Inter-Country Parliamentarians Workshop

“The Challenges of HIV/AIDS: A Special Focus on Preventative Vaccines”

30 October-1 November 2003

Bangkok, Thailand

Tim Barnett, Labour MP

Emma Dunlop-Bennett, Programme Manager, FPAID

Background

This conference was organised by the International AIDS Vaccine Initiative (IAVI) and the Asia Forum of Parliamentarians on Population and Development. It was supported by the Parliament of Thailand, Ministry of Public Health, International Medical Parliamentarians Organisation, and UNAIDS.

There were 49 participants at the conference from Australia, Cambodia, China, India, Indonesia, Laos, Malaysia, New Zealand, Philippines, South Africa, Thailand and Viet Nam.  There were no representatives from the Pacific.  A full list of participants, resource people and observers is provided in Appendix 1.

The objectives of this conference were:

1. To increase awareness amongst parliamentarians from Asia and the Pacific of the need for an AIDS vaccine to fight the pandemic. 
2. To bring together to learn about the key challenges and opportunities for development and distribution of a vaccine to prevent AIDS.
3. To encourage international cooperation and collaborative measures in policy development to promote the need for an AIDS vaccine.
4. To identify actions which parliamentarians can specifically employ to support trials to find a successful AIDS vaccines.

The conference was held over two days at the Siam City Hotel in Bangkok, with an extra meeting for secretariats of parliamentarian groups held on the third day. 

The following is a brief summary of the papers presented at this conference.

Summary of Conference

Opening Ceremony:

Senator Dr Malinee Sukavejworakit, Secretary General of AFPPD and Chairperson of the Advisory Board of Senate Standing Committee on Public Health, welcomed participants with a brief introduction of the successes of AFPPD over the past year, including its work on violence against women, population and HIV/AIDS.

Poi. Gen Pracha Promnog, Deputy Minister of Public Health of Thailand, told conference delegates that nearly 8000 people die of AIDS every single day and that as parliamentarians and leaders in their communities, they must demonstrate strong leadership and explore avenues for further strengthening cooperation to combat this crisis. 

H.E. Senator Manoonkrit Roobkajorn, President of the Thai Senate, spoke about the challenges of the HIV/AIDS pandemic and recommended a multisectoral multiministerial strategy in order to meet this challenge.  Strong political will is critical and the senator told the parliamentarians that as elected representative of the people, they have a role in supporting their respective governments to develop effective strategies to prevent HIV/AIDS from spreading. 

Mrs Kate Bourne, Vice-President of the International AIDS Vaccine Development, said that parliamentarians are the key link between talk and action and that political leadership at all levels is essential to moving forward.  She said that IAVI’s work faced challenges around a) scientific difficulties, b) the stigma surrounding this disease and c) this disease was most prevalent in countries which face competing pressing problems.

Mr Kapil Sibal, a parliamentarian from India, concluded the opening addresses by reiterating the important role of parliamentarians in influencing perception, increasing public awareness, developing and supporting legislation, attracting media attention and mobilizing support.  He concluded by saying that, “extreme political support

Session One:

Overview of HIV/AIDS in Asia

Mr Paul Toh, Community Mobilisation Advisor, UNAIDS/SEAPICT

Asking whether we are doing enough to fight AIDS in South Asia and South-East Asia, Mr Toh presented a review of the situation in:

• Nepal which is just uncovering the epidemic
• Viet Nam where there is rapid spread in the cities
• Indonesia where the epidemic is taking hold
• China which has a growing heterosexual transmission
• Cambodia where prevention has made an impact
• Thailand which is seeing the benefits of prevention.

Mr Toh said that HIV transmission trends could be altered, as in the cases of Thailand and Cambodia, through strong political will and well-funded prevention efforts. However prevention in other countries is lagging, i.e. a) low condom use, b) little awareness, c) limited coverage of prevention programmes and d) rare effective responses. Mr Toh concluded by saying that, “the response will determine the course of Asian epidemics – the future is in our hands”.

Session Two:

Introduction to Vaccine Research, Development and the Clinical Trial Process

Prof Emeritus Prasert Thongcharoen, Chair of the Subcommittee on HIV/AIDS Vaccine Development, Ministry of Public Health, Thailand

Working from the basis of “prevention is better than cure”, Professor Thongcharoen said that a vaccine is imperative given that every day 16,000 people are infected with the virus.  Approaches in HIV prevention include:

• Education and behaviour modification
• Drug abuse treatment
• Condoms and other barriers
• Cleaned syringes
• Topical microbicides
• Interruption of mother-to-child
• Vaccination.

