
Vaccines Against H.I.V., Malaria and Tuberculosis Unlikely, Study Says - okket
https://www.nytimes.com/2018/09/07/health/vaccines-hiv-malaria-tuberculosis.html
======
hannob
Given what I learned in recent years about the scientific process I'm always a
bit wary of making this a "spend XXX money to get YYY results".

We have issues like that still a sizable amount of medical studies are
unpublished because they don't produce the desired result the funder wants,
that experts think a vast amount of studies are simply research waste due to
poor methodology or that the majority of pre-clinical cancer studies can't be
replicated. How much better could we be at tackling diseases if science
wouldn't have these problems?

Sure, more funding is one part of the equation. But I increasingly get the
feeling that if modern science wants to make a significant step forward they
need to clean up their methodological problems. And that will not necessarily
cost more, in many situations it may even cost less. (E.g. don't pay for
studies that won't get published later or that are methodologically so weak
that they won't produce actionable results.)

~~~
FabHK
> don't pay for studies that won't get published later or that are
> methodologically so weak that they won't produce actionable results.

Most typically, to make studies methodologically stronger, you require a
bigger sample, ie more subjects, to increase power while maintaining or even
improving significance. And that would make it more expensive.

~~~
leoc
But it's uncertain whether simply pouring more money into the funding hopper
would generally result in studies with larger sample sizes, or whether it
would just result in a larger number of surveys with a sample size similar to
the deficient ones we see today, as a larger number of scientists manage to
cling by their fingertips to the gravy train. After all, there's presumably
little good reason why we couldn't have fewer but better studies today, at
existing funding levels.

~~~
Broken_Hippo
You could be reasonable and make larger sample sizes and so on requirements.

While it isn't certain that simply pouring money into funding hoppers results
in more studies, it is pretty certain that larger sample sizes (and things
like this) cost more money. It is prudent to give enough for these things.

If you want to have more accountability with money, build it in. You might
find it costs more or less than current funding levels - I'm going to guess
costs will vary with sort of funding. Use equipment funds for equipment. Give
researchers and their staff actual, decent, steady wages not reliant on
results. (A "negative" result isn't negative, after all, for it disproves
something).

And so on.

------
TangoTrotFox
Can anybody briefly describe how a 3x funding increase would change things
from "may not be able to invent" to "[likely] to be able to be produced in the
foreseeable future"? I'm very disappointed that news articles no longer hit on
even the most fundamental questions like this. Instead articles now take a
position (you should be in favor of donating money to [x,y,z]) and then go
from there.

This seems to challenge belief. There are almost always rapidly diminishing
returns on increasing allocation of resources once you reach a certain
baseline. And almost is a weasel word there -- I can't think of anything where
this is not true. Just like 50 programmers won't work 50 times faster than 1
programmer on a given task, 50 times the amount of money dedicated to a task
will often provide far less than 50x the return. And the article's premise is
suggesting not only a linear return on investment, but a largely exponential
one.

Of course this all goes out the window when you're desperately understaffed or
underfunded, but if $3 billion a year is anything remotely close to
'desperately underfunded' then it makes one wonder if that may be a product of
waste and inefficiency than a lack of funding.

~~~
thomasfedb
For some science, the baseline is very high. You can't do X-ray
crystallography of organic compounds, for example, without a synchrotron.

~~~
yborg
DNA's structure was deduced from X-ray crystallography using a conventional
X-ray tube, most laboratory protein crystallography doesn't require a
synchrotron light source.

Here's a typical unit:

[https://www.rigaku.com/en/products/protein/micromax007](https://www.rigaku.com/en/products/protein/micromax007)

~~~
CamperBob2
_The MicroMax™ 007 HF is the most widely used home lab X-ray source for
protein crystallography and a popular source for small molecule
crystallographers who need the additional flux of a rotating anode generator._

Yow. I thought _I_ had a pretty hardcore home lab with my Faxitron cabinet
machine.

------
aussieguy1234
There is already prep, a once a day pill that if taken consistently, is over
95% effective at stopping HIV infection, I've heard some sources say it's 100%
effective. While it's not medically considered to be a vaccine, most vaccines
for other conditions have a lower effectiveness rate.

There is work being done to turn prep into an injectable chip in the arm, like
long term contraceptives, but for HIV prevention.

~~~
ekianjo
Can you point us to a source regarding this pill? Is it in clinical trials?

