Ugandan Parliamentarians Gather for Vaccine Summit

By Emily Bass

On 12-13 August, 2002, a Policymakers Conference on HIV/AIDS and AIDS Vaccine Initiatives was held in Kampala, Uganda. Attended by 180 Ugandan MPs, 3 Kenyan MPs, along with religious leaders, scientists and NGO representatives, the meeting was organized by a working group led by the Ugandan AIDS Commission (UAC) and funded by IAVI. The two-day meeting featured talks from Professor Edward Rugomayo, Minister of Trade and Industry (on behalf of President Yoweri Museveni), Minister for Ethics and Integrity Miriam Matembe, (on behalf of the Minister of the Presidency), Gilbert Bukenya, Minister of Health Brigadier Jim Muhwezi, and John Rwomushana, Director of Research and Policy Develop-ment at the Ugandan AIDS Commission. IAVI speakers included CEO Seth Berkley and Vaccine Preparedness Vice President Balla Silla.

The meeting was designed to raise MPs’ awareness of the status of HIV/AIDS and HIV vaccine development; to mobilize MPs to join in advocacy and outreach efforts aimed at enhancing regional collaboration around vaccine trials; and to advocate for AIDS vaccines on the global stage.

At present, an estimated 1.1 million Ugandans are living with HIV, a prevalence of roughly 5%, according to the most recent UN estimates. Often singled out for its successes in addressing AIDS, Uganda needs continued, innovative action, said Minister of Health Brigadier Jim Muhwezi, who estimated that 120,000 of HIV-infected Ugandans were in symptomatic stages of disease, requiring additional care and support. He placed particular emphasis on the provision of antiretroviral therapies, which will be purchased using a US$9 million grant from the Global Fund to Fight AIDS Tuberculo-sis and Malaria.

The speech read on behalf of President Museveni also emphasized the need for new efforts.” Whereas Uganda has made commendable progress in combating the epidemic,” Museveni wrote, “the remaining challenges for the country are still grave and urgent.” These include the rising rate of new infections among some populations over the past year and a recognition that, without treatment, it is difficult if not impossible to control the epidemic. “ARV treatment is an achievement that we must consolidate as we search for lasting solutions. There is no doubt at all that the ultimate weapon against AIDS is a preventive vaccine.”

Professor Roy Mugerwa (Makerere University) provided a brief history of the ALVAC trial (Africa’s first AIDS vaccine trial, a Phase I study of a subtype B-based canarypox candidate), noting that, “From the start, we knew that this trial was only the beginning.” Pontiano Kaleebu of the Uganda Virus Research Institute (UVRI) spoke about the trial and revisited Uganda’s decision to test a non-clade matched vaccine—a choice made in 1999, at a time when it was “unclear” when clade A and D based vaccine candidates would be available for testing on Africa. The decision-makers also saw the trial—which was primarily focused on determining vaccine safety—as a step towards understanding the importance of clade in vaccine design.

There are now several candidates entering early phase trials the East African region, as summarized by Kaleebu. The Walter Reed Army Institute of Research has a collaborative project with Makerere University and the Rakai Project; the Joint Clinical Research Center, site of the ALVAC trial, is working with the Italian National Institute of Health to plan for Phase I and II trials of a tat-based vaccine. Also in the preclinical pipeline: A clade A vaccine based on virus-like particles produced in a baculovirus expression system, under development by the Naples Viral Oncology Institute and UVRI. In September, an IAVI-sponsored trial of a clade A DNA-MVA vaccine strategy received final approval. Immunizations are set to begin at UVRI before the end of 2002.

Balla Silla’s speech emphasized the need for policymakers to facilitate vaccine testing and delivery through financial and political support, and public education. These goals were reflected in the meeting’s outcomes, which included accelerated plans for the creation of a Permanent Standing Committee on HIV/AIDS in the Ugandan Parliament, and the creation of a Parliamentarian Declaration similar to that signed at IAVI’s Parliamentarian Meeting in Delhi, India in May. Participants suggested other potential action steps, such as launching a pilot project to deliver an already-licensed vaccine to adults; developing linkages with other parliaments in East Africa and around the world; and supporting creation of simplified educational materials on vaccines and vaccine trials.