Tackling HIV and AIDS in China
IRA FLATOW, host:
By the end of 2004, an estimated 78 million people worldwide were infected with HIV, the virus that causes AIDS. And China is not immune to the epidemic. According to 2003 statistics compiled by UNAIDS, as many as a million and a half Chinese were thought to be infected with HIV. UNAIDS says China has one of the fastest-growing HIV epidemics in the world. My next guest has traveled to China where she is working on trials for an HIV vaccine. She's here in New York to talk about it. Sarah Schlesinger is research associate professor in the Laboratory of Cellular Immunology and Physiology at Rockefeller University and Aaron Diamond AIDS Research Center. She's, as I said, here with us in New York.
Welcome to SCIENCE FRIDAY.
Professor SARAH SCHLESINGER (Rockefeller University): Well, thank you for having me. It's a pleasure to be here.
FLATOW: How bad is it--is it fair to call it an epidemic in China?
Prof. SCHLESINGER: It is definitely fair to call it an epidemic. And it's an epidemic that's still growing and still in the early phases as compared to, say, the epidemic in sub-Saharan Africa, which would be considered a mature epidemic.
FLATOW: Mm-hmm. And does China recognize that and working towards...
Prof. SCHLESINGER: Yes. I mean, the good news is that, yes, China does recognize that, and I think they've begun to mobilize. And the resources of the developed world--both UNAIDS, the Gates Foundation, a number of other organizations including our own--have been called upon to help in that effort and use the experience garnered in other places in the world to help change the course of the epidemic, because the good news is it's still early enough to do that.
FLATOW: Mm-hmm. And how's it spreading? Is it in all parts of China?
Prof. SCHLESINGER: No, that's actually a very interesting question. There are two major sites of the epidemic, and the place where my colleagues and I work is Yunnan province, which is the southwestern portion of China that borders Burma. And that epidemic is largely fueled by IV drug use and the proximity to the Golden Triangle. There's also some spread of heterosexual sexual epidemic from Thailand, which is a more mature epidemic. And that epidemic is sort of an organic epidemic much like that in South Asia, Southeast Asia and Africa.
Prof. SCHLESINGER: There's an additional distinct epidemic farther north in central China in Henan province, which has been fueled by unsafe blood collection practices. And that's a unique and distinct epidemic that is--I think it's--you know, comparisons are odious and no epidemic is more tragic than any other, but this one's particularly poignant because it's taken place in the sort of agricultural heart of the country where there are these peasant farmers who are very poor in terms of cash, but they have agricultural riches, they have food.
Prof. SCHLESINGER: And the blood collection practices to make plasma that involved not changing the cassettes in the machinery that was used to collect the blood...
FLATOW: Right. Right. It spread AIDS...
Prof. SCHLESINGER: ...and spread that way.
FLATOW: ...HIV that way.
Prof. SCHLESINGER: That way.
FLATOW: And you're working on a vaccine.
Prof. SCHLESINGER: Yes, I am working on a...
FLATOW: Is it being tested in China?
Prof. SCHLESINGER: We're working--it will be tested in China. It's currently being tested in New York, and we are making all plans and working hard to move to a testing in China. Both here in New York and my colleagues in China are working on manufacturing the vaccine that will be tested in China.
FLATOW: And so you were telling me that you just signed up your last patient today.
Prof. SCHLESINGER: Oh, right. We just signed up our last patient today. So our vaccine is two distinct products; one that's DNA and one that's a modified smallpox vaccine. And we believe that we need to use both together to get the kind of immune response we hope for. So we've completed testing on the DNA portion. When I was here last year, we had just begun the...
Prof. SCHLESINGER: ...trial of the smallpox-like vaccine, and we enrolled our last volunteer this morning.
FLATOW: Why China? Why test it in China?
Prof. SCHLESINGER: Well, that's an interesting question, and the reason for testing it in China is probably complicated in several fold. Most simplistically, the epidemic is in a place where one can do efficacy testing. So to know if a vaccine works--because we don't have a good animal model that would give us the answer, nor do we have a test that we can do on people's blood who receive the vaccine--you have to go in, do what's called a field trial or a phase III efficacy trial, where you go into a place where there's a high incidence or a high number of people getting infected and you have to figure out how many people are getting infected, then you have to bring in all of the things to prevent infection that we already have--education, condoms, clean needles--then resurvey to make sure still enough people are getting infected to test it, and then ask people to come forward, volunteer in informed consent manner, you know...
