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Shouldn't this be more of a temporary problem? As soon as there is a vaccine its patents will expire at least 20 years afterwards. And then lots of much cheaper

by gst 15y ago

Shouldn't this be more of a temporary problem? As soon as there is a vaccine its patents will expire at least 20 years afterwards. And then lots of much cheaper vaccines will flood the market.

burgerbrain 15y ago
And with any luck by that time everyone who has it but refuses to seek treatment will be dead, and everyone else will have been exposed to years of news about the vaccine.. and years of people refusing to take it dying. I think things should work out well in the end, but it might take a while.
- joshklein 15y ago
  "Refuses to seek treatment" is not necessarily a fair description of these people's actions. They can get HIV at birth through their mother without engaging in any "at risk" behavior. They can have it and not know it. They can lack education. They can lack resources. They can have received misinformation. There are places where the official government-endorsed treatment for HIV was sex with a virgin. There are religious notions that declare use of birth control sinful. There are moral police that call education about safe sex (instead of abstinence) wrong, despite its proven efficacy.
joshklein 15y ago
The tough part about vaccines is that they only protect the recipient from the disease if they get the vaccine, and they only eradicate the virus if everyone on the planet is vaccinated. The Science (making the vaccine) and cost (creating enough vaccine) are only two barriers. Getting everyone (and it really must be EVERYONE) to take the vaccine is a very challenging project. That's what makes the story of [edit: smallpox] so fascinating. Here's a relevant TED Talk about pandemics: http://www.ted.com/talks/larry_brilliant_wants_to_stop_pandemics.html http://www.ted.com/talks/larry_brilliant_wants_to_stop_pande...
- rdl 15y ago
  You don't need to get 100% vaccination to eliminate the disease; somewhere around 90% works, unless it's incredibly contagious and in a high density environment. "Herd immunity" protects the others -- basically, the disease itself can't spread if a sufficient number of people are vaccinated, so it dies out in a few generations (of the disease, not of humans).
  - ComputerGuru 15y ago
    From my classes in veterinary medicine, I believe the herd immunity is around the 80% mark, at least for livestock and their diseases.
    - rdl 15y ago
      It depends on a lot of factors -- how many people will catch the disease, assuming no one is vaccinated, per infected individual is the primary one). I think most livestock diseases are aerosols (foot and mouth disease, etc.), and so are a lot of human diseases, but thankfully not AIDS. The problem is the standard models of herd immunity depend on some simplifying assumptions which may be true in livestock, but are not true in humans -- specifically, that it's a homogenous population with equal chance of giving any other individual the disease, and that vaccines will be distributed fairly randomly as well. If you have backwater villages which never get vaccinated, and are highly interconnected, you can end up with persistent reservoirs of disease, even if it's only 1% of your overall population. Then, you can have periodic epidemics when an individual from that area travels to an unvaccinated area elsewhere (because compliance rates on vaccination go down once the disease is "cured" in a population). (I know about this from drinking with some of the UN/WHO vaccination people in Afghanistan)
byoung2 15y ago
Shouldn't this be more of a temporary problem? As soon as there is a vaccine its patents will expire at least 20 years afterwards. And then lots of much cheaper vaccines will flood the market. I think his point is that much of the problem of preventing the spread of HIV has less to do with the science of killing the virus, and more to do with the difficulty of actually getting it in the hands of people who need it. There are already very cheap, readily-available ways of preventing HIV transmission (condom use comes to mind), but people aren't using those. The reasons are varied, but some cite misinformation, cultural misconceptions, government ineptitude, and so on. Even if there were a 99% effective HIV vaccine that were as cheap as water, it still wouldn't make it into the hands of every person in the developing world. Proof of that is the fact that we can't even get water to all of these people.
- rflrob 15y ago
  Proof of that is the fact that we can't even get water to all of these people. Not sure how good an analogy this is. I suspect it would be moderately expensive (i.e. on the order of a few billion dollars), but possible to deliver a liter of clean water to nearly everyone in the developing world. The problem is, that solves their water problem for about 12 hours, if you're being generous. Solving their problem long term is the hard part. With vaccines, you only need to visit the people a finite number of times, and then you're done. Given that HIV is sexually transmitted (and assuming that the vaccine can be given relatively young), you wouldn't even need especially frequent visits to immunize the next generation of people.
  - spp 15y ago
    In the context of this discussion, I believe "a few billion dollars" would be pretty cheap.
rdl 15y ago
Patents aren't the problem here, but it's an interesting thought experiment to think about what commercial terms a vaccine for AIDS or other diseases which at this point mainly affect poor, third-world people would be distributed under. India would probably just violate the patent, claiming national security reasons, and sell it for ~production cost throughout the world. The USA might enforce a patent domestically, and it would be a rational economic choice for insurers to pay for it for many patients instead of long-term treatment if someone contracts AIDS otherwise -- if you have a 0.1% risk of contracting AIDS in a lifetime, and lifetime treatment costs $1mm, it's worthwhile to pay $100-$1000 for it. A charity (or government) might pay for full rights to the vaccine globally, and then distribute it for the good of humanity (and to burnish their reputation), but the really out of the box thing would be for a consumer product company to distribute the vaccine cheaply, purely as a form of PR. Imagine: "Coca-Cola, the drink that is good for you. Remember, we cured AIDS."
- nihilocrat 15y ago
  Insurance would not be quite as clear-cut, but I suppose it would be a sensible option. Companies would point to herd immunity (linked in the comments above) to avoid paying for vaccination for 30% or so of the population. I'm sure they have ways to put people into that 30%, and knowing them, they will try to cheat their customers of every penny they can.

