What to do with $88 million?

Community health and prevention measures like safe injection sites? Vaccine delivery initiatives? International AIDS programs? Basic research?

Having seen the flagship initiative of Canada’s long-term HIV vaccine strategy blasted out of existence with the cancellation of plans to construct a pilot lot manufacturing facility in Winnipeg, Manitoba, Canadian researchers and AIDS activists have a raft of views on how the government should repurpose the $88 million once ticketed for the initiative.

Anxious about how the government might spend that money, some are even calling for national consultations on a suitable plan to spend the money and ensure that Canada can adequately exploit fruits from the labour of the country’s AIDS and HIV vaccine research community.

For its part, though, the government is holding its cards close to its chest. The Public Health Agency of Canada (PHAC), which oversees how monies will be spent under the $137-million Canadian HIV Vaccine Initiative (CHVI), says it likely won’t make a decision until the fall.

“We’re actively working on this,” says Dr. Rainier Engelhardt, PHAC’s assistant deputy minister of infectious diseases and emergency preparedness. “It’s certainly not years. We’re talking about the next few months.”

But all the options under consideration will make a contribution to finding or preparing for an HIV vaccine, Engelhardt says.

The manufacturing facility was to have specialized in the production of small lots of vaccine for clinical trials. But PHAC said the project was cancelled after it was determined that none of the four bidders “met the bar” to qualify to host the facility (CMAJ 2010. DOI:10.1503/cmaj.109-3255).

The $88-million facility was to be funded in part by a $28-million contribution from the Bill and Melinda Gates Foundation. Engelhardt says both the federal government and the Gates Foundation are committed to repurposing this money and are enthusiastic about seeing it put to work as soon as possible.

Much of that enthusiasm stems from the recent success of highly publicized clinical trials in Thailand, he adds. The trial combined two different vaccines — AIDSVAX and a separate vaccine from Sanofi — and showed a 30% protection rate, the most successful HIV vaccine clinical trial to date.

The success of the trials opens up the possibility that some of the available monies could be used to prepare the community for the administering of an HIV vaccine, he adds.

Some monies may also be allocated to international initiatives. To date, about $10 million of the CHVI’s $139-million allocation has been spent, primarily to fund clinical trials, some of which were delivered under the rubric of the Global Health Research Initiative. That will likely continue as PHAC officials indicated that some forthcoming announcements will involve improving clinical trial capacity in Africa.

There are also hopes on the front-lines of the battle against AIDS that some money will be available for community health and prevention efforts.

To that end, those toiling on the front lines are calling for national consultations on reallocation of the $88 million. Monique Doolittle-Romas, executive director of the Canadian AIDS Society, says her organization has already written to the federal government requesting restoration of roughly $22 million taken from AIDS programs when the CHVI was launched.

Engelhardt, though, indicated that’s not in the works. The programs will not be restored, he says.

Still, Doolittle-Romas says it is essential there be a broad consultation on how best to use this money. “Government needs to gather input from the people who work in this field on a daily basis.”

Dr. William Cameron, president of the Canadian Association of HIV Research, says there’s considerable speculation that the government plans to divert some of the $88 million to the International AIDS Vaccine Initiative, a global program that has received significant funding from Canada in the past.

But that would be a mistake, Cameron says, as it would result in less financial support for many Canadian HIV/AIDS programs.

Cameron adds that there are promising areas of research that the scientific community could pursue, particularly in the area of prevention. Avenues could include hard reduction measures such as the promotion of safe sex and safe injection sites, he says, adding that “unfortunately, our government has not been very supportive of measures like that.”

The federal government could also issue a general request for proposals for basic research, Cameron says, arguing that Canada lags behind many developed countries in outlays for vaccine research. “Canada has a tremendous untapped potential in vaccine research and discovery. We’re just not realizing our potential and perhaps this money can help with that.”