Rapid Responses to:

FEATURE: Alison Tonks Quest for the AIDS vaccine BMJ 2007; 334: 1346-1348 [Full text]

Rapid Responses: Submit a response to this article

Rapid Responses published:

The Societal Costs of Failing to Develop an AIDS Vaccine

Jeremiah Norris   (30 June 2007)

The Societal Costs of Failing to Develop an AIDS Vaccine 30 June 2007
Jeremiah Norris, Director, Center For Science in Public Policy Hudson Institute, Washington DC 20005 Send response to journal: Re: The Societal Costs of Failing to Develop an AIDS Vaccine	Allison Tonks recently made the dire but honest statement that the AIDS epidemic requires a vaccine to stem its spread, even as this form of medical treatment remains elusive: “A vaccine against HIV would seem the best way to halt the AIDS epidemic … but it is as far away as ever.” In order to bring the urgency of this statement into full light, policy- makers need to consider not what it would cost to develop a vaccine, but rather what it would costs global society if it fails to develop one. While we are always learning more about AIDS treatment in the developing world, we do know in the developed world that: •On an annual basis, a cohort of those under ARV treatment will develop drug resistance in the best of medical circumstances; •That cohort will be cumulative from one year to the next; •In time medical care costs will increase exponentially for drug resistant patients, exceeding by several orders of magnitude the price of therapies. According to data from the World Bank in 2004, the range of primary HIV-1 drug resistance rates extends from 6.6 percent in Brazil to 10 percent in Spain to 15.4 percent in France and 27.7 percent in the United States and Canada.(1) The high rates in the developed world may be accounted for by the frequent testing of AIDS patients in highly sophisticated healthcare systems where surveillance systems are mandatory. Yet, this high rate may serve as a portent to what is to come in the developing world. By the end of this year, projections are that there will be 2 million on AIDS treatment. Many of them entered into therapy from resource limited settings where initial testing was limited, adherence was problematic, and substandard drugs were the first choice of treatment. As molecular pharmacologist Dr. Terrence Blaschke has noted: “it is widely believed that suboptimal adherence is the most important factor in virological failure, and studies suggest 90-95% overall adherence or greater is necessary for a durable response.” (2) This will be difficult to achieve in resource-limited settings over the natural life span of an AIDS patients, increasing the possibility for an early onset of drug resistance. If the Brazilian rate of 10% holds for the developing world, this would mean that 200,000 will be drug resistant by 2010 and would have to be moved to 2nd line therapies. According to Medecins Sans Frontieres, the price of 2nd line therapies is over 20 times the price of lst line treatment regimens.(3) However, the price of drug products is but one barrier: the more important cost consideration lies in the increased skill levels of the medical cadre that will be needed for those on 2nd line and salvage therapies, such as virologists, thoracic specialists, liver specialists, endocrinologists, dermatologists, and clinical pharmacologists, to name but a few. Despite the scientific barriers to the development of a vaccine, the donor community has no other option than to pursue its development with urgency. There is a global war on AIDS, and like other wars, which often are a series of catastrophes followed by victor, so too must this war be won. The central policy issued faced by global policy makers is not that the development of a vaccine is the most cost effective approach to AIDS containment. Instead, by failing to assign the proper value to it, that choice leads to a sequential increase in the number of chronically sick people whose care and maintenance will ultimately prove financially unsustainable for both donors and affected governments. EndNotes 1.Debrework Zewdie, et al., ARTICLE TITLE? AIDS Resistance and Adherence, Vol. 18, Supplement 3, the World Bank, Washington, D.C., June 3, 2004. 2.Terrence Blaschke, M.D., White Paper on Essential Medicines, Stanford Medical School, Stanford University, California, August 2004. Unpublished. 3.Medecins Sans Frontieres, MSF AIDS Treatment Experience: Rapid Expansion, Emerging Challenges: Briefing Document, July 2004. Competing interests: None declared