Prof. SCHLESINGER: ...respecting human subjects protection--which is very, very important to us and to all of our colleagues--and then you give the vaccine to half the people or two-thirds of the people and you give a placebo or an irrelevant vaccine to the others, and then you follow and see who gets infected. And if all of your infections fall into the group that got the placebo, you know your vaccine worked. And if they fall equally in the two groups, sadly it didn't.
Prof. SCHLESINGER: And this is called a field trial. So to do that, you have to have a site. But you have to know where you're going to test it before you make the vaccine because you make the vaccine because you want to match it to the strain of HIV that circulates in the place that you're going to test it. So China was a place with the appropriate kind of epidemic, where my boss, David Ho, had both ties and the appropriate kinds of connections to allow the work to go forward, and so that's how the choice was made.
FLATOW: 1 (800) 989-8255. We're talking with Sarah Schlesinger of Rockefeller University and the Aaron Diamond AIDS Research Center, and Lester Brown, author of "Plan B, 2.0: Rescuing a Planet Under Stress and a Civilization in Trouble."
Lester, do you think the AIDS epidemic impacts the future of China here?
Mr. BROWN: Well, first of all, I wanted to say how exciting it is that we're at the point where, as Sarah was describing, we have a vaccine that has a chance of preventing AIDS. That's a major advance if it materializes in the field trials.
The thing that I think about in particular with an AIDS epidemic--and we have much more experience in Africa--is the relationship between disease and hunger, because as the--this disease uniquely takes its heavy toll among adults and particularly younger adults. There are a lot of villages in Africa where there's almost a missing generation now. There are elderly people and there are a lot of youngsters, but not many people in between. And in these villages, it's becoming very difficult to produce enough food to supply need. So hunger and malnutrition are expanding in Africa, in part, as a result of the AIDS epidemic there. But the infection rates are very, very high compared with those in Africa, of course.
Prof. SCHLESINGER: Wait...
Mr. BROWN: I'm sorry. In China, of course.
Prof. SCHLESINGER: Lester, what you say is absolutely true and tremendously poignant for anybody who's ever been to a village where you see this missing generation. And in the Henan epidemic, the one with the blood selling, that's already happened, and you see grandparents and small children and really nobody in the income-producing generation because they're all dead.
FLATOW: Do you find a different way that the Chinese are attacking the problem than other epidemics around the world are?
Prof. SCHLESINGER: Well, I think that in China, there's a tremendous amount of technology.
Prof. SCHLESINGER: There's a tremendous willingness to embrace technology, and there's a tremendous ability to get people to all work on something, which is--it's kind of mind-boggling, you know, me having come from New York, and there's infrastructure there that really doesn't exist in other places in the developing world. I mean, you have this odd juxtaposition of high tech and, really, developing world.
So, for instance, the vaccine on which I work--and I'd like to just make clear that both of these vaccines have been sold to the People's Republic of China for $1 by my boss, and so they are Chinese vaccines. And they've been embraced and taken on that way, which is wonderful on several levels.
FLATOW: So they're making it themselves.
Prof. SCHLESINGER: They're making it themselves. They have to...
Prof. SCHLESINGER: ...in order for it to be tested there. So the Institute of Medical Biology, which is where our vaccines are being made, makes more polio vaccine than any organization in the United States. I mean, they make the polio vaccine for China, so they know how to make vaccines. They have GMP manufacturing practices in place, they have the equipment, they have the personnel...
FLATOW: They have wealth. They have wealth there as opposed to other poorer countries that can't do this.
Prof. SCHLESINGER: Exactly. So they have technology...
Prof. SCHLESINGER: ...they have wealth and they have personnel who have both technological understanding and the ability to learn the stuff very quickly. And so that's a huge resource and a huge boon and a fundamental difference from, say, sub-Saharan Africa.
FLATOW: Yeah. Talking about AIDS in China this hour on TALK OF THE NATION/SCIENCE FRIDAY from NPR News.
