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To Improve Human Health: A History of the Institute of Medicine
The 1986 report had called attention to the international aspects of AIDS and recommended that the United States be "a full participant in international efforts against AIDS and HIV infection." As a step toward facilitating this involvement, the IOM organized a workshop, held in October 1987, that focused on the epidemiology of AIDS in an international context. The United States Agency for International Development funded the small workshop that was intended to review "the art of modeling of HIV transmission and the demographic impact of AIDS." Burton Singer, head of Yale's Department of Epidemiology and Public Health, chaired the steering committee, which also included authorities from Europe, Canada, and Africa. Participants at the workshop came from around the world, but all spoke a common statistical language. Despite the elegance of their methods, the epidemiologists and demographers admitted that the "development of reliable, specific long-range predictions was out of reach of current or foreseeable model capabilities and data." The data did suggest that the number of AIDS cases "was certain to grow for many more years" and, in particular, that AIDS in Central Africa would cause "substantially increased mortality in the general population.'' Participants agreed that they needed to know much more about sexual behavior—the frequency of sexual contacts, the duration of partnerships, the selection of partners—in order to understand the course of the epidemic. They realized, however, that the ''ethics of answering questions about sexual behavior" differed from country to country, complicating the process of creating an international data set. In the end, the workshop on modeling AIDS, like the conference on drug development, highlighted problems rather solutions. It also served as a forum for a much-needed international discussion on the size and shape of the AIDS epidemic.31
At the end of 1987, the IOM held a third workshop on AIDS, this one concerned with vaccine development. Support came from the Pharmaceutical Manufacturers Association, the National Cancer Institute, and the National Institute of Allergy and Infectious Diseases. David Baltimore headed the small steering committee for this conference, which included experts in immunology, retrovirology, vaccine design, and vaccine evaluation. Baltimore began the conference with another gloomy assessment about the prospect of a vaccine. He vowed, however, to continue the work "along every possible line of attack because the only way that science can produce its surprises is if we keep working at it, but I suspect that in the long run we are going to need more than a standard surprise." The conference was intended to be a meeting of scientists talking to other