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An evolving programme
It is unlikely that there will only ever be one vaccine or one clinical trial. The first candidate vaccines will probably have limited efficacy and will certainly be cumbersome to deliver. Most require multiple injections over an extended period. This means that a series of extended clinical trials will prove necessary, over the next fifteen or twenty years.
It has been argued mathematically (Anderson and Garnett) that even a low–efficacy vaccine targeted at high–risk populations could have a major impact on the course of an HIV epidemic, provided that limited effect was long–lasting. Such a vaccine would obviously have to be offered in the context of a wider prevention campaign.
It may be that very different vaccines, eliciting entirely different immune responses, prove equally capable of preventing HIV disease.
It may be that sexual transmission (in the general population, including gay men and injecting drug users) and blood–borne transmission (injecting drug users, healthcare workers and others exposed to blood) ultimately require different vaccines (e.g. Finkielstejn).
If there will be no single magic bullet in the foreseeable future, then it follows:
- that vaccine research must be multidisciplinary and integrated with other prevention research
- that we must find ways to test and later to deploy vaccines in ways that complement and reinforce other prevention methods, and vice versa.