April 1, 2003
(USA TODAY) -- In a simpler world, the news might be greeted with
cautious jubilation. After 20 years of setbacks, the first full-scale
study of an AIDS vaccine offered a tantalizing hint that it may protect
some black people from AIDS.
Instead, the findings announced in late February triggered a racial
face-off between the two groups that need a vaccine most.
The vaccine, AIDSVAX, had failed to meet its key test by failing to
outperform a dummy injection in the 5,400-person trial. But when
researchers looked at the results for blacks, Asians and people of mixed
race, they say, they got the surprise of their lives.
"This race thing fell out," says VaxGen's president, Donald Francis.
"It stood out like a sore thumb. We thought, 'Oh God, how are we going to
deal with this?' "
The announcement instantly provoked a vehement rebuttal from
predominantly white, gay AIDS-advocacy groups and some vocal scientists,
who noted that the vaccine failed to protect the majority of volunteers,
who were whites and Hispanics. The skeptics dismissed the finding as
statistical sleight-of-hand by a company struggling to salvage a 10-year,
$200 million research effort.
Black AIDS advocates were angered by the quick condemnation of the
first evidence suggesting that an AIDS vaccine might work in humans,
especially in the population burdened by half of all new cases of the
disease.
Phill Wilson of the UCLA African-American AIDS Policy and Training
Center says the study didn't create racial tension among AIDS advocates;
it revealed a rift that has existed for years. "Quite frankly," he says,
"the study simply forced us to look at it."
Wedged between the warring parties sits VaxGen, whose vaccine has been
ridiculed by some of the firm's most vocal critics -- one critic went so
far as to label the vaccine "dishwater."
At a meeting Monday in Banff, British Columbia, the firm reported that
the vaccine failed to clear a second hurdle in its study by failing to
boost the immune systems of people who already are infected with HIV.
But the newer, more detailed analysis presented this week suggests that
the vaccine works best when a person is exposed to an HIV strain that
closely matches the strain used to make the vaccine.
In addition, women in the study appear to produce more potent
antibodies than men. "The bad news is that the vaccine isn't effective
overall," he adds. "The good news is that we may have found a chink in the
wall."
VaxGen's decisions may reverberate for months or years as the company
explores its data and critics dissect VaxGen's handling of it. The
sharpest criticism yet emerged last week in U.S. District Court in
Northern California, where investors filed a lawsuit claiming that VaxGen
defrauded them by hyping the vaccine's prospects. When the findings were
announced on Feb. 24, the firm's stock plummeted 85% to $3 a share from a
Nov. 18 peak of $23.25. VaxGen's lawyers dismiss the claim as lacking any
merit.
Experts say the study raises several key scientific questions:
* Public service vs. corporate survival. Private research companies are
obligated first to stockholders and regard their scientific data as a
company secret. Scientific traditions, including the examination of
research data by outside experts before being released, fall by the
wayside. How, then, will the world be able to test the validity of
scientific claims?
* The insider-trading problem. Publicly held firms must release
information to everyone at once to assure that no investor gets an unfair
edge in the stock market. But that may mean releasing data before every
aspect of it can be analyzed.
* Truth, lies and subgroup statistics. The company asserts that its
trial produced a statistically significant association between the vaccine
and HIV immunity in blacks and possibly Asians, even though the vaccine
flopped in the majority of volunteers. But statisticians question the
significance of the finding, saying that VaxGen didn't apply rigorous
enough statistical tools.
* The Tuskegee legacy, part one. If blacks' hopes are dashed, the study
may further heighten blacks' distrust of the medical establishment because
of such episodes as the government-financed Tuskegee study, in which white
doctors withheld antibiotics from black patients with syphilis so they
could study the course of the disease.
"If people don't trust the results, and they think there's some kind of
scam going on, it does hark back to Tuskegee," says Cornelius Baker,
director of the Whitman-Walker Clinic in Washington, D.C.
"Black people don't believe (the backlash over the trial results is
really) about VaxGen; they believe it's about the HIV/AIDS power structure
not wanting to benefit black people."
* Tuskegee, part two. If blacks' hopes are dashed, researchers could
have an even tougher time than they have now recruiting blacks into
vaccine trials. The VaxGen study failed to produce convincing results in
blacks because researchers couldn't recruit enough blacks into the study.
