In April 2023, I was asked to review an article submission for a major history of medicine journal. As leading academic journals like Nature are now contemplating publishing peer review reports, and I myself have had a paper go through open review (ISIS-CB Pandemics Special Issue, see: https://pandemics.isiscb.org/essay.html?essayID=16), I thought it would be a good idea to post an example of how I review journal submissions. More importantly, I want to show how the peer review process involves broader discussions about where a particular academic discipline should go in light of recent historical developments, as well as how historians of medicine have conversations about analyzing and interpreting our sources. I’ve anonymized the title but left the quotes verbatim. It should be helpful for graduate students and early career researchers in history, the humanities, and social sciences who are either submitting or being asked to review papers. Enjoy!
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Novel HIV vaccine approach from Scripps Research and IAVI (Feb. 2021): https://www.scripps.edu/news-and-events/press-room/2021/20210203-hiv-vaccine.html
I am pleased to review <<A PAPER ON WHO’S HIV VACCINE RESEARCH COORDINATION>> for the Social History of Medicine (SHM). While this is a valuable and important research topic that I am very pleased to see addressed by fellow contemporary historians of medicine, unfortunately, my honest assessment is that this paper is not ready and that further rounds of peer review in SHM will not help get it closer to publication. My main concern is the lack of evidence.
There are interesting tidbits of information in the paper, but all we seem to really learn is that there were clinical trials for testing HIV vaccines, which in my view is not much of a scholarly contribution that we need rigorous examination of historical archival primary sources for. I am unclear how your 81 archival files obtained from WHO (do you mean IRIS or digitized files sent to you by the archivist in an official request?), combined with the materials from Pasteur do anything more than illustrate ‘the administrative heaviness of such an international collaboration’ (p. 9), which, forgive me, does not come across as particularly historically significant. I am not sure examining reservations of plane tickets and invitation letters is necessary – I usually ignore these and go directly to the correspondences between WHO and the clinical trial conducting institutions. For instance, with the Thai trials on IVDUs at Mahidol, there was an extensive debate between WHO, Thai researchers, and Mary Lou Clements-Mann (Jonathan’s wife who unfortunately passed away in the 1998 flight accident, also head of vaccine research at Johns Hopkins) on whether the VaxGen trials in Thailand should continue, when the parallel trials in the United States had a volunteer actually infected with HIV (which Cohen describes from the American-NIAID perspective in Shots in the Dark). It’s a fascinating dilemma on research ethics: are the Thai IVDU’s voluntarily being recruited, should trials conducted in different countries using vaccines from the same biotech company be stopped altogether? WHO has strong opinions on this and similarly historically significant information should have been in the files you purportedly examined.
This is reflected in the paper’s organization where, even having read it several times, the reader does not get a clear sense of the empirical timeline and the events unfolding, as well as the precise activities of WHO in vaccine coordination, beyond having a say in the selection of the clinical test sites. When exactly did WHO develop a network gathering data on HIV variability, which is necessary data for vaccine development? When did it develop standard operating procedures on clinical trials for HIV therapeutics and vaccines? Merson clearly lays this out in p. 199 and 207 of his book The AIDS Pandemic. I think you also missed that this universal biological standardization is one of the most important and classic roles that WHO has historically played –see Steve Sturdy, et. al., ‘Making Knowledge for Health Policy’ in a volume of SHM 2013. You also missed that WHO played an important role in issuing safety warnings about miracle vaccines and therapies produced by enterprising researchers in independent labs, which you mention in the paper but do not relate to WHO.
Furthermore, I would have wanted to see the author’s proficiency in the scientific literature and that the paper knows exactly why it has been so difficult to produce an HIV vaccine – there are so few cases of natural immunity or recovery (unlike, say COVID or other influenza-like viruses) and HIV has multiple strains, that it really complicates the research process. Moreover, there have been important scientific advances in terms of understanding how the HIV virus affects the human immune system. We also are recently seeing several cases of full recovery – will this affect HIV vaccine development? The literature review is also sparse – why not draw from pharmaceutical histories on the particularities of the vaccine (vs. therapeutics) business? I was surprised not to see Galambos and Sewell’s Networks of Innovation in the references, which is perhaps evident in why the paper treats the coordination of scientific expertise as a novel finding. From understanding the history of the vaccine business, the author would have known that vaccine development and clinical trials changed a great deal just prior to HIV (more conservative, more safe), which might have influenced WHO’s perceived need for international coordination by a UN multilateral.