~~~
matthewmacleod
This is a medication that’s far beyond the clinical trial phase and is widely
available in many countries, though still subject to some large-scale trials
for this particular usage. There’s lots of information on sites like
[https://www.iwantprepnow.co.uk](https://www.iwantprepnow.co.uk) \- it’s
available through the healthcare system in some parts of the UK, purchasable
privately in others, and from what I understand available on some insurances
in the US.

It’s a combination of two antiretroviral drugs also used in HIV treatment
(Tenofovir and Emtricitabine) and the effectiveness of it can’t really be
overstated - my understanding is that there are only _two documented cases_ of
someone correctly using this drug becoming HIV-positive, and in both cases due
to rare strains with resistance to both drugs.

It’s not a vaccine, but it does change the picture massively for at-risk
groups.

~~~
craftyguy
> and in both cases due to rare strains with resistance to both drugs.

So then it is only a matter of time before we have 'super' HIV strains that
are resistant running around. Perhaps it's not such a great idea to have large
numbers of people exposing these drugs to the virus regularly, else we'll end
up with more resistant strains..

~~~
root_axis
So what are you suggesting exactly, an end to vaccines? What makes HIV any
different?

~~~
craftyguy
That is not a vaccine... No antibodies are created by the body to attack HIV.
There's a big difference.

------
DoreenMichele
I will note that since these are "diseases of the poor," a valid approach
would be to eliminate poverty instead of assuming it will always be with us.

You can't ever eliminate _relative_ poverty, which is about "keeping up with
the Joneses". But you can make real progress on _absolute_ poverty. This is a
fundamental difference between developed and developing countries.

We need to do this anyway to address the growing issue with antibiotic
resistant infections.

------
ezequiel-garzon
The title of the article seems to suggest no vaccines are available for these
diseases, but at least in the case of tuberculosis there is one [1]. The
article does refer to it:

“The foundation still hopes to show that booster doses of BCG, a century-old
childhood tuberculosis vaccine, can protect adolescents and that a vaccine
candidate it is developing with GlaxoSmithKline, the pharmaceutical company,
will stop latent tuberculosis from becoming active.”

[1]
[https://www.cdc.gov/tb/topic/basics/vaccines.htm](https://www.cdc.gov/tb/topic/basics/vaccines.htm)

~~~
classichasclass
BCG has its own issues, though. Immunity wanes after awhile, the protection is
incomplete and it seems to be more effective at preventing extrapulmonary
disease than pulmonary.

This by no means says it's useless. It has probably greatly diminished
pediatric tuberculous meningitis in at-risk counties, which can be devastating
(one of my nightmare cases was a two-year-old who lost part of his occipital
lobe to contaminated dairy). In low-prevalence countries, however, where
pulmonary TB is the primary concern, its utility is questionable.

[https://www.cdc.gov/tb/publications/factsheets/prevention/bc...](https://www.cdc.gov/tb/publications/factsheets/prevention/bcg.htm)

------
rdl
AIDS/HIV seems largely containable through PReP. I don’t know if long term
pervasive but not universal use of PReP by those at risk would eventually lead
to resistance to the medications used, though.

Malaria probably can be eliminated for single digit millions of dollars
through gene drive against specific species of mosquitoes which carry it.

TB scares me, mainly due to high risk populations and XDR variants.

~~~
shard972
We cannot stop AIDS/HIV research until gay sex is just as safe as hetrosexual
sex. Much higher priority than malaria according to where the money is being
spent....

~~~
rdl
Even if AIDS went away overnight, there would still be a whole range of other
diseases spread particularly through male homosexual sex, IV drug use, and
high-partner count or professional sex. I wonder at what point hepatitis
actually becomes more of a problem in rich first world cities than HIV.

~~~
kadendogthing
>there would still be a whole range of other diseases spread particularly
through male homosexual sex

Like what?

~~~
rdl
Hepatitis, especially correlated with HIV fear being reduced due to PReP, and
decreased use of condoms.

