A billion dollars goes to AIDS research annually, and that’s just scratching the surface.
Question: How has the technology you use changed?
Seth Berkley: I was talking the other day when I was living in Uganda, there was no email and we were still working by telex. It had great advantages because the telex machine could just be broken for long periods of time when you didn’t want to talk to anybody. The truth is that to operate as a small organization now in 24 countries across time zones would be impossible without the technologies we have, whether it be email, a web-based application, our ability to have sharing of data and operations. It just couldn’t happen. The other side of it now is that as we’re beginning to move into completely new science areas, we’re trying to solve these neutralizing antibody problems, we’re trying to do them in a high throughput fashion like they did for drugs, but these are for biologics. We’re using computation aspects that couldn’t be done without the technologies. We have a robot that now mechanizes the creation of crystals to try to look at the structures of these compounds. In the old days, it would take years of technicians’ hand time to try to do it. Now you can do years of technicians’ times in weeks and so it allows you to screen hundreds of thousands of experiments as opposed to tens and hundreds. It just accelerates the process of trying to come to a breakthrough.
Question: If research remains stagnant, where will AIDS be in 10 years?
Seth Berkley: It’s a very interesting question. All epidemics eventually burnout; they come to a steady state. So it would likely happen with HIV but at a minimum, 100 million people will have died. We don’t see the epidemic stopping spreading for a period in the near future and I don’t know what else would stop it. If male circumcision, which is a new issue that has come out, if microbicides got developed, if better drug therapy, if stigma could be removed -- so there is a plausible way to say we may slow it down more but the only way we’ve ever stopped a viral epidemic has been through the use of a vaccine. To me, that’s really the only way we’re going to do it. Without it, we’re probably going to see 30 or 40 million new infections.
Question: Is enough money going to AIDS research?
Seth Berkley: There is not enough money and part of it is, what is enough? Ten years ago, the world was spending about $150 million. If you think that an average product costs between half a billion to a billion dollars -- and this is a real tough scientific challenge -- you can imagine $150 million a year for the entire global expenditure: public, private, north, south. You weren’t going to get there. That number’s closer to a billion now so it’s a bigger number, it’s still an ideal. What you would like to do is get it to a level where all experiments are moving in parallel and you’re taking sufficient risks. So there’s two issues: one, trying to get more money but as important is how that money is spent. We need basic science. We need investigator-originated research that allows people to follow their own needs. But we also need consortia and applied programs to try to solve things. And last, we need risk capital. We need capital that can be put on very, very high-risk things that we know most of it’s going to fail with the idea being that we’re going to try to drive innovation.
Question: Is male circumcision relevant?
Seth Berkley: The male circumcision thing is interesting. Even when I lived in Uganda now close to 20 years ago, we had cross-sectional evidence that suggested that men who were circumcised were less likely to get infected than those that weren’t. The challenge was that circumcision as you can imagine has a lot of other confounders: different religions, different beliefs, all kinds of other socio-economic issues, et cetera. So the challenge is how do you separate all that? So for the first time, a series of prospective studies have been done looking at this and they confirmed that in fact if you’re circumcised, you’re less likely to get infected than if you are uncircumcised. These studies prove this. The question is, is this a practical effort? It certainly wouldn’t solve the problem but how many places can do it? What are the cultural issues, social issues? When is it done? What are the risks of doing it in those circumstances when you don’t necessarily have the best surgical grounds, et cetera. But there is a movement now to try to roll that out and that presumably will have an effect on the epidemic as well. In addition, people who are treated in stage of life probably don’t transmit as well. That may have an effect on the epidemic and there’s a parallel effort to what we’re doing to try to create microbicides. These are substances that women can use to protect themselves against infections. All of those may together affect the dynamics of the epidemic. We hope so.
Question: Why is AIDS such a sensitive topic?
Seth Berkley: I think that at the end of the day, people have a hard time focusing on the long term. People want immediate gratification. It’s an unbelievable thing in AIDS when you see somebody who is dying and you can put on drug therapy and they have the so-called Lazarus effect: they get up, they look healthy, they lead a productive life. It’s really moving. If you can stop prevention from mother to child, it’s an unbelievable thing to save those lives. So these are really important things so people tend to focus on that stuff. But it’s also critical to look at the population dynamics and trying to make sure it is an either/or that we have an effort that’s going on over the long term. The problem with long-term stuff is there aren’t necessarily politicians who are going to be there when this happens. There’s not necessarily a funding person who’s going to be there when it happens and so the challenge is getting people to think in the long term. As you know, I don’t need to tell you that our society’s become more and more short-term focused, quarterly earnings, instant information on the internet all the time. So taking that long-term view has been less popular and yet, if we’re going to solve these big global problems, we’ve got to be able to focus on the long term and I think that’s going to be one of our challenges.