I was also surprised to see no reference to the emergence of PPPs after UNAIDS to develop a vaccine, starting with Seth Berkeley’s IAVI and then GAVI (Gates) – subsequent events have shown that WHO was not crazy in thinking that smooth communication and sharing of results internationally in a significantly scaled-up global research initiative was essential to find and develop a successful vaccine. From this you would have known that many WHO vaccine people like Esparza went on to play important roles in these initiatives. Finally, there has been a lot of important historical work on WHO in other vaccine initiatives, such as with UNICEF on children’s immunizations, see William Muraskin’s work or smallpox variolation by Sanjoy Bhattacharya. Other people have addressed influenza vaccine coordination, TB-BCG and the Chingleput clinical trials in India, etc. The paper should have been able to answer: for HIV, where did WHO/GPA’s attempt at coordination fit into this new political economy and division of labour in terms of research, production, clinical trials, safety testing, approval, delivery, follow-up, etc?
This is reflected in the argument, which gives the reader an uneasy sense that the author is not confident in the following statement (p. 7): ‘that the work of WHO’s VAD committee configured a specific form of “experimentality”, a particular way of redistributing HIV research, not only by “mutating potential conflicts” but by rendering political power relations invisible, by presenting a so-called neutral position in order to promote access to study populations’. First, the fact that WHO-GPA wanted to coordinate all HIV efforts is not new for historians of medicine (Fee Cueto Brown’s institutional history, Merson and Inrig’s the AIDS Pandemic, and ‘Disease in a Debt Crisis’ vis a vis World Bank by Kanazawa Reiko, 2020, among others) so I am unclear on what we gain from learning that yes, indeed, in vaccines as well as in financing, etc., WHO was jealous of its coordinating role.
More importantly, I am not at all convinced that your paper has illustrated how within WHO’s trial design process (which by the way, was heavily informed by local researchers and required permission from health ministries), there was embedded ‘political and geostrategic constructions aimed at securing positions of power in Africa and Asia’ (conclusion, p. 26). I simply cannot encourage the imprecise use of ‘Western/international neocolonial global health’ argument based on selective and sporadic analysis of a few sources, mostly, because I do not believe this is a productive contribution that historians of medicine can make to current policy. This is not enough to explain the complexities of how and why WHO and other subsequent agencies/initiatives sought to coordinate scientific expertise, with the hope of adding vaccines to the public health response: a sensible and rational approach, in my view, since AZT and later combination therapies were already keeping people alive since 1987, even more so since the mid-1990s.
I would like to reiterate that I am very glad to see someone address this important topic. I do not want the author to be discouraged, and hope that they keep researching. Although this paper is not ready for SHM, it needs to be written. I encourage the author to visit WHO Archives in Geneva, do a more thorough search on all the publications of the individuals involved such as Esparza, and familiarize themselves with the scientific literature – perhaps even conduct some interviews. I believe Esparza worked with a Russian virologist, Saladin Osmanov, which is significant because of the bacteriophages research ongoing in the Soviet Union prior (Dora Vargha on socialist medicine and vaccine research with polio, it is good to see you cite her work). Nakajima Hiroshi’s files in WHO-Geneva Archives are not available to the general public as he was DG (I tried), but there are full folders relating to GPA. I believe all the HIV files have not been fully digitized but if you haven’t already, you really ought to set up an enquiry with their archivist through the WHO website. They are very helpful and capable, though perhaps still occupied with COVID. You may also want to read more deeply on Merson’s take on the Nakajima v. Mann conflict, as he was Mann’s successor and has an insider’s look.
In short, my honest assessment is that this paper is not ready and further rounds of peer review in SHM cannot help with this iteration. However, the above advice will hopefully help the author continue their research. Wishing the very best for future publication in another journal, perhaps very soon.
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