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 pandemi c, especially in less-developed countries. To ensure its future availabilit y 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 t he USA and Thailand. Initial results from these trials will be available wi thin 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 promotio n of the parallel development and assessment of other candidate vaccines is important. Financial mechanisms should also be developed as an incentive t o industry and to ensure equitable distribution of future vaccines in less- developed countries. Moreover, a concerted effort is needed to ensure the d evelopment and future availability of appropriate vaccines for Africa.