Antiretrovirals, condoms, microbicides, pre-exposure prophylaxis regimens, male circumcision and all the other interventions currently in the arsenal and on the horizon, have a significant role to play, but history has shown that vaccines are the best interventions for an infectious disease.

‘€œA vaccine is the easiest ‘€“ it’€™s cleaner and it’€™s simpler,’€ says Dr Francois Venter, President of the Southern African HIV Clinicians Society.

He points out that many of the future prevention interventions still need some form of behavior change whether it’€™s taking a pill every day or inserting a microbicide. ‘€œI worry that because of this pre-condition they may not be as effective,’€ says Venter.

Almost 2 000km to the south of the bespectabled Venter’€™s HIV clinic in Johannesburg, a modest woman and her team are quietly making their contribution to finding a vaccine.

A molecular scientist, the University of Cape Town’€™s Professor Anna-Lise Williamson laughs when quizzed whether she ever regrets throwing her name into the hat. ‘€œI think we were a bit naïve, but we wanted to make a contribution and thought ‘€“ ‘€˜How hard could it be’€™?’€

Williamson and colleagues across the world spend years in high-tech laboratories developing candidate vaccines which are eventually handed over to a team of clinical researchers who in turn get the vaccines ‘€œinto people’€.

‘€œIt’€™s a very long-term project and there are always differently perceptions of how far down the road you should be, we all want a vaccine yesterday,’€ she says.

‘€œEvery trial that takes place moves us closer, moves us forward. Nobody in Africa has done what we are doing, but the amounts of money needed are huge.’€

South Africa’€™s flagship vaccine development body, the South African AIDS Vaccine Initiative (SAAVI) was handed a massive blow in 2008 when the Department of Science and Technology ceased to fund the effort.

Williamson and others were left with the task of retrenching a large team and most laboratory based SAAVI funded research stopped.

SAAVI supported and co-ordinated the vaccine effort on many levels and huge multi-disciplinary projects ceased to exist. A lot of funding was also channeled into   SAAVI projects and this is also no longer happening with overseas funders less keen to invest in South Africa’€™s vaccine development unless government does its bit as well.

‘€œWe do need a huge co-ordinated effort, we need an organization such as SAAVI.

‘€œWe also need global input which includes expertise and money,’€ says Williamson.

However, Williamson said there were hopes that SAAVI could be revived with positive meetings taking place between researchers and the national health department as well as department of science and technology.

The last 15 months have been the richest period in HIV vaccine research since the epidemic began 27 years ago. The landmark HIV vaccine trial in Thailand (RV144) has provided great insights and is opening up new strategies for safe and effective vaccine development.

RV 144, began in 2003 and enrolled more than 16 000 HIV-negative Thai men and women between the ages of 18 and 30. The trial tested a combination of two vaccines: ALVAC HIV vaccine (the prime) and AIDSVAX B/E vaccine (the boost). The trial results, first released on September 24th revealed that the prime-boost combination lowered the rate of HIV infection by 31.2% compared with placebo.

‘€œThis study showed us that HIV vaccines work better when you have a prime and boost, which basically means that a mixture of different vaccine vectors work better,’€ said Williamson. Informed by the Thai data a trial is planned to combine the SAAVI candidate vaccines with a protein boost from Novartis. An application to conduct a trial is currently with the Medicines Control Council.

Samples from the SAAVI102/HVTN073 vaccine are currently being analysed and according to Williamson early results are showing an immune response to the vaccine.

Two trials, the amended HVTN073 / SAAVI 102and HVTN086 / SAAVI 103 are due to start in South Africa next year with Glenda Gray (University of the Witwatersrand) and Gavin Churchyard (Arum Insititute) heading the teams.