Being young in each decade means something
different. Each generation has new challenges and struggles, new fashions, new
pressures. Some things though, remain universal. In the 80s in this country the
struggle referred to fighting an oppressive government and perhaps now it means
a similar thing. We have bridged the gap between the 80s boomboxers and the millennials
with a dark and ominous threat, HIV/AIDS and with no vaccine or cure in the
foreseeable future, this looks to be set in. Despite this, we have come a long
way in South Africa. From scandal that radiated from the division of AIDS in
the early 90s (a ridiculous musical, a strange solvent turned injectable) to
the early 2000s where our own president denied HIV causation and our minister
of health “solved the world’s problems” with the African potato, we have been
plagued with a series of poor political decisions. These have I’m pleased to
say resulted in some great decisions; we have the highest governmental rollout
in the world of ARVs and a mother to child transmission rate of less than 2%.
We have great research culture in HIV too. Some of the brightest young minds
are working on the best way to solve multiple problems. But vaccine research,
now that’s a tricky business and it is really the only way to ensure a bright
future for the youth.
I have just entered the world of HIV vaccine trials.
I need to mention upfront that clinical trials are hard. It will take a minimum
of 5 years to run safety and feasibility trials and product development is a
nightmare. This is only after all the basic science has been completed which
often takes a decade (monkey studies, idea development). But these are things
that cannot be helped. So why do I say the vaccine field has failed? Vaccine
trials feel very much like the blind leading the blind. Often decisions have
been made completely out of line with sound scientific basis. There are many
reasons for this, some more sinister than others. One is as a result of old
dogma, which is a problem with science in general. There are almost always
great innovations coming out from literature but people in the higher echelons
make the decisions and sometimes they push their own agendas and sometimes they
are nervous. Understandably; these trials use stupid money. A failed trial
means lack of funding and more worryingly a dangerous trial means loss of faith
in vaccines- something the world can simply not afford. The recent spate of
measles related deaths is the US and polio-induced paralysis in children is a
direct result of the anti-vaxxers movement. They are inspired by a paper, which
has since been retracted for falsification, that showed a link between autism
and vaccination. A lot of damage can be done by a poorly run trial but the
misnomers that come from media are equally destructive.
Another argument for quick decisions within a
vaccine research body can be made for progress for progress sake. This is
important. We cannot wait another 20 years to get the perfect vaccine immunogen
and we will learn from negative results. Having said that, we have to be going
forward with new brave ideas. Some of them will fail but they won’t fail
because they aren’t well conceived. We will head into the unknown but it should
not be blindfolded or wearing blinkers. We need leadership that really gets it
-that is not detached and far removed from the lab work, is not exclusively
feeling the pressure of finance alone and is happy to listen to the bright
minds they hire to run the trials and trusts them to input ideas.
The world is a scary place for the youth. 90% of the
time we are in murky waters. We still have many of the same problems but we can’t
solve them with 100 year old tools. We can no longer err on the side of caution
and we can no longer allow politics to govern science. The field of science
needs to start really listening and stop patting itself on the back for Nature
papers no one ever implements into policy. Where is the application? Doing
proof of concept studies with no measurable product in a clinical trial is a
scary thought. What are we saying to the volunteers? “Please give us your time.
If this works, we can’t give it to you because it is completely impractical.”
We have to improve and we have to be better for those who are yet to come. We
need to make it normal for the youths only problems to be a trivial shortage of
selfie sticks or what to wear on Friday nights and not a fear of contracting a
death sentence. A tall order-one I hope will be realised in my lifetime.
