R&D models: lessons from vaccine history

A preventive HIV vaccine offers the best hope for ending the AIDS pandemic. Scientific evidence suggests that an HIV vaccine is possible, and funding for HIV vaccine research and development (R&D) has increased substantially in recent years. The speed of progress toward an HIV vaccine will depend on the management of the effort as well as on its scale, however, and organizational issues have been the subject of vigorous debate. With this paper, we seek to shed light on these debates by examining the history of vaccine development, as well as some examples of large R&D initiatives in other areas. We focus on two issues: the roles of the public and private sectors, and the merits and risks of strong central direction of R&D. We also consider the scientific, regulatory, and institutional changes that complicate extrapolation from past experience to the case of HIV vaccines. Our analysis draws on extensive interviews with experts in the field as well as a literature review.