I recently stumbled upon another article involving ethics and an AIDS vaccine. The author stated that he believed despite studies showing that a specific AIDS vaccine could have increased the risk of HIV in trial participants, we should forge ahead with research and not look back. I should not have been surprised to learn that the author was the controversy-stirring Arthur Caplan.
Over two years ago, Merck Pharmaceuticals and the National Institute of Health announced the creation of a breakthrough vaccine. This vaccine was marketed to be different and more effective than any other AIDS vaccine available. However, it was learned at the end of last year that the vaccine did not come close to achieving the claims set forth. In fact, after testing the vaccine on 3,000 trial participants, it was learned that some may have developed HIV and died because of the vaccine.
Caplan acknowledges that this is an ethical problem but quickly brushes it aside and says that we should not be deterred--greater risks are at stake if we do not come a solution through a vaccine, even if it means more deaths along the way.
Personally, for such a highly valued man of ethics, I feel as if Caplan throws away the ethical issues present much too easily. How can he dismiss so readily the deaths which were caused by this vaccine? The participants were of course told that the vaccine was experimental but were also lead to believe that the vaccine was almost certain to be beneficial, or at worst would have a neutral effect. Never did these participants imagine that such a vaccine might actually give them HIV.
That being said, I do agree with Caplan that research should continue. However, I definitely think that more guidelines need to be put in place to ensure that a substantial "mishap" like this one does not occur again.
Source: http://www.msnbc.msn.com/id/22023841/
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I would have to agree with Caplan on this point. It is true that this vaccine may have the unforeseen effect of increasing risk of HIV, but this is no reason why research on this vaccine shouldn’t be continued. If (or when) scientists discover the cause of this increased risk and address the problem, there is no reason why they shouldn’t try again with human trials. After all, there is no guarantee that the next vaccine that is tried would be any safer anyways. As Caplan notes, there will always be unavoidable losses when advancing medical treatments. This is unfortunate but true – science is, after all, a trial and error process.
This case does however highlight one of the central problems of bioethics. Bioethics exists solely to protect the rights of human subjects, but is at a loss when the interests of one group of people conflicts with the interests of another – in this case the present health of a small group of test subjects versus the future health of the population in general. Let’s say the ethical community comes together and decides as a whole that research on this vaccine should be stopped. Would it be any different if the risks were slightly less and the potential benefits were slightly greater? Should the numbers matter at all, or should the presence of any risk preclude research on this vaccine? I would say that since generally accepted rules for these kinds of situations will probably never emerge, the best we can hope for is to handle these on a case-by-case basis, and in this case we should continue with the research.
Alana was incorrect in stating that Merck’s vaccine gave some of the trial participants HIV. It most certainly did not give them HIV. Instead, it increased their risk of contracting HIV. The vaccine was creating using the standard adenovirus vector, i.e. the vector that the common cold virus uses to infect people. There appears to be an inverse correlation between a participant’s immunity to the common cold and their likelihood of contracting HIV. That is, people who were more immune to the common cold were the ones that were infected with the virus, but the vaccine did not give the participants HIV. They did that to themselves.
A big issue that one must tackle in thinking about AIDS vaccine trials is that in order for the study to produce any useful results, the participants must be at high risk for contracting HIV because of their behavior (unprotected sex, sharing dirty needles etc.). In light of the fact that the vaccine was hoped to be effective, and if not, it should have not affected the participant’s risk of contracting HIV, it is incorrect to say that the vaccine caused the unfortunate deaths of those trial participants. Those people died of acquired immune deficiency syndrome, caused by the human immunodeficiency virus. This trial compared the vaccine to participants who had been given a placebo, and although I do not know for sure that any of them died, a good number of them also contracted HIV.
Having tried to counteract the vilification of Merck’s failed vaccine, I would hope that it is universally accepted that AIDS vaccine research must continue. Because there is no cure for AIDS and the triple cocktail therapy required to keep the disease under control is expensive, the development of a vaccine would be the best way to cope with the AIDS pandemic, especially in poor African countries. It is far worse to sit back and accept AIDS as a reality than to try to actively find a way to prevent the spread of this horrible disease.
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