Intended for healthcare professionals

Education And Debate

Development of an AIDS vaccine: perspective from the South African AIDS Vaccine Initiative

BMJ 2004; 329 doi: (Published 19 August 2004) Cite this as: BMJ 2004;329:454
  1. Timothy J Tucker, director (,
  2. Gatsha Mazithulela, deputy director1
  1. 1 South African AIDS Vaccine Initiative, Medical Research Council, PO Box 19070, Tygerberg 7505, South Africa
  1. Correspondence to: T J Tucker

    Most work on HIV vaccines is being done in the public sector rather than the pharmaceutical industry. Although international cooperation is producing candidate vaccines, greater investment is needed to speed up progress


    The HIV epidemic continues to expand at an alarming rate1 and is predicted to be the worst infectious disease ever to affect humanity. Other infectious diseases such as smallpox and polio have been controlled or eradicated by vaccination, and vaccines continue to be the most cost efficient and effective intervention available for preventing infectious diseases.2

    Although investment in HIV vaccines was initially small, support has increased greatly over the past decade. This article describes the experience of vaccine development in South Africa.

    Early development

    The processes of developing a vaccine against HIV have been distinct from that of any previous pharmaceutical product. Although most existing vaccine capacity resides within the private sector, most research into an HIV vaccine has taken place (or been funded from) within the public sector. This is because manufacture and distribution of an HIV vaccine is unlikely to generate much profit.3

    HIV is a genetically diverse microbe that is categorised into many genetic subtypes. Although HIV subtype B is responsible for a minority of HIV infections, it is the predominant subtype in developed countries.4 Early vaccine development focused on sub-type B genes and proteins, and clinical trials were predominantly in the United States and Europe. However, in the mid to late 1990s groups such as the International AIDS Vaccine Initiative and the South African AIDS Vaccine Initiative (SAAVI), placed the development of vaccines against different subtypes on the global agenda. In addition, greater investment went into clinical trials of products in developing countries.

    South African AIDS Vaccine Initiative

    SAAVI was established in 1999 by the South African government, Eskom (a private sector electricity supplier), and the Medical …

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