Accelerating the development and future availability of HIV-1 vaccines: why, when, where, and how?

An HIV-1 vaccine offers the best long-term hope to control the AIDS pandemic, especially in less-developed countries. To ensure its future availability we need to increase our research efforts today, including clinical trials. Although small-scale clinical trials of HIV-1 vaccines have been underway since 1987, the first phase III efficacy trials started only recently in the USA and Thailand. Initial results from these trials will be available within the next 2-3 years, and we must start planning now how vaccines should be used if found to be effective. In the meantime, the continuing promotion of the parallel development and assessment of other candidate vaccines is important. Financial mechanisms should also be developed as an incentive to industry and to ensure equitable distribution of future vaccines in less-developed countries. Moreover, a concerted effort is needed to ensure the development and future availability of appropriate vaccines for Africa.