Promote prevention, not an AIDS vaccine BY CHARLES KRAUTHAMMER   The reviews are in on President Clinton's dramatic declaration pledging the United States to finding an AIDS vaccine, moonshot-like, within 10 years. Apart from AIDS activists who complain that the president did not commit serious moonshot money to the enterprise, the reaction was mostly favorable. Who, after all, can be against a vaccine against anything? No one seems to want to raise the obvious, if indelicate, question: Why embark on a huge national venture to create a vaccine for a disease that is already extraordinarily preventable? Unlike most communicable diseases, AIDS is not contracted casually. Unlike tuberculosis, it is not contracted by being coughed on in the subway. Unlike dysentery, it is not contracted by drinking the wrong water. To get AIDS you must, in all but the rarest cases, engage in complex consensual social behavior, namely unsafe sex or intravenous drug abuse. It would be nice to live in a world where one could engage in such behaviors while enjoying vaccine-induced immunity. But is that really a top national priority? Would any president propose as a top national priority an anti-lung-cancer vaccine so that people who smoke -- 48 million Americans do -- could do so with immunity? Nor do presidents call for a 10-year campaign to produce a vaccine against cirrhosis of the liver. Why? Not because we want to stigmatize people who drink or smoke. But for a very practical reason: These behaviors being voluntary and preventable, it makes a lot more sense to spend the scarce intellectual, scientific and financial resources of the country trying to give people immunity from diseases that they cannot otherwise protect themselves against. The classic case is polio. When FDR contracted it in 1921, we had not a clue how people got it. By the '50s, frightened parents kept their children away from swimming pools and movie theaters and even crowds. They lived in terror not knowing what they might be doing that was contributing to their kids' chances of getting polio. With no obvious behavioral cause, polio was the classic case of a disease crying out for a vaccine. Meningitis, cervical cancer and multiple sclerosis are in a similar position now. But AIDS? Moreover, Clinton is calling for a huge technological innovation (which many in the field doubt is a reasonable prospect anyway) to prevent the spread of AIDS. Yet, at the same time, the traditional way of controlling the spread of communicable diseases has been largely abandoned in the case of AIDS. And uniquely in the case of AIDS. We fight just about every epidemic -- tuberculosis, syphilis, gonorrhea -- by identifying carriers and warning their contacts. The usual epidemiological tracing has not been done for AIDS. Gay activists and civil libertarians have vociferously opposed it. And the politicians have caved. The story of this travesty -- ``the effective suspension of traditional public health procedures for AIDS'' -- is laid out in damning detail by Chandler Burr in the current Atlantic Monthly (``The Aids Exception: Privacy vs. Public Health''). ``AIDS has been so thoroughly exempted from traditional public health approaches,'' writes Burr, ``that civil libertarians have defeated in court attempts by health authorities to notify the spouses of people who have died of AIDS that their husbands or wives were HIV-infected.'' In 1985, in fact, gay activists brought suit to prevent the use of the first test for HIV, unless assured the tests would not be used for widespread screening of gays. Even today they oppose the mandatory HIV screening of pregnant women, even though we know that early treatment of the mothers would reduce by 50-75 percent the number of kids born with HIV. ``Traditional public health is absolutely effective at controlling infectious disease,'' says Dr. Lee Reichman, who works with tuberculosis and AIDS patients. ``It should have been applied to AIDS from the start, and it wasn't. Long before there was AIDS, there were other sexually transmitted diseases, and you had partner notification and testing and reporting. This was routine public health at its finest and this is the way STDs were controlled.'' Marcia Angell, executive editor of the New England Journal of Medicine, is blunter than most: ``I have no doubt . . . that if, for example, we screened all expectant mothers, we could prevent AIDS in many cases. And if we traced partners, we would prevent AIDS in many cases. And if we routinely tested in hospitals, we would prevent AIDS in many cases.'' And if we had a president with guts, he would be demanding these elementary measures to save people from getting AIDS today -- instead of waving a wand and telling scientists to produce for him a magic vaccine 10 years from now. Charles Krauthammer is a columnist for the Washington Post.