Medical Research Council (MRC): New Developments on HIV/Aids Vaccine

Meeting report

ARTS, CULTURE, SCIENCE AND TECHNOLOGY PORTFOLIO COMMITTEE
24 June 2003
MEDICAL RESEARCH COUNCIL (MRC): BRIEFING ON NEW DEVELOPMENTS IN HIV/AIDS VACCINE

Chairperson: Ms M Njobe (ANC)

The following documents will be available on Friday 4 July 2003:
South African Aids Vaccine Initiative (SAAVI): Presentation
Indigenous Knowledge Systems Unit (IKS): Presentation

SUMMARY

SAAVI briefed the Committee about its work on developing an HIV vaccine and the progress made since the inception of the initiative. A presentation by the MRC's Indigenous Knowledge Systems (IKS) explained how traditional African medicines are being researched to assess their potential in treating HIV/Aids and how traditional healers/knowledge is being involved in the process. The issues of funding, time frames, human trials, intellectual property and community awareness were discussed.

MINUTES
South African Aids Vaccine Initiative (SAAVI)
Dr Tim Tucker, Director: SAAVI, explained the functions and activities of the South African Aids Vaccine Initiative. SAAVI was founded in 1999 to develop an affordable, effective HIV vaccine and to create an enabling environment for its use. South Africa was the world's only developing country developing a homegrown product of this nature and SAAVI was a national asset.

There were currently fifty researchers at the University of Cape Town working on candidate vaccines and twenty researchers at the University of Stellenbosch developing technology platforms for an HIV vaccine. The work also involved immunology assessments on animals to see if products were safe. There was a behavioural science component to investigate issues such as why people volunteered (or not) for vaccine trials. A full-time dedicated ethics group attended to ethical issues. There was also a focus on community preparedness to inform and educate people at a grassroots level about vaccine developments. Actuarial assessments were being made to establish the dosage needs of different risk groups.

SAAVI had been expanding its capacity and now had twenty-two principal investigators, having started out with nine. Dr Tucker said SAAVI was a model of transformation. More than sixty-five percent of staff were women, most senior positions were filled by women and more than fifty per cent of staff was historically disadvantaged.

According to Dr Tucker, SAAVI would need more than R100 million over the next eighteen months to operate successfully. It would eventually cost R3 to R4 billion to build a vaccine manufacturing facility. Three agencies were submitting trials for review: International Aids Vaccine Initiative (IAVI), Merck and AlphaVax.

Dr Tucker also explained the clinical trial phases in humans. A group of trial volunteers would be recruited and counselled, after which the vaccine would be administered to fifty per cent of the group and a placebo to the other fifty per cent.

SAAVI's primary objective was to make a vaccine strong enough to prevent infection. If this was not possible, a vaccine needed to be found that would slow down the onset of Aids by ten to twenty years. However, a decade or two of research would be needed before either objective might be achieved.

Indigenous Knowledge Systems Unit (IKS)
Dr Motlalepula Matsabisa, Manager: IKS (Health), explained that his division of the MRC was looking at the role of traditional African medicines and/or natural products in the fight against HIV, focussing on plant medicines that could restore immune compromised positions. The MRC wanted to commercialise these products and simultaneously protect the intellectual property of the people who came forward with them. About eighty per cent of South Africans relied on traditional/natural remedies and there were 250 000 traditional healers in the country. Of South Africa's 24 000 plant species, about 4000 were used in traditional medicines. The benefits of these plants had not been fully researched. In the meantime there was an unregulated trade in traditional medicines with a turnover running into billions of rands. South Africa needed to look at its traditional medicines, research them and give them the same global status as traditional remedies from for, instance, India or China.

The MRC received up to five calls per day from members of African communities claiming knowledge of traditional HIV/Aids medicines. Agreements had been signed in some of provinces for the MRC to evaluate (and test the safety of) various plant medicines brought forward by community members or traditional healers. These agreements guaranteed confidentiality and intellectual property rights.

Dr Matsabisa outlined the evaluation process for immune-boosting traditional products in terms of safety studies and dosage research. Preliminary results of one product in particular were promising. This mixture of three traditional plants resulted in a ninety-eight per cent recovery rate from opportunistic infections in human volunteers. However, such products would have to be tested more extensively. Because sufficient material for further research was required, large numbers of specific plants would first need to be grown and harvested in controlled and disease-free environments.

Dr Matsabisa said that the MRC wanted to play an advocacy role regarding the benefits of traditional medicines. It was seeking to develop these products in order to provide affordable and easy-to-use HIV/Aids medication.

