AIDS RESEARCH AND HUMAN RETROVIRUSES Volume 8, Number 8, 1992 Mary Ann Liebert, Inc., Publishers

XII. Future Directions

Spoken Before the Audience at the Final Conference Plenary Session, Entitled: "Future Directions," at the

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International Conference on Advances in AIDS Vaccine Development. Fourth Annual Meeting of the National Cooperative Vaccine Development Groups for AIDS NZILAMBI NZILA

an African, I have been asked some questions during this meeting about AIDS vaccine clinical trials in Africa. I want to share some of my ideas about that with you now.


/. Do you think that it is possible vaccine clinical trials in Africa?

to move to


Yes. Given the magnitude of the problem in Africa (high prevalence and incidence rates of HIV/STD and high mortality rates due to AIDS), HIV-infected persons, AIDS patients, their families, and friends are looking to us, the scientific community, for a solution. When I return home to my country, the first question I will be asked is: Did you find a drug or a vaccine? Unfortunately, my answer will be the same as it has been these past three years: Not yet; but, we are moving in the right direction, to HIV/AIDS vaccine clinical trials. To respond to that pressure from our communities, I think that there is a need to help these millions of suffering people. AIDS is at our front doors, ready to enter and to kill. Everybody is at risk, since the disease which is established in some families knocks at our household and we are all a part of this world.

2. Do you

want to

be involved in vaccines trials?

Yes. Why not? We want to be involved—to be involved early—in the early phases of clinical trials. AIDS is a challenge

for humanity in both developed and developing countries. In the fight against AIDS, we want to share our experiences with the developed world and then we hope to share the benefits of a safe and efficacious vaccine if any is found. We have been told that information, education and communication (IEC) is the solution to AIDS, but we realize now after massive IEC campaigns that it is not enough. For example, what can I do for my daughter to avoid AIDS in a country where 30% of pregnant women are already infected with the AIDS virus? Do you think that advising her to use condoms is enough when we know that a significant proportion of the population doesn't use condoms with steady sex partners? Her first sexual experience could be infectious and then her entire life would be in jeopardy. We want to be ready for vaccine clinical trials. While it is easy to recruit volunteers—especially HIV-negative volunteers—to participate in clinical trials in America, in Africa it is not easy. We have to be prepared: we have to have physicians, nurses, and other trained personnel, reinforced infrastructure, and appropriate cohorts of people established. It takes time. So, the sooner, the better. For that, we need the support of politicians, the press, and also of our communities. We then will move quickly but cautiously to interventional programs. There is a slight difference between courage and rashness.

Deputy Director, Project SIDA, Kinshasa, Zaire and Visiting Scientist at the Center for Immunization Research of the Johns Baltimore, MD 21205. 1521

Hopkins University,


3. Don't you think that Africans will be used




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No. I don't think so, since we are aware of the situation. That is another reason for us to be involved early in the management of HIV clinical trials. But, it's true that if we agree to conduct a large-scale vaccine trials in our country, we must succeed; we don't have an alternative. If we fail, we obtain a negative effect; we will lose the confidence of the population. Then, it will be difficult to conduct other trials on the same population. For that reason, the National Ethical Committee of the host country has to carefully review protocols of studies.



all enthusiastic about


vaccine clinical

trials, but we must realize that we can obtain either a positive or a negative result, especially if we are not cautious enough.

Despite the potential outcome, we must decide how long we are willing to wait before moving to clinical trials. Address

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Nzilambi Nzila Visiting Scientist Center for Immunization Research The Johns Hopkins University Baltimore, MD 21205

Remarks spoken before the audience at the final conference plenary session, entitled: "Future directions," at the International Conference on Advances in AIDS Vaccine Development. Fourth annual meeting of the National Cooperative Vaccine Development Groups for AIDS.

Nzilambi Nzila, Visiting Scientist at the Johns Hopkins University Center for Immunization Research, responds to frequently asked questions about AIDS...
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