SAN FRANCISCO — It is a question that scientist Robert Gallo frequently asks himself: why aren't the world's big pharmaceutical companies taking a more active role in the battle against AIDS?
"I go around giving lectures, trying to goose them into getting involved," says Gallo, the first U.S. researcher to isolate the virus that's believed to cause the lethal ailment.
"There's been a small increase in interest in the last few months, but we could still use a five or tenfold increase in private sector participation," says the National Institutes of Health scientist.
"Maybe they think we don't know enough about the virus yet," Gallo muses. "We do."
"Maybe they don't think the market is big enough," he adds. "It is."
Gallo is not alone in calling for more corporate help in combatting what some are now calling the greatest health threat of the century. But four years after the federal Centers for Disease Control first identified the new Acquired Immune Deficiency Syndrome, many pharmaceutical giants with the resources and expertise to develop new drugs against AIDS or a vaccine to prevent it are sitting on the sidelines.
Companies cite economics and the magnitude of the scientific challenge for their reluctance to invest tens of millions in the chancy quest for an effective treatment or vaccine. Other forces that have slowed industry's response include lethargy in corporate bureaucracies, failure to grasp the magnitude of the epidemic and, some charge, indifference because most of the disease victims in the United States have been homosexuals and intravenous drug abusers.
To be sure, some drug makers--most of them small or based in Europe--have launched active efforts to find a cure. About a dozen experimental compounds have been approved for testing by the Food and Drug Administration, some on an expedited basis. Most of those drugs, however, had been developed for other ailments.
Two manufacturers have applied for tax breaks under the "orphan drug" law, which gives companies incentives to market drugs for diseases affecting relatively small numbers of people.
Moreover, the scientific barriers are formidable. Few drugs have proven effective against any virus, let alone one like the suspected AIDS agent, which can lie dormant for years and "hide" in the brain, lungs and other body organs.
Even a successful attack on the virus would leave AIDS patients with badly deficient immune systems; the current thinking is that some sort of immune-system stimulator would be needed in conjunction with an antiviral agent.
Difficult to Produce
And because the AIDS virus is constantly mutating, scientists say a vaccine will be difficult--but not impossible--to produce.
But most scientists believe these challenges can be overcome with the proper investments of time, money and effort. "Throwing money at a problem rarely speeds up the solution, especially in a disease as complex as AIDS," says Dr. Edward N. Brandt, former assistant secretary of health and human services. "But neither does starving it." Critics blame several factors for the industry's sluggish response. "The association of AIDS with homosexuality and drug abuse gives it a tawdry flavor," laments Thomas Coates, a psychologist and co-director of the department of behavioral medicine at the University of California at San Francisco. "Other diseases, like lung cancer, are based on personal behavior, but there seems to be more compassion surrounding them."
Others blame corporate bureaucracies for industry's cautious approach. "Decision-making at big companies is slow, tedious and ponderous," says William Haseltine of Harvard Medical School and the Dana Farber Cancer Institute. Besides, he adds, "it's easier and more profitable to develop a new Valium than an antiviral specific for AIDS."
Pharmaceutical houses are also keenly aware that any AIDS vaccine would face the additional hurdle of this nation's product-liability laws.
Earlier this year, for example, a shortage of DPT (diphtheria, tetanus and pertussis) vaccine developed after two of the nation's three makers withdrew from the business when they had difficulty obtaining liability insurance.
May Need Legislation
"Until something is done legislatively, I don't think anyone will want to get involved" in production of an AIDS vaccine, says Thomas Perkins, chairman of Genentech Inc., a major genetic engineering firm.
The fact that companies are leaving the vaccine market "is a scandal for our society," says Donald Francis, a medical epidemiologist at the federal Centers for Disease Control who played a key role in the worldwide eradication of smallpox.
Some propose that the government assume liability for an AIDS vaccine. But it isn't eager to do so, having been hit with nearly $1 billion in claims as a result of its ill-fated swine-flu vaccination program in 1976. The program was canceled after more than 50 of the 42 million people who were inoculated were stricken with a sometimes fatal form of paralysis.