Discussion
Ms S Motubatse-Hounkpatin (ANC) asked what happened to people bringing traditional medicines for HIV/Aids to the MRC. Were they partners in the process? Would they benefit from sales?

Dr Matsabisa replied that the MRC had developed a benefit-sharing mechanism. Traditional healers/communities were equal partners in research and would share in profits (fifty per cent going into a trust for use by the communities from which the information came, ten per cent going to the individual who brought the information).

Mr N Ngcobo (ANC) said that the Committee had been told, in the presentations made that day, that Government is a leader in HIV/Aids research among developing countries. He asked if this disproved claims that Government was doing too little regarding HIV/Aids.

Dr Tucker replied that, despite controversies around Government's handling of HIV/Aids, Government had done well to set up a vaccine structure and fund it.

Mr S Dithebe (ANC) asked whether the International Aids Vaccine Initiative was funding SAAVI. He also wanted to know about the level of awareness among ordinary people about SAAVI's work.

SAAVI replied that it received no funding from the IAVI because the latter is not a funding body. Regarding awareness, the MRC had a media group responsible for briefing journalists. Brochures were being distributed and, when an announcements was appropriate, the news would be rolled out with the assistance of the Department of Health. Professor I Mohamed (ANC) asked how the statistics of vaccine trial volunteers were being managed and whether the MRC thought international ethical standards were applicable to the South African situation.

Dr Tucker replied that statistical models varied from case to case due to variations in the costs of clinical trials. He expressed satisfaction with current ethical standards.

Mr V Gore (DA) asked how long it would take before there was a vaccine. What would it cost to develop a vaccine? What would be an 'affordable' vaccine? How many disabled people had been employed as part of the MRC's transformation process.

Dr Tucker replied that the development of a vaccine usually took between twenty and twenty-five years, although SAAVI was looking at between ten and twelve for a successful HIV vaccine. It would take three to four years before the MRC would know what the cost of developing such a product would be. South Africa would not be able to afford the process by itself. International funding would be required. There were ongoing funding negotiations with European Union bodies and the US government. No figures were available regarding the disabled sector, but Dr Tucker said he sensed that representation was low. He would attend to the matter of actively recruiting disabled people.

Ms H Mpaka (ANC) enquired about compensation for clinical trial volunteers. She also asked how many offices the MRC had countrywide and whether there was one in Limpopo, a province known for having many medicinal plants.

According to Dr Tucker, it was not SAAVI's policy to pay volunteers. People would be assisted with transport and meals. Dr Matsabisa added that the MRC's head office was in Parow and there were branches in Kimberley, KwaZulu-Natal and Pretoria. An office was going to open in Limpopo.

A DA member enquired about the MRC's position on HIV causing Aids.

Dr Tucker said the HIV virus does exist. It can be seen with a microscope. Pamphlets from the Health Department say that HIV leads to Aids. SAAVI would not be making a vaccine for a non-existing virus.

Reverend L Tolo (ANC) pointed out that traditional healers derived their knowledge from the ancestors. Were Western health practitioners at the MRC assisted and educated by traditional healers?

Dr Matsabisa replied that the MRC did not train individuals to be traditional healers, but worked with them and learned from them.

The Chair asked whether African people's reluctance to disclose traditional knowledge was affecting the progress of the MRC's research of plant medicines.

Dr Matsabisa said the MRC did not go to communities to ask them about traditional treatments. People willingly approached the MRC with evidence of the benefits of treatments because they trusted the MRC and Government.

The Chair also posed the following questions:
Would Western and African treatments be used simultaneously?
Was the traditional medicine knowledge of the Khoi, San and Nama being incorporated?
Could members tell their communities about SAAVI's work on vaccines?
Would the HIV vaccine work like other vaccines, containing the virus in order to attack it?

Dr Matsabisa said that Western and traditional African treatments could be used together. The Western component could be preventative (vaccine) and the traditional component could be therapeutic (treatment). The Khoi, San and Nama had expressed interest in working with the MRC, but this needed to be followed up. Dr Tucker said communities could be informed that the MRC is in process of developing a vaccine, but at the same time they should still be advised to be faithful to one partner, to use condoms and so on. The HIV vaccine would contain a small portion of the virus, but not enough to contract the virus.

Dr Matsabisa asked what the Committee could do to assist the MRC with its research on a vaccine for HIV/Aids.

Mr S Dithebe (ANC) said the work of SAAVI and IKS (Health) had the Committee's support as a priority project and that the Committee would continue to grapple with budget processes to ensure its continuation.

The Chair added that it was the beginning of the financial year and a good time to engage on funding issues. She said more information from the MRC would be helpful, especially copies of the presentations made.

The meeting was adjourned.