Ethical Considerations In Hiv Preventive Vaccine Research

This document highlights, from UNAID'S perspective, some of the critical elements that must be considered in HIV vaccine development activities.

This book explores some of the complex ethical quandaries entailed by proposed phase III HIV preventive vaccine trials. The book argues that such trials must be initiated as soon as politically and ethically feasible on the one hand, and that no such trials should be undertaken until we can assure full compliance with the Nuremberg Code and the WHO/CIOMS International Ethical Guidelines for Biomedical Research Involving Human Subjects on the other. The tension between these two positions is fully detailed and suggestions offered for how to think about possible resolutions.

"The book is a balanced and comprehensive treatment of an important social issue. It is accessible to the general reader and belongs in public as well as academic libraries." -- Religious Studies Review "Painstaking analysis of the knotty ethical problems involved in human-subjects research, and a well-thought-out proposal for a community approach to conducting field trials for an HIV vaccine.... Highly recommended for medical ethicists and anyone concerned about the AIDS epidemic and how HIV research is conducted."Â -- Kirkus Reviews "... a carefully reasoned account of how research for and trial of a preventive vaccine differ from the methods used to discover a therapy."Â -- Booklist "I highly recommend reading this book which I would attest to be a thrilling, ethically challenging, and informative descent into the allopathic solution." -- Ryan Hosken, Bastyr University Library Newsletter "As the scientific effort to produce an efficacious vaccine continues, [Grady's] work provides an ethical compass that will guide us well, regardless of where phase III HIV vaccine trials ultimately occur." -- Journal of the American Medical Association "Highly recommended... " -- AIDS Book Review Journal "A remarkable treatment of a most difficult and complex subject... Grady's book is of special merit because it is simple, readable, and understandable, while conveying in-depth perceptions that are critical to the reader. A useful and essential reference work for those who would engage in the initiative to bring about a resolution of a mighty human health problem." -- Maurice R. Hilleman, Ph.D., D.Sc., Director, Merck Institute for Therapeutic Research "Dr. Grady's important study captures the complexity of the search for an AIDS vaccine with startling clarity. Her insights into the full range of forces that shape our national response to AIDS vaccine development should read like signposts to vaccinologists, AIDS community activists, and most importantly, the Public Health Service. An impressive contribution." -- Derek Hodel, Gay Men's Health Crisis "This book is recommended to medical ethicists, those involved in non-HIV vaccine trials, and all persons involved in HIV vaccine trials, including investigators, sponsors, study subjects and communities at risk." -- Journal of Health Politics, Policy and Law The creation of a vaccine now seems the best hope for controlling AIDS. Yet developing and testing an HIV vaccine raises a host of difficult ethical issues. These concerns are the focus of this timely and important book. Essential reading for everyone interested in ethics and the conduct of HIV vaccine research.

This important work takes as its subject one of medicine’s most pressing arenas of ethical debate. There has been a consistent interest in ethical issues arising in the context of HIV research. Ongoing international and multi-site studies and the continuing search for an HIV vaccine continue to prompt examination of how this research is conducted. Also examined are how participants are engaged in the studies and the obligations of the researchers to individual participants and their communities during the course of and following the conclusion of the research. Each chapter of this book is authored primarily by one of the editors (secondarily by the other) and is accompanied by one to two case studies.

This work explores some of the complex ethical quandaries entailed by proposed phase III HIV preventive vaccine trials. It argues that such trials must be initiated as soon as is politically and ethically feasible on the one hand, and, on the other, that no such trials should be undertaken until we can assure full compliance with the Nuremberg Code and the WHO/CIOMS International Ethical Guidelines for Biomedical Research Involving Human Subjects. The tension between these two positions is documented, and suggestions offered for how to think about possible resolutions.

The motivation and inspiration for this book come directly from expe- ences with clients during the years that I practiced HIV-related law at the Legal Aid Society of San Diego, Inc. The issues discussed in this work reflect issues that arose on a recurring basis with clients participating in HIV research studies, with investigators calling for guidance on the legal implications of particular aspects of their proposed studies, and with research institutions and health care facilities struggling to make sense of legal maneuvers aimed at obtaining the records of their HIV-infected patients. It is impossible to thank each of these persons individually for their provocative questions and their insights. The discussion of ethical and legal issues relating to the design of clinical trials reflects questions raised during discussions with Donald J. Slymen, Ph.D. Don was one of the first researchers, in my realm of experience, to pay close attention to ethical concerns, and I am greatly appreciative of his contribution to both my professional growth and the development of various scenarios discussed in this text. The portions of this text dealing with confidentiality are the result of many hours of thoughtful discussion and analysis with Penn Lerblance, J.D., now deceased and still missed. Penn and I often participated together as presenters of in-service training programs for health prof- sionals. Penn addressed discrimination, and I focused on confidentiality.

AIDS researchers are investigating new vaccines that would prevent infection with HIV and reduce the spread of AIDS. Some have argued that product liability concerns have discouraged investment in HIV vaccine research and development. The purpose of this OTA background paper is to describe the current state of development of HIV vaccines, and to discuss what is known about adverse reactions that may occur. The background paper provides an overview of ethical issues that arise in the conduct of HIV vaccine trials. The report also discusses alternatives to the current product liability system to encourage the development of HIV vaccines and to fairly compensate those who are harmed as a result of adverse reactions to the vaccine. This background paper was prepared in response to a request from the Subcommittee on Health of the House Ways and Means Committee. It is eleventh in OTA's series of studies on HIV-related issues.