Immunisation is a well-established method of preventing viral infections.  Further the passive transfer of anti-HIV to monkeys has prevented infection under certain conditions.  To date, several HIV vaccine candidates in early human trials have been safe and immunogenic and bio statistical modelling suggests that even a partially effective preventative intervention may have a powerful effect on the epidemics.  Professor Thongcharoen then gave participants a detailed explanation on the trial process including; issues to be considered before a trial, selecting a vaccine candidate, the steps in vaccine development, the types of experimental AIDS vaccines, recombinant live-vector vaccines and possible outcomes of immunisation against HIV.  He concluded with a brief outline of the state of current AIDS vaccine research in Thailand.

Introduction to HIV/AIDS Vaccine Trials

Jean Louis Excler, Scientific Director, IAVI, India

Dr Punnee Pitisuttitham, Associate Professor, Faculty of Tropical Medicine, Mahidol University

Vaccine research is extremely complicated, technical, risky and expensive.  In addition to the challenges of the science are the issues related to the ethical treatment of trial volunteers, confidentiality of information and the sheer volume of detail, data management and analysis, as well as the potentially tremendous regulatory hurdles involved in moving a candidate through the three-phase trial sequence.  Science says a vaccine is possible; what is needed is the support of the global community in terms of committed resources and enabling policies.

Session Three:

Experiences of Parliamentarians

Dr David Apuuli, Director General, Uganda AIDS Commission

This session focused on recapturing the experiences of the site visit and of the first day’s discussions in considering the role of parliamentarians in creating a facilitating environment for vaccine development and use.  This session was moderated by Dr Apulli, who shared with participants the experiences of Uganda, which has turned the HIV/AIDS situation around.

Session Four:

A Comprehensive Approach Towards Ending the Epidemic: Prevention, Treatment, and Vaccines

Dr Praphan Phanupak, Director, Thai Red Cross AIDS Research Centre

Dr Surya Chandra, MP Indonesia

Each side of the “comprehensive approach” (prevention, treatment and vaccines) has its special value, challenges and limitations.  The total package is required to stem the spread of a disease that has infected over 42 million people, most in the developing world.  This session will focus on actions that can minimise existing hurdles and maximise future actions to all services.  The second part of this presentation focussed on the role of parliamentarians in this comprehensive package

The Role of Media in Supporting HIV/AIDS Vaccine Development

Mr Dilip Cherian, India

Mr Tawee Jantrapromlin, Thailand

Mr Cherian’s presentation focused on:

• why media matters: because it creates public opinion
• understanding media: media is not a homogenous entity but is increasingly fragmented, specialised, and therefore needs a planned strategy
• managing misreporting: assess the damage and talk to the journalist.  Be careful about the next interaction with the journalist.
• management of technical knowledge: the level of understanding varies between journalists and be careful of talking jargon
• how to make media an effective partner: prepare yourself, customize information, communicate positively and realistically and be simple.

Session Five:

Vaccine Development and Access: A Global Responsibility

Mrs Kate Bourne, Vince-President, International AIDS Vaccine Development

Mrs Bourne reiterated that a vaccine is the only long-term solution to the epidemic and that IAVI’s mission is to ensure the development of safe, effective, accessible, and preventative HIV vaccines for use throughout the world.  Usually it takes 35 years after development for a vaccine to be accessible in most countries.  This is too long in terms of the HIV/AIDS pandemic and highlighted that a new approach is needed which focuses on:

• accelerating research and development
• vaccine financing
• regulatory issues
• manufacturing
• understanding demand and use
• delivery infrastructure.

To address the challenges of developing a vaccine, local, national, regional and global leadership was crucial.  Mrs Bourne answered concerns about the vaccine being available to people in developing countries, by saying that any vaccine that IAVI develops will be easily accessible.

Session Six:

Group Work and Report Back: 

The participants were divided into two groups to discuss:

a)      accelerating research and development

b)      accelerating access

Both groups gave their recommendations to IAVI who collated them onto one page and distributed it to all participants.  During the report back, there was some debate over the wording that IAVI used, as there were several occasion where it varied from what was discussed during the groups’ session.  Following this discussion, IAVI agreed to amend the one page handout.  However due to time constraints, the amended version was not redistributed.  

Call to Action

Senator Mechai Viravaidya, President, Population and Development Association of Thailand

Mr Shiv Khare, Executive Director, AFPPD

Throughout the two days of the conference, a drafting committee worked towards a “Bangkok Declaration” for the parliamentarians to sign.  IAVI assisted this process by giving the drafting committee a final version of a declaration, which they themselves had written.   The drafting committee did make some major changes to this declaration, some of which were not reflected in the final version, which was presented to participants during the last session.  While a discussion did arise over several points of the Bangkok Declaration, in the interest of time all parliamentarians signed the declaration.   The workshop was then closed with a few remarks from:

• Senator Dr Malinee Sukavejworakit, Secretary General, AFPPD and Chairperson, Advisory Board of Senate Standing Committee on Public Health, Thailand
• Mrs Kate Bourne, Vice-President, International AIDS Vaccine Development
• Mr Shiv Khare, Executive Director, AFPPD.