Big Shot: Passion, Politics, and the Struggle for an AIDS Vaccine by Patricia Thomas, Public Affairs, £19.99, pp 515, ISBN 1 891620 88 6, Rating: ★★★★
Every day more than 10 000 people around the globe become infected with HIV—two to three times the number who perished in the terrorist attacks of September 11. Day in and day out, the widening circle of AIDS quietly expands.
In the 20 years since AIDS was first recognised, more than 25 million people have died from complications of HIV infection. Another 40 million are today living with HIV, most with no hope of accessing costly new antiretroviral drugs. The staggering human toll of the AIDS pandemic has no historical precedent.
Ambitious preventive programmes based on public education, testing and counselling, and the distribution of condoms and clean needles have markedly reduced the spread of HIV in recent years. But such efforts alone cannot win the war against AIDS.
Victory in the struggle against AIDS calls for a vaccine.
There is now little scientific doubt that a safe and effective vaccine against HIV can be developed. Studies of non human primates and intensive research into the immunopathogenesis of HIV suggest that commercial production of a preventive vaccine for large scale use in human populations is a feasible goal.
Why has science taken so long to come to this consensus? Why has no candidate vaccine ever completed a phase III trial after nearly two decades of scientific inquiry? Why does it seem unlikely that an effective, affordable, and accessible HIV vaccine will come to market in time for the 10 year deadline set by President Bill Clinton in May 1997?
In Big Shot, US journalist Patricia Thomas sets out to answers questions like these in an engaging narrative in which the stories of several leading HIV vaccine strategies and their all too human developers are woven together with a novelist's skill. Thanks to Thomas's tireless investigative work—including 175 lengthy interviews with key players in the world of AIDS vaccine development—readers come to know on a first-name basis a large and diverse cast of scientific personalities, from those inhabiting the lab benches of upstart biotech firms to those who walk the corridors of power in the US National Institutes of Health.
While each character plays a vital part in the unfolding drama, Thomas leaves little doubt about who are the heroes and who are the villains. But fortunately her depictions of these gifted and complex individuals are never simplistic and usually include a few shades of grey.
When Thomas began work on her book in 1997, she expected to find that the technical challenges thrown up by the virus itself were largely to blame for the slow development of an AIDS vaccine. What she soon found, and brilliantly portrays in her book, is that progress on vaccine development has been derailed much more by political timidity, by anxieties about corporate profits and liabilities, and by petty rivalries between the theorists of academic science and the empiricists of applied research.
Ultimately, Big Shot shows that development of a safe and effective AIDS vaccine has failed because of the absence of an outspoken public constituency pushing for it. Drug companies have preferred making pills to be taken daily over vaccines taken only once. Likewise, AIDS activists have focused their attention on getting care for those already infected.
As Thomas points out, there have been no crowds of healthy people marching on Washington, demanding that science find a way to protect them from acquiring AIDS. Perhaps only when that happens will we get a usable vaccine and bring an end to AIDS for all time.