YOKOHAMA, Japan — The U.S. government will boost its budget for basic laboratory research on the AIDS virus by 20% next year by shifting $70 million away from clinical studies now designed to test drugs and vaccines to curb the epidemic, Dr. William E. Paul, the new director of the Office of AIDS Research, said here Tuesday.
In another move that won the immediate approval of activists, Paul also said his office will sponsor new research on sexual behavior--an area of research that had been forbidden by the Reagan and Bush administrations and by conservative members of Congress.
Finally, Paul said he will minimize the role of government officials in directing research, relying instead on new funds to attract young researchers with fresh ideas.
"We must always recall that the path-breaking work, which has the capacity to transform our approach to this disease, will come from insights that cannot be planned in any administrative office," he said in an address to the 10th International Congress on AIDS.
Although clinical researchers here did not comment on Paul's proposal to shift funds from their programs to basic research, activists were uniform in their appreciation of the new plan.
"In the six international AIDS conferences that I have attended, I have never seen anyone from our government articulate a strategy that is as comprehensive and coordinated," said Mark Harrington of the Treatment Action Group. "He is using money in a way that is going to save lives."
The changes in research direction, added Kevin Frost of ACT UP/New York, "are so long overdue that it almost verges on the criminal."
The seeds for the changes were planted almost a year ago when Congress, in response to intense criticism by activists and some scientists, drastically reorganized the oversight of AIDS research within the National Institutes of Health. It wrested budgetary control for such research from the 14 separate institutes and vested it in the Office of AIDS Research, which previously had a part-time director, Dr. Anthony Fauci.
To run the AIDS office, NIH director Harold Varmus brought in Paul, an immunologist by training with no experience in researching AIDS--and, thus, presumably with no vested interests in any one facet of research on acquired immune deficiency syndrome. Paul, in turn, recruited an all-star panel of researcher-advisers, who recommended the new proposals.
The consensus of this panel--as well as of many AIDS researchers and activists--is that more basic laboratory studies are necessary if science is to come up with a way to combat the complex human immunodeficiency virus, which causes AIDS. Although much has been learned about the way HIV works, much remains unknown.
Researchers do not fully understand, for instance, how HIV spreads inside the body, or the precise mechanisms by which it wages its attack on the immune system. Unraveling these mysteries could lay the groundwork for developing better AIDS treatments and a vaccine to prevent infection with the virus.
Paul's ideas have to be taken very seriously, said Dr. Mervyn F. Silverman, chairman of the American Foundation for AIDS Research, "because he has power that the previous 'AIDS czar' never had--the power of the budget."
Paul himself emphasized that "OAR now has the authority to shift resources to meet these scientific priorities, and I can assure you we have already begun to do so."
OAR has control over a budget of about $1.3 billion, a full 12% of the entire NIH budget. About 42% of it is spent developing and testing new drugs and 9% on vaccines.
In contrast, only about 25% is devoted to basic scientific research, with the remainder going to prevention, education and other activities. The new proposal would shift about $70 million from other areas to basic research but would not increase overall funding.
Activists and researchers have charged that there is redundancy and wasted effort in the clinical trials portion of the budget.
Paul seemed to agree. "A more complete, coherent and cost-effective clinical research effort is necessary and possible," he argued.
In a major change from recent policy, Paul said his office will begin efforts to obtain information about the nature and extent of various sexual practices and substance abuse--proposals that in the past have been castigated by the religious right and others.
This information, said ACT UP's Frost, is "fundamental to our understanding of the pathogenesis of AIDS. Without it, we are wandering around in the dark."
"We've got to understand the nature of both substance abuse and sexual behaviors before we can begin to change them," Paul said.