by gst 15y ago

Shouldn't this be more of a temporary problem? As soon as there is a vaccine its patents will expire at least 20 years afterwards. And then lots of much cheaper vaccines will flood the market.

burgerbrain 15y ago

And with any luck by that time everyone who has it but refuses to seek treatment will be dead, and everyone else will have been exposed to years of news about the vaccine.. and years of people refusing to take it dying. I think things should work out well in the end, but it might take a while.

joshklein 15y ago
"Refuses to seek treatment" is not necessarily a fair description of these people's actions. They can get HIV at birth through their mother without engaging in any "at risk" behavior. They can have it and not know it. They can lack education. They can lack resources. They can have received misinformation. There are places where the official government-endorsed treatment for HIV was sex with a virgin. There are religious notions that declare use of birth control sinful. There are moral police that call education about safe sex (instead of abstinence) wrong, despite its proven efficacy.

joshklein 15y ago

The tough part about vaccines is that they only protect the recipient from the disease if they get the vaccine, and they only eradicate the virus if everyone on the planet is vaccinated. The Science (making the vaccine) and cost (creating enough vaccine) are only two barriers. Getting everyone (and it really must be EVERYONE) to take the vaccine is a very challenging project. That's what makes the story of [edit: smallpox] so fascinating. Here's a relevant TED Talk about pandemics: http://www.ted.com/talks/larry_brilliant_wants_to_stop_pandemics.html http://www.ted.com/talks/larry_brilliant_wants_to_stop_pande...

rdl 15y ago
You don't need to get 100% vaccination to eliminate the disease; somewhere around 90% works, unless it's incredibly contagious and in a high density environment. "Herd immunity" protects the others -- basically, the disease itself can't spread if a sufficient number of people are vaccinated, so it dies out in a few generations (of the disease, not of humans).
- ComputerGuru 15y ago
  From my classes in veterinary medicine, I believe the herd immunity is around the 80% mark, at least for livestock and their diseases.
  - rdl 15y ago
    It depends on a lot of factors -- how many people will catch the disease, assuming no one is vaccinated, per infected individual is the primary one). I think most livestock diseases are aerosols (foot and mouth disease, etc.), and so are a lot of human diseases, but thankfully not AIDS. The problem is the standard models of herd immunity depend on some simplifying assumptions which may be true in livestock, but are not true in humans -- specifically, that it's a homogenous population with equal chance of giving any other individual the disease, and that vaccines will be distributed fairly randomly as well. If you have backwater villages which never get vaccinated, and are highly interconnected, you can end up with persistent reservoirs of disease, even if it's only 1% of your overall population. Then, you can have periodic epidemics when an individual from that area travels to an unvaccinated area elsewhere (because compliance rates on vaccination go down once the disease is "cured" in a population). (I know about this from drinking with some of the UN/WHO vaccination people in Afghanistan)

byoung2 15y ago

Shouldn't this be more of a temporary problem? As soon as there is a vaccine its patents will expire at least 20 years afterwards. And then lots of much cheaper vaccines will flood the market. I think his point is that much of the problem of preventing the spread of HIV has less to do with the science of killing the virus, and more to do with the difficulty of actually getting it in the hands of people who need it. There are already very cheap, readily-available ways of preventing HIV transmission (condom use comes to mind), but people aren't using those. The reasons are varied, but some cite misinformation, cultural misconceptions, government ineptitude, and so on. Even if there were a 99% effective HIV vaccine that were as cheap as water, it still wouldn't make it into the hands of every person in the developing world. Proof of that is the fact that we can't even get water to all of these people.

rflrob 15y ago
Proof of that is the fact that we can't even get water to all of these people. Not sure how good an analogy this is. I suspect it would be moderately expensive (i.e. on the order of a few billion dollars), but possible to deliver a liter of clean water to nearly everyone in the developing world. The problem is, that solves their water problem for about 12 hours, if you're being generous. Solving their problem long term is the hard part. With vaccines, you only need to visit the people a finite number of times, and then you're done. Given that HIV is sexually transmitted (and assuming that the vaccine can be given relatively young), you wouldn't even need especially frequent visits to immunize the next generation of people.
- spp 15y ago
  In the context of this discussion, I believe "a few billion dollars" would be pretty cheap.

rdl 15y ago

Patents aren't the problem here, but it's an interesting thought experiment to think about what commercial terms a vaccine for AIDS or other diseases which at this point mainly affect poor, third-world people would be distributed under. India would probably just violate the patent, claiming national security reasons, and sell it for ~production cost throughout the world. The USA might enforce a patent domestically, and it would be a rational economic choice for insurers to pay for it for many patients instead of long-term treatment if someone contracts AIDS otherwise -- if you have a 0.1% risk of contracting AIDS in a lifetime, and lifetime treatment costs $1mm, it's worthwhile to pay $100-$1000 for it. A charity (or government) might pay for full rights to the vaccine globally, and then distribute it for the good of humanity (and to burnish their reputation), but the really out of the box thing would be for a consumer product company to distribute the vaccine cheaply, purely as a form of PR. Imagine: "Coca-Cola, the drink that is good for you. Remember, we cured AIDS."

nihilocrat 15y ago
Insurance would not be quite as clear-cut, but I suppose it would be a sensible option. Companies would point to herd immunity (linked in the comments above) to avoid paying for vaccination for 30% or so of the population. I'm sure they have ways to put people into that 30%, and knowing them, they will try to cheat their customers of every penny they can.