The Asian group was even smaller.
Stacked deck
Opposition to AIDSVAX has been simmering for a long time. The vaccine
is an updated version of one made by Genetech in the early '90s. Even
then, some scientists were skeptical that it would prove effective, partly
because the company's tests weren't as rigorous as those done in other
labs.
Early tests were conducted with a lab-tamed strain of HIV, not the wild
strains circulating in patients. And primate studies involved a chimpanzee
infected with HIV that was an exact genetic match for the one in the
vaccine.
"The deck was stacked for the vaccine's success," says John Moore of
Weill Cornell Medical Center in New York, a prominent AIDSVAX critic who
was part of a consortium of experts that analyzed data from an earlier
study of the vaccine. Then, in 1998, the Food and Drug Administration
approved VaxGen's bid for a full-scale human trial, and the stage was set
for more controversy.
On Feb. 15, a team of VaxGen data analysts checked into a hotel not far
from the firm's offices to analyze the study's results.
Researchers found absolutely no difference between those who received
the vaccine and those who received a placebo. Then they began examining
the data by looking at certain subgroups, including sex and race. The
vaccine appeared to be 78.3% effective in blacks and 68% effective in
Asians. "We found remarkable efficacy, especially in blacks," says
VaxGen's Phillip Berman, the vaccine's inventor. "The result was highly
statistically significant."
But the subgroups were small, which almost always saps a study's
validity. Blacks numbered just 314 of the 5,400 volunteers, half the
number the firm would have needed for a representative population. The
number of Asians was so small that researchers can't rule out the
possibility that the positive finding was pure luck.
Science and the SEC
Nevertheless, the finding sent researchers at the NIAID-funded HIV
Vaccine Trials Network in Seattle scurrying to see whether they can find
any race-related differences in protection among volunteers in all
previous trials.
"The real story here is that the scientific community is starting to
take a long, hard look at what differences we might expect in men and
women by race," says Steve Wakefield, the network's associate director for
community relations and education.
Francis says VaxGen didn't have time to analyze all the data, and the
firm couldn't withhold the results. That information, no matter what it
was, would affect the price of VaxGen stock. If the information leaked to
some stockholders, but not others, those who knew the results would gain
an unfair edge.
"We had to announce this because of (U.S. Securities and Exchange
Commission) requirements that investors all get the same information at
the same time," he says.
On Feb. 23, Francis revealed the findings to key scientists and
activists in an invitation-only conference call. The results were to be
released through the news media the next morning before the stock market
opened.
Because of the racial implications, Francis had called Wilson to invite
him to take part. As Wilson listened, his concerns grew. "I called Francis
back after midnight," he says, and told him that the "announcement is
going to be problematic. A white company is going to say it has a vaccine
that only works for black folks, so we're not going to vaccinate white
folks?"
Cornell's Moore says he was blindsided by the way the company embraced
such preliminary findings. "I knew they'd do something to keep themselves
alive. I didn't know they'd focus on race," he says. "Once they played the
race card, everything changed. Science took a back seat. I was appalled."
A consortium of AIDS advocacy groups, including the American Foundation
for AIDS Research, the Gay Men's Health Crisis in New York, the AIDS
Vaccine Advocacy Coalition (AVAC), Project Inform in Los Angeles and the
International AIDS Vaccine Initiative fired off their rebuttal.
"We were concerned about being over-optimistic, and we felt it was
important to emphasize caution in interpreting the results," says Chris
Collins, AVAC's executive director. "It doesn't serve the field as a whole
or the communities involved to draw any conclusions before we know what we
have."
Search for vaccine continues
"They came down with a sledgehammer, saying the vaccine is a failure,"
Wilson says. "Then people got pissed. They felt if the data had shown any
efficacy among white people, they wouldn't have so cavalierly dismissed
it."
Collins, of AVAC, says the lesson hasn't gone unnoticed. "A lot of
groups have grown from this experience," he says. "We're more often
working together."
Baker, of the Whitman-Walker Clinic, says, "The reality is, the search
for a vaccine is just beginning. It's better to get these issues out on
the table now than four years from now, when we have another trial in the
works."
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