OPINION | We are closer to an HIV vaccine now more than ever before

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It took less than a year for researchers to develop a vaccine against Covid-19. The search for an HIV vaccine began almost 40 years ago.

The unprecedented pace at which the Covid-19 jabs were developed and the scientific breakthroughs they required have re-energised those efforts to develop