I believe a lot of other STDs and diseases caused by STDs (anal cancer from
HPV) are prevalent in certain communities at higher rates. It is a good
argument for increased targeted education and health resources for those
communities, both to help them and to reduce spread.

~~~
kadendogthing
>Hepatitis

This isn't limited to homosexual activity and is far more prevalent in
exclusively heterosexual "populations." In fact, there isn't a correlation
between any kind of sexual spectrum (though there are sexual activities that
increase risk of infection, male or female partners). It just _is_.
[https://www.ncbi.nlm.nih.gov/pmc/articles/PMC1195276/](https://www.ncbi.nlm.nih.gov/pmc/articles/PMC1195276/)

Where are you getting your information from?

>HIV fear being reduced due to PReP, and decreased use of condoms.

As a Western homosexual (there are more heterosexuals in the world with HIV
than homosexuals), this is a concern. But it's largely about HIV resurgence.
Condoms can help prevent a whole host of STI's/STD's so it's always just good
practice, and one that's been waning lately due to lack of education,
community reinforcement because of the former, and people thinking everyone is
on PReP. And of course, HIV isn't the death sentence it once was.

As far as other STD's go, you'll need to provide some data in regards to those
diseases specifically impacting the homosexual community.

~~~
rdl
There of course isn't one global homosexual community, but SF public health
and other targeted information is what I see the most of. It may be biased
just because it's pretty well funded and relatively well executed, but as
someone without particular interest in STDs, it's what I see the most
information about.

e.g. [https://josephsciambra.com/increasing-rates-of-all-stds-
amon...](https://josephsciambra.com/increasing-rates-of-all-stds-among-gay-
men-in-san-francisco/)

[https://www.sfdph.org/dph/files/reports/StudiesData/STD/SFST...](https://www.sfdph.org/dph/files/reports/StudiesData/STD/SFSTDAnnlSum2014.pdf)

[http://www.sfcityclinic.org/providers/PromotingSexualHealth_...](http://www.sfcityclinic.org/providers/PromotingSexualHealth_Clinicians_112717.pdf)

[https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4034619/](https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4034619/)

Re: Hepatitis: [https://www.cdc.gov/msmhealth/viral-
hepatitis.htm](https://www.cdc.gov/msmhealth/viral-hepatitis.htm)

In general total number of infected persons is probably not as meaningful a
metric in terms of transmission risk for a member of the population as rate
per 100k or rate of new infections per year per 100k in a group. There are a
lot more heterosexuals, non-IV-drug-users, and non-professional-sex-workers in
the world. It's also possibly worth normalizing rates based on age cohort or
number of sexual partners, relationship status, etc.; a monogamous gay couple
of 20 years is essentially certainly of lower STD risk than a heterosexual
with multiple new partners per year. But as a population, certain populations
do tend to engage in a constellation of riskier behaviors, and have higher
incidence of disease and of new infection.

~~~
kadendogthing
Of course a decrease in condom use would most likely yield an increase in STD
rates in _any_ community. I'm having trouble discerning which source supports
this:

>are prevalent in certain communities at higher rates.

You then seem to switch your perspective in the comment I'm replying to:

> total number of infected persons is probably not as meaningful a metric in
> terms of transmission risk

Which I would agree with, but you're not even addressing it. And of course the
obvious needs to be said, the total number of people effected is needed to to
ascertain which STD's "are prevalent in certain communities at higher rates."
I'm still trying to figure out which STD's (besides HIV in the Western
hemisphere), you're talking about.

Also if you're going to source stuff could you be bothered to not link to
opinion pieces that are just a collection of cherry-picked quotes? There was
no data or real scientific hypothesis involved. It was an opinion piece from
an author who has quite the record on fighting LGBT+ rights. In fact there are
two authors who clearly have a religious context to their arguments, a context
that is detrimental to any rational conversation about this subject. It's well
understood that such attitudes affect care and treatment, and the willingness
to seek out care and treatment for young LGBT+ people. At best it's just non-
sense, at worst such authors are actively helping the problem stay around.

~~~
rdl
1) "About 10% of new Hepatitis A and 20% of all new Hepatitis B infections in
the United States are among gay and bisexual men" (CDC,
[https://www.cdc.gov/msmhealth/viral-
hepatitis.htm](https://www.cdc.gov/msmhealth/viral-hepatitis.htm)) -- that's a
much higher number than the incidence of gay and bisexual men in the overall
population of the US (2-5%?).

2) "Gay and bisexual men and other men who have sex with men have the highest
prevalences of gonorrhea, chlamydia, and early syphilis." (SFDPH,
[https://www.sfdph.org/dph/files/reports/StudiesData/STD/SFST...](https://www.sfdph.org/dph/files/reports/StudiesData/STD/SFSTDAnnlSum2014.pdf))

3) "Men who have anal sex with men (MSM) are more likely to get anal HPV than
men who only have sex with women. Researchers estimate that the prevalence of
anal HPV among men who only have sex with women is around 15% while anal HPV
prevalence for MSM is around 60%." ([https://betablog.org/anal-cancer-hpv-gay-
men-need-know/](https://betablog.org/anal-cancer-hpv-gay-men-need-know/) which
references
[http://jid.oxfordjournals.org/content/203/1/66.full.pdf+html](http://jid.oxfordjournals.org/content/203/1/66.full.pdf+html))

~~~
kadendogthing
>that's a much higher number than the incidence of gay and bisexual men in the
overall population of the US (2-5%?)

1) A valid insight, but misdirected. The prevalence rate is still higher in
heterosexuals. You'll find a common point in many medical texts that a lot of
what happens in the homosexual community, disease wise, is due to how small it
is. A smaller network makes it easier/faster for every node to get the
message.

>Gay and bisexual men and other men who have sex with men have the highest
prevalences of gonorrhea, chlamydia, and early syphilis.

2) Right, in San Francisco. Not world wide.

>Men who have anal sex with men (MSM) are more likely to get anal HPV than men
who only have sex with women.

3) This isn't surprising, since homosexuals definitely have more anal sex than
heterosexuals. You should compare this to general HPV rates.

I am still awaiting support for your original claim about homosexual sex.

------
m3kw9
Is also unlikely given if everyone gets vaccinated, drug companies lose
hundreds of billions, they are likely to buy out and bury such endeavours.
Someone tell me I’m wrong to think that way.

~~~
HarryHirsch
The recent Hep-C antivirals (Sovaldi & friends) should be a counterargument.
With a course of medication you actually _cure_ Hepatitis C. Previously you'd
be looking at a liver transplant and taking immunosuppressants for the rest of
your life.

------
ars
This article is seriously lacking. For example this:
[https://www.hiv.gov/federal-
response/funding/budget](https://www.hiv.gov/federal-response/funding/budget)
says:

"With the generous support of the American people, the U.S. government has
annually committed more than $6.6 billion to bilateral HIV/AIDS programs, the
Global Fund to Fight AIDS, Tuberculosis and Malaria, and NIH international HIV
research."

And yet the entire world spent 3B on all vaccine research combined, of which
the US alone spent half?

The numbers are not adding up, unless most of the research is not for a
vaccine, and if that's the case the article should have said so.

~~~
thomasfedb
> unless most of the research is not for a vaccine

This. Only a small sliver of that would be for vaccine research, probably at a
handful of labs.

~~~
ars
So under the assumption that the researchers involved are smart people, they
believe that this is the best use of the money.

So why should I believe a random article that increasing _specifically_
vaccine spending is the right thing to do?

If it's only a small sliver, them to get the massive increase the article
wants, total spending must go up massively. Either that or the researchers are
not directing their money in the right proportions, which seems unlikely to
me.

Whatever the correct situation is, the article is seriously lacking for not
even mentioning any of it. And if that's the case, I am inclined to disbelieve
the entire thing.

~~~
lostmyoldone
Researchers are usually bright people, but funding is often decided by
entirely different people, and policy. But anyway ...

Vaccines, as well as antibiotics are hard to find/make and eithee have high
price sensitivity, nobody will pay a million for a dose of vaccine, or as with
new antibiotics, will only be used as a last resort to combat bacterial
resistance. As most medical research today is made by for profit companies,
less money is spent on things that are harder to make money on.

Many 'easy' vaccines are already done, and the same goes for antibiotics, so
there is. need to move public funding into the entire pipeline for these kinds
of substances. Almost forgot, antivenoms also suffer from this, mostly because
there are many venoms, and few victims.

------
sidcool
At least for HIV/AIDS & TB, a widely available and a sure cure would be great.
Of course nothing beats the efficacy of vaccination.

~~~
classichasclass
TB is very curable in most cases. The problem is it takes a long time, the
regimens can be difficult, and active cases become resistant if they're not
monitored (why we use directly observed therapy), and latent cases with the
typical treatment take just about as long.

What we really need for TB are shorter high-efficiency regimens. These would
be done quicker, leave less opportunity for drug resistance, and make progress
on today's latent cases which are tomorrow's active cases. The newer 3HP
regimen reduces latent treatment to 3 months instead of six to nine, but we
really need to get it down to weeks or less.

