AIDS breakthrough finds charitable champions

An inexpensive gel that could protect women from sexually transmitted diseases is finally getting the development funding it needs, but not from pharmaceutical companies.

By MARY JACOBY

© St. Petersburg Times,
published July 27, 2001

WASHINGTON -- Scientists have developed an inexpensive microbe-killing gel to protect women from AIDS and other sexually transmitted diseases. But big pharmaceutical companies have been unwilling to risk money to develop a product that offers uncertain profits.

In step the philanthropists.

The Bill and Melinda Gates Foundation, the Rockefeller Foundation and other charitable endowments are filling a gap between the free market and the goals of public heath advocates by funding the development of prophylactic vaginal gels and creams known as microbicides.

Advocates say microbicides will go a long way toward slowing the global AIDS epidemic. The innovation will be especially useful in developing nations where women do not have the power or status to require their sex partners to wear condoms.

Lack of condom use is a major reason AIDS is spreading virtually unchecked in parts of Africa and Asia. Latex condoms protect against transmission of HIV, the virus that causes AIDS. But many people find condoms unpleasant and disruptive and avoid using them.

A protective gel or cream that a woman could apply without her partner's knowledge would seem to be a promising alternative to condom use, both in the United States and abroad, said Polly Harrison of the Alliance for Microbicide Development.

The ointments also appear to work against herpes, chlamydia and the human papilloma virus, which can lead to cervical cancer. The Alan Guttmacher Institute estimates that the United States spends $8.4-billion a year treating sexually transmitted diseases.

But to be effective, such ointments must be available cheaply over the counter. And that's the problem, Harrison said: Pharmaceutical companies won't spend tens of millions of dollars on clinical trials to develop a drug that will not command a high price.

"Another thing is, they see the market as being primarily in the developing world, and they do not see the developing world as being able to pay a lot," Harrison said.

The federal government spent about $32.4-million last year on basic research on microbicides. The Gates Foundation came close to matching that amount. It gave $25-million to the non-profit Consortium for Industry Collaboration in Contraceptive Research in Arlington, Va., to help bring products to market.

In addition, the foundation gave $4-million to the New York-based Population Council to test a microbicide with the brand name Carraguard.

"Not a lot of folks were working in microbicides," said Gates Foundation spokeswoman Annemarie Hou. "We saw that it has huge benefits but faces many obstacles."

The Gates Foundation, created by the Microsoft co-founder and his wife, is the world's richest, with an endowment of $23.5-billion. It works to improve global health and education.

The $3.8-billion Rockefeller Foundation has also been involved in the debate and is about to get more involved. It is putting together a new initiative to explain microbicides to the public and promote them with policymakers.

Although Rockefeller trustees have not yet approved a funding level for this new initiative, it is expected to be several million dollars over several years.

Rockefeller also gave $75,000 in 1998 to start the Alliance for Microbicide Development, the advocacy group run by Harrison. Through a venture capital fund, it has given money to a small Philadelphia company called Biosyn that needs help testing a product called Savvy.

On the advocacy side, the Ford Foundation donated $1-million to the Global Campaign for Microbicides, founded in 1998. And a Washington, D.C., foundation called the Moriah Fund donated a similar amount to the Alliance for Microbicide Development.

So now the microbicide concept is a hot one in the foundation world, where ideas often get funded only after enough people are talking about them to create a buzz.

Advocates spent years trying to generate that buzz, touting microbicides at international health conferences and in other forums. Slowly, the concept took root in the minds of the program officers who control foundation purse strings.

"It took a long time to bubble up into the level of mainstream acceptability so people could say, "Okay, I can get behind this,' " said Megan Gottemoeller, international programs coordinator for the Global Campaign for Microbicides.

"Foundations work together. They all pretty much know what each other's doing. They like to be involved in things where foundations are joined together. There's more reassurance that it's a worthwhile endeavor," said Michael Harper, director of the Consortium for Industrial Collaboration in Contraceptive Research.

The consortium is distributing the $25-million from Gates to small for-profit pharmaceutical companies, including Biosyn, that need help paying for expensive clinical trials.

In securing the grant, it didn't hurt that Harper is a longtime friend and former colleague of Dr. Gordon Perkin, the Gates Foundation's global health program director, who made the grant.

Now, this nascent advocacy movement is pushing Congress to boost funding for microbicide research at the National Institutes of Health to $100-million a year. Rep. Connie Morella, R-Md., is the movement's chief ally in the House.

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