER the stage that is reported here- excitement over this is quite premature though always heartening to see. Following proof of principle in a non-human species, we need safety data, dose finding and finally proof of efficacy. These studies can take years to come to fruition after the animal stage is complete. Often, in TB, we find that something which works well in animal models (rabbits, guinea pigs) and even gives the expected immune response in humans (called correlates of protection) fails miserably in terms of efficacy. The lack of funding and attention by early administrations was tragic and did not set us off on the right footing but that has since been resolved- there are incredible global collaborations to test vaccines in vulnerable populations. We also need to account for the fact that our toolbox for HIV prevention has grown significantly since the early days- condoms, male circumcision and PREP, and we cannot ethically provide a candidate vaccine to at risk individuals without counselling and perhaps providing access to these prevention methods, which makes the whole problem that much harder, as the incidence of HIV can be affected by these methods as well.
All of this should really impress upon people how incredible and fast the progress was for the multiple COVID vaccines that were developed simultaneously in what was certainly a moon shot for people involved in infectious disease public health. It was a breathtaking moment of science, and unfortunately due to differing pathogen characteristics, we can't expect similar progress for HIV, though there is no reason to hold scientists, public health officials and politicians to the fire to make progress as rapid as possible.
posted by rene_billingsworth at 10:51 AM on September 16, 2022 [10 favorites]

*not to
posted by sixswitch at 10:54 AM on September 16, 2022 [1 favorite]

Dear God: Please (a) let this work, but also (b) don't let it get tangled up in IP so that developing countries can't afford it, the way You did with the COVID vaccines.

We must, as a race, find a way to distract Bill Gates.
posted by srboisvert at 12:12 PM on September 16, 2022 [1 favorite]

@They sucked his brains out!

Except for years of literal fag jokes in the White House hallways and in press conferences, Reagan and his administration slow-walked their response. The virus spread in the US and worldwide. 35 million people are ultimately dead, largely as a consequence of the initial choices to do nothing. I'm too exhausted to even go into this further. We can and should do better than defend that trash here.

Except the fag jokes in the WH and the dead people so far have nothing to do with what I said. The point under discussion is "Did the Reagans effectively kill a lot of people and doom us to a world full of AIDS that we might otherwise have escaped" and the answer to that, clearly, is "no."

Had the Reagans been sterling examples of compassionate rectitude and immediately commenced a research project comparable to what happened after 1985, almost all of those 35M dead people would still be dead. We know this because almost all of them have been dead for more than three years. If you want to argue that a different world could have happened, without megadeaths and widespread infections, you have a lot of explaining to do about what exactly was going to happen to constrain the spread, when it turned out to be so fucking hard to prove what the infectious agent was even after effectively unlimited funding was available for that.

It's not defending trash to point out that the death toll of AIDS is not the Reagans' fault. Their behavior was shit but their behavior was not what caused those people to die.
posted by Aardvark Cheeselog at 1:06 PM on September 16, 2022

while governor of Ohio, Trump's second Pence

*cough cough* Indiana, please - we've got plenty of our own problems here in Ohio, no need to shackle us with that ripe suck, too.
posted by soundguy99 at 1:11 PM on September 16, 2022 [4 favorites]

The point under discussion is "Did the Reagans effectively kill a lot of people and doom us to a world full of AIDS that we might otherwise have escaped" and the answer to that, clearly, is "no."

I think those are two separate questions.

Did the Reagans effectively kill a lot of people by ignoring AIDS? I think the answer to that question is arguably yes. We can argue about just how much responsibility they had (they certainly weren't the only government figures to ignore the outbreak), but Reagan presided over a government that really ignored an epidemic breaking out.

Did the Reagans doom us to a world full of AIDS that we might otherwise have escaped? No, that genie was out of the bottle by then. Although the world would probably be less "full" of AIDS in the alternate reality where the government cared about gay men.
posted by grae at 1:39 PM on September 16, 2022 [1 favorite]

*cough cough* Indiana, please

Sorry, absolutely!
posted by They sucked his brains out! at 1:49 PM on September 16, 2022 [1 favorite]

Thank you grae, I was trying to figure out how to word a similar response. Clearly the question of whether "the death toll of AIDS is not the Reagans' fault" is a little different than "could Reagan have hastened the creation of a vaccine by a meaningful amount." (Personally, my answer to the first is that of course it's Reagan's fault, and that early-80s widespread acknowledgement, education and prevention efforts, funded out over the globe, could have put a significant dent in the epidemic, while we waited for the researchers to come through on treatments.)
posted by mittens at 1:50 PM on September 16, 2022

Is there a direct link to the recording?
posted by bendy at 6:40 PM on September 16, 2022

Are people thinking that if the vaccine had just happened early enough Reagan's delay would have been a meaningful delay, but since it's taken longer it's less meaningful? If so the meaningfulness of a delay in a good end result shouldn't be based on time since the start of something, or how difficult the end result was. Maybe what's meaningful is how long the harm took to be rectified, when it never should have happened in the first place.

I judge Reagan on what he did in office, not how long medical science is taking now. He failed this country, horrifically, as the President dealing with the HIV outbreak.

I don't think we can know exactly how many people Reagan's response to HIV, or lack thereof, killed. A body count of even zero wouldn't excuse him in my view, a shorter delay in taking things seriously wouldn't be forgivable, because he could have done the right thing from the get go. With HIV, I see any unnecessary delay as meaningful.

Anyway getting back to the vaccine candidate, is there anything particular that sets this one apart from previously tested vaccines?
posted by Chrysopoeia at 1:40 AM on September 17, 2022 [2 favorites]

Since I was the one who introduced the Reagans to the discussion, I feel I need to make it even clearer: guys, that was not a serious assessment. Regardless how much his lack of action measurably had on things, certainly we can agree it didn't help?

And again, I am a person who likes to blame Reagan for practically everything. I'd blame the guy for my current ear infection if I could.

So....maybe we can table the Reagan thread and get back to the mechanics of this vaccine. Here, I'll start - so, one thing I heard discussed about why we had a Covid vaccine so soon, was because there were so many other existing similar avenues of research into that family of viruses, coupled with a huge influx of money from various governments, and that's why it seemed unusually fast. But this also seems fast for me - precisely because it was a difficult-to-pin-down vaccine that was pretty new. But I'm ignorant of how long the "when do we find a vaccine" turnaround typically is. Is it?
posted by EmpressCallipygos at 4:13 AM on September 17, 2022 [4 favorites]

Except for years of literal fag jokes in the White House hallways and in press conferences

As I remember the 80s, this was nowhere near constrained to the halls of power.
posted by dances with hamsters at 11:22 AM on September 17, 2022

If you want an actual accurate assessment of the state of HIV vaccine research, rather than breathless press releases about animal models, I recommend the Treatment Action Group's annual Pipeline Report. Here's the HIV vaccine section.
posted by gingerbeer at 5:06 PM on September 17, 2022 [5 favorites]

While I am very happy to blame the Reagans for a lot, including intentionally slowing the government's response to HIV and causing a lot of deaths, all of the Administrations and Congresses since then also bear the blame for not better funding HIV vaccine and treatment research, care, and prevention. All of it. There's plenty of blame for all, folks.
posted by gingerbeer at 5:09 PM on September 17, 2022 [2 favorites]