July 26, 1990

An AIDS Vaccine

Some remedies are worse than the disease.

Publius Syrus (circa 75 A.D.)

It's just a matter of time before the perception that AIDS is a gay and drug-addict disease disappears. When AIDS hits the high schools and colleges -as it inevitably must- our culture will have a rude awakening.

There has been much talk about an AIDS vaccine. Unlike vaccines for smallpox, measles and polio, a vaccine for AIDS poses some very special problems. As a consequence of these problems, a vaccine might not be the way to go. Let me explain:

There are two basic types of vaccines for virus diseases. One type is the killed vaccines such as the Salk polio vaccine, which is now seldom used. The other type is the live virus vaccine, which is what the smallpox and live polio(Sabin) vaccines are. Basically, the live vaccines work better than the killed ones. They also produce a permanent immunity.

No vaccine is without some risk. When killed polio vaccine (Salk vaccine) was first used, some kids got polio because the virus wasn't completely killed in several batches of the vaccine. The live polio vaccine is polio virus that has been weakened by passage in tissue culture, over a long period of time. Its side effects are small. There is, however, the possibility of a mistake in its manufacture, or of a change in the virus, making it virulent again.

The oldest of the vaccines is for smallpox. A very small percentage of children who are vaccinated, develop a full blown disease that is similar to smallpox. In the past generation, there were more deaths from vaccination than from smallpox. Consequently, vaccination is no longer routinely performed. If smallpox ever got started again, as it might, the dangers of vaccination would be trivial, compared to the dangers of that terrible disease.

As far as antibodies in the blood are concerned, it is not possible to differentiate between a person who has been vaccinated against a disease and one who has actually had the disease. A person vaccinated for AIDS would test positive for HIV(Human Immunodeficiency Virus; the AIDS virus) and would be indistinguishable from someone who actually has the contagious AIDS virus. As things stand now, it is possible to find out if someone is infected by doing a blood test. This might not be possible if a person has been vaccinated; whether the vaccine was completely effective or not. If a fast inexpensive test could be perfected which measures the actual presence of the virus, rather than the body's response to it, this problem would be solved. This is being worked on.

Another problem may be that HIV might behave similarly to herpes virus and it might be possible for an immune individual to still get infected or re-infected. We just don't know.

Giving polio vaccine to a high percentage of school age children, will stop the spread of polio. Who would you give an AIDS vaccine to? Giving it to a high risk population may simply give these people a false sense of security, putting them at higher risk of getting the disease than those who were afraid of the disease and took the proper precautions. People who were at little or no risk would refuse to take the vaccine for good reason. As I've said: no vaccine is without some risk.

Unlike smallpox, measles and polio, AIDS is almost 100% preventable. To date, no one has found a true carrier state with AIDS. All of the people infected seem get the disease and die of it. In short, if spread can be prevented, everyone with the disease will die and take the virus with them. That is how Mother Nature does it; like a cat kills a mouse after playing with it for a while. If you could prevent its spread for about 20 years, it might be possible to eliminate the virus from the population entirely. The same procedure that could eliminate AIDS might, if combined with treatment, also eliminate syphilis and gonorrhea.

Is this really possible, considering human nature? Probably not. Even if everyone used condoms, there would always be some idiots who will try to economize by using a condom on both sides.

One of the critical tests of a vaccine is to give the vaccine to a group of people and then try to infect them with live virus. The risk with a universally fatal disease like AIDS is very great. Before anyone would dare to attempt a human test, no vaccinated animals should get infected after being given the virus. Even then, people might be different from the animals used and the vaccine may not work; or worse, the vaccine itself might cause AIDS.

The people who are usually used to test a dangerous drug or vaccine are people who are about to die of something else, such as cancer. However, in the case of AIDS, that would not be possible. The average time that it takes a person who has been infected with the virus to show the symptoms of AIDS is about 11 years. This means that you would have to test a vaccine using relatively healthy adults, who would be expected to live for a long time. Who would be willing to undergo such a test? It appears as if Jonas Salk is looking at ageing priests as a possibility. The reward, presumably, would be martyrdom. Martyrdom, however, seems to have more appeal to the young than the old. Is it worth sacrificing even a relatively few years of anyone's life for a vaccine which, even if it works, may never be used?

In short, a vaccine for AIDS would probably not be the panacea that will solve the problem of that killer disease. Even if it is developed, it may not be practical to either test it, or use it.

Much as people would like to believe that a cure for AIDS is just around the corner, the truth is that a cure will require a scientific breakthrough of the magnitude of penicillin. There is no way of predicting when, or if, such a breakthrough will occur. The prophylactic already exists.

We are back to the old standby of PREVENTION: SAFE SEX and STERILE NEEDLES --or NO SEX and NO DRUGS. YOU either take precautions, or risk an early and very unpleasant death. That's life!

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