Talking with Sarah Schlesinger at Rockefeller University and the Aaron Diamond AIDS Research Center; Lester Brown, president of the Earth Policy Institute.
Lester, things sound, you know, a little bit more hopeful than they do in other parts of the world, at least...
Mr. BROWN: In terms of AIDS in China you mean?
FLATOW: Yeah. Yeah.
Mr. BROWN: Yeah. Now the Chinese government has been slow to respond to the AIDS epidemic, but it looks as though it's beginning to take it seriously now and to move ahead, and that's encouraging. Obviously, with a population of 1.3 billion, anything that can be done to keep infection levels low is a major contribution.
FLATOW: Mm-hmm. I've just about a minute. I want to ask each of you to sum up, if you can. Lester, let me--I'm going to ask you to go first. Do you think that, you know, that we can head off this global tragedy that you see coming before we get to a tipping point?
Mr. BROWN: A lot depends on what we do in the next few years. Time is probably our scarcest resource. I didn't talk much about what we could do in this country with automobiles, gas-electric hybrids with batteries and so forth. But if we use wind energy--if we were invest at the same time we're investing in gas-electric hybrids with a plug-in capacity and build hundreds or maybe even thousands of wind farms across the country, we could essentially run our cars on wind energy and at a cost of something like the equivalent of 60-cent-a-gallon gasoline.
The neat thing about this, this model for the transportation sector, is that it is--it provides cheap energy and it is inexhaustible. It's also within our boundaries. So when you referred to "Plan B, 2.0" earlier as being sort of a grim report--but most of the book deals with solutions, and there's some very exciting ones there, including shifting to gas-electric hybrids and using wind power as a source of electricity.
FLATOW: Is this going to come from the grass roots up, or is the government ever going to take a hand from the top down?
Mr. BROWN: Right now it's coming from the grass roots up, but it could also be corporate leaders. I mean, I've talked and corresponded with Mr. Toyota, the senior member of the family at Toyota, in--near Nagoya in Japan and tried to encourage him to get a plug-in model on the market, because I think the interest in wind energy and the enormous potential we have could marry with that technology to create an exciting new automotive energy economy where we can largely run our cars on wind energy.
FLATOW: Did you talk to Toyota because you think Detroit just is not listening?
Mr. BROWN: Well, Toyota's way ahead in the thinking in this area. And unfortunately, Detroit is years behind in developing this technology.
FLATOW: Mm-hmm. Sarah Schlesinger, where does your vaccine go from here? What kind of timetable are we talking about?
Prof. SCHLESINGER: Well, I agree with Lester completely. I mean, time is our most precious resource with this epidemic, and we're acutely aware of that. Though to develop a vaccine also takes time, and we've been very fortunate in our ability to move as expeditiously as possible, that our colleagues in China have manufactured pilot lots which are getting qualified. And we're finishing the phase I trials here; there's one more to conduct, the combination trial. We're hoping to start that in this year, and that will be done within a year, we hope, as well. So within two to three years, we're certainly hoping to be in more advanced development in Yunnan...
Prof. SCHLESINGER: ...and that's the only thing that we can do, is put one foot in front of each other, do the work as expeditiously as we can and hope. You know, ultimately, we're going to have to be lucky. You know, the biggest question of all is will these vaccines work, and will they work--you know, they might not work to prevent the epidemic the way we might hope completely, but they might work well enough to make a significant impact.
Prof. SCHLESINGER: And that's really what we're all hoping for.
FLATOW: Well, good luck to you. Thank you very much for joining us.
Prof. SCHLESINGER: Thank you.
FLATOW: Sarah Schlesinger is a research associate professor in the Laboratory of Cellular Immunology and Physiology at Rockefeller University and the Aaron Diamond AIDS Research Center. Lester Brown is founder and president of the Earth Policy Institute; his new book, "Plan B, 2.0: Rescuing a Planet Under Stress and a Civilization in Trouble." A terrific read. I recommend all of you to pick up a copy.
Thank you both for taking time to be with us today.
Prof. SCHLESINGER: My pleasure.
Mr. BROWN: Thank you, Ira.
FLATOW: You're welcome.
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I'm Ira Flatow in New York.
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