No Free Lunches for AIDS Research in Europe


Applied Clinical Trials

Clinical research is playing a prominent part in the European Union's response to HIV/AIDS in its member states and in neighbouring countries in eastern Europe, according to a review by the European Center for Disease Prevention and Control.

Some of the ongoing work funded by the EU is listed in an interim "special report" entitled "Monitoring implementation of the European Commission Communication and Action Plan for combating HIV/AIDS in the European Union and neighbouring countries, 2009–2013."

One project, known as EUROPRISE; is promoting integrated research on HIV vaccines and microbicides and is exploring whether combined use of these two technologies can lead to more effective prevention. The partners have been involved in 31 clinical trials and have produced more than 200 peer-reviewed publications. The network, which has established collaboration between European and US researchers and with industry partners such as Novartis and GSK, has also played an important role in promoting a harmonized experimental approach and use of standardized reagents, says ECDC.

A consortium of 10 European partners known as THINC, coordinated by Leuven University in Belgium, has taken forward the development of a new class of anti-HIV drug, building on earlier research and working in partnership with the pharmaceutical company Tibotec. Successful negotiations have been concluded with Pfizer further development studies and clinical trials after project funding ends, says the report.

The NEAT network of excellence is implementing clinical trials for new treatment combinations, and has recently commenced a randomized clinical trial that will enrol more than 800 patients in 15 European countries—a trial of unprecedented scale in Europe. Coordinated by the Istituto Superiore di Sanita in Italy, it involves 41 partners and has promoted collaboration between European researchers on more than 21 clinical trials.

Overall, the money funds HIV prevention, increasing access to prevention, treatment, care, and support, especially in priority regions and for priority groups, research, surveillance, and monitoring and evaluation. And the money is substantial. In the research programme that ran from 2002 to 2006, the EU contributed 123 million euros to 41 projects on HIV-related research and 200 million euros to the European and Developing Countries Clinical Trials Partnership. During the first five years of the current programme (2007–2011), the total EU contribution to 17 HIV-related research projects was more than 82 million euros.

Most of this spending (94 per cent) was on development of treatment, vaccines, and microbicides, with a small allocation for basic science. Of an estimated annual spend totalling 27.1 million euros on this EU policy, research funding amounts to 16.4 million euros, says ECDC.

All very impressive. But the ECDC report is not entirely satisfied with the arrangements. "The balance of research funding does not fully reflect the priorities identified in the Action Plan," it complains. Allocating research funding primarily to biomedical research may be understandable given the "inherent comparative advantages" of regional research initiative. But the result is that less funding has been provided for social and behavioral research and socioeconomic analysis—which merits greater attention, suggests the report.

Worse, the outcomes of the spending are less than satisfactory. Little evidence is available on the outcomes" of the "substantial" support to strengthen research capacity, networking, and collaboration. And worse still, "Commission engagement with the private sector appears to have had limited impact on antiretroviral pricing and treatment coverage or the coverage of HIV-related workplace programs." ECDC argues for a tighter rein and a clearer direction—better-focused research and cheaper medicines. "The European Commission should develop and implement a strategy for engagement with the private sector, including the promotion of increased commitment by EU member states to the dialogue on affordable antiretroviral drugs," it says. No such thing as a free lunch for industry!

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