Efforts of the International AIDS Vaccine Initiative
Despite a promising career advancing health research at Rockefeller University, Seth Berkley made a surprising mid-career move when he went all-in to develop an AIDS vaccine.
Published July 1, 2006
By Alan Dove
Academy Contributor
In 1996, Seth Berkley, MD, threw away a promising career. The Ivy-League-trained physician was the Associate Director of the Health Sciences Division at the Rockefeller Foundation, a rising star in infectious disease and epidemiology, when he hatched a plan that many experts considered absurd. He wanted to establish an unprecedented public-private collaboration, then gamble its money on an impossible long shot: an AIDS vaccine.
“There certainly was a lot of skepticism” that a non-governmental organization would have a role to play, says Berkley. Nonetheless, his nascent not-for-profit, the International AIDS Vaccine Initiative (IAVI), persisted.
It’s too early for gloating—there is still no effective vaccine against HIV, the cause of AIDS. But there also is no doubt that IAVI has redefined the discussion about AIDS vaccines.
Rather than placing the burden of vaccine development entirely on pharmaceutical companies, IAVI helped pioneer the use of public-private partnerships and collaboration between rich and poor countries. In hindsight, the advantages of its strategy seem obvious.
IAVI’s approach is to take promising preclinical leads into small-scale human trials in developed countries first, then move the successful candidates to large-scale trials in developing countries. That keeps the tests for human safety under the watchful eyes of first-world regulators, but ensures that efficacy trials take place in third-world populations who need the vaccine most.
For a group that runs complex scientific collaborations around the world, New York was an obvious place to settle. “We are a global organization, and you need a city that is global in its nature,” says Berkley, citing New York’s position as an international scientific, transportation, media, and finance hub.
Based in NYC, Global Impact
After setting up in borrowed space at Rockefeller University, IAVI soon moved to a shared office for nonprofit groups in Midtown. Its move to Lower Manhattan was driven by a factor New Yorkers know all too well: expensive real estate.
“The rates in Midtown were $60 a square foot, and as a nonprofit we couldn’t really justify that,” says Berkley. A new office in a renovated building on William Street had the needed transportation options and high-speed Internet service, so IAVI moved downtown in 2001.
Not long after, Berkley saw the jets fly into the Twin Towers. After the attacks, IAVI operated temporarily out of its original home, Rockefeller University, and it was nearly a month before the team’s Internet servers were back online. Much of the organization’s work could be done from any office with a broadband connection, but the group decided to stay in the city.
“There’s only so much you can do virtually,” says Berkley. “In the end, there has to be the pressing of flesh.” IAVI has already expanded its office space in Lower Manhattan. It is also participating in on-going discussions with the Mayor’s Office about the fate of Governors Island, the former U.S. Army and Coast Guard base in New York Harbor. Berkley advocates turning part of the island into a campus for global health research and meetings.
As much as IAVI loves New York, most of the Initiative’s work takes place away from headquarters at sites scattered around the world. IAVI currently has no laboratory space of its own. Instead, it funds research in established academic laboratories and clinics.
Searching for the “Holy Grail”
At the preclinical end of the pipeline, IAVI now runs two research consortia focused on different HIV vaccine strategies. The Neutralizing Antibody Consortium is searching for what Berkley calls the “Holy Grail” of AIDS vaccines: antibodies that can neutralize multiple strains of the rapidly mutating virus.
The Live Attenuated Consortium is taking an entirely different approach, trying to identify the biological markers that correlate with HIV immunity in monkeys vaccinated with a live, weakened strain of the virus. A live attenuated vaccine works well in monkeys, but without a clear understanding of how it works, researchers are reluctant to try it in humans.
Preclinical projects like the consortia are critical, but comparatively cheap. The bulk of IAVI’s budget funds clinical trials, ranging from small phase 1 safety tests to large-scale phase 3 efficacy trials, the latter often involving thousands of volunteers and hundreds of medical professionals. To fund its research and trials, the organization has raised nearly $500 million to date, from a combination of philanthropic foundations, governments, and pharmaceutical companies.
Several IAVI-sponsored vaccine trials have already failed, underscoring the high risks that have kept many pharmaceutical companies from trying to develop an AIDS vaccine on their own. Undeterred, the Initiative is now conducting 20 clinical trials worldwide on newer vaccine candidates, and more await at the preclinical stage.
Today, the 49-year-old Berkley says IAVI’s persistence continues to rest on the same reasoning he used on donors in 1996: There’s no guarantee that giving will result in a vaccine, but it’s guaranteed that there will be no vaccine without giving.
Also read: A Public Good: Accelerating AIDS Vaccine Development
