AIDSWEEKLY Plus; Monday, September 21, 1998
Daniel J. DeNoon, Senior Editor
The loss of Drs. Mary Lou Clements-Mann and Jonathan M. Mann in the crash of Swissair Flight 111 represents a terrible blow to the international AIDS effort.
The two researchers followed different paths, but shortly before their deaths each made major efforts to support empirical development of AIDS vaccines. In March 1998 Mann blasted the so-called rational approach to HIV vaccine development as "unethical practice" that "violates human rights of Americans." And in May 1998 Clements-Mann publicly criticized the National Institutes of Health for failing to grasp the urgent need for an AIDS vaccine.
In their tireless efforts against the AIDS pandemic Mann and Clements-Mann accomplished a great deal.
Mann became well known as an AIDS crusader in 1984, when he took on the directorship of Project SIDA in Zaire. He was one of the first scientists publicly to recognize that human rights issues lie at the core of AIDS prevention efforts.
In February 1987 Mann was named founding director of the World Health Organization (WHO) Global Program on AIDS. His aggressive leadership of the program challenged governments to end the stigmatization of groups at risk of acquiring HIV and to institute public health programs. Mann left the WHO in 1990 when the organization's leadership demanded control over AIDS policy. He then joined the Harvard School of Public Health and this year became dean of Philadelphia's Allegheny University School of Public Health.
Until the end of his life, Mann remained a staunch advocate for seeing AIDS as a human rights problem. In his March 1998 presentation to the Presidential Advisory Council on AIDS, he argued that there would be no delay in empirical trials of AIDS vaccines if the disease affected affluent people instead of marginalized populations.
"The failure to proceed to field trials, in the context not of an ideal world but in the real world of successful vaccine development, is unethical and violates human rights," Mann said. "The failure to act, like silence, has moral consequences."
Mann felt deeply that when one person is able to help another, he or she is morally obliged to do so. Mann maintained this standard in his own life and never gave up trying to get his nation - and the world - to adopt it.
"The key ethical concept of concern is the duty to help people in need, and the central human rights violations involve the right to share in scientific advancement and its benefits, and the rights to non-discrimination and to life," he said.
Clements-Mann specialized in the design of clinical trials for vaccines. Prior to and during her work on AIDS vaccines, she was involved in the development and testing of vaccines against respiratory and diarrheal diseases.
She was one of the organizers of the National Institute of Allergy and Infectious Diseases AIDS Vaccine Clinical Trials Network and the later AIDS Vaccine Evaluation Group (AVEG).
In an address to the May 1998 First Annual Conference on Vaccine Research, Clements-Mann strongly urged the National Institutes of Health to change its current policy of rational drug development. This policy, advocated by David Baltimore, chair of the National Institutes of Health AIDS Vaccine Research Committee, is to quickly conduct small trials of candidate vaccines as they become available. Information gleaned from these small trials wold be used to develope improved vaccines, and the process would be repeated until researchers arrive at a vaccine considered to have a good chance of efficacy. Only at that point would large-scale trials be conducted.
Clements-Mann vehemently disagreed. She favored the traditional approach of large-scale, iterative clinical trials - not laboratory research based on analysis of small numbers of subjects - to answer crucial safety and efficacy questions.
"AIDS is a fatal disease," she said. "Ninety percent of the world can't afford drugs. Many populations - even in this country - are willing to volunteer. Is it ethical not to do a vaccine trial? If this epidemic occurred in 40,000 U.S. university students, wouldn't we be doing a Phase III study? ... When you get right down to it, what are the drawbacks of doing a [large-scale] study?"
It can only be hoped that the legacy of personal integrity that Clements-Mann and her partner brought to AIDS research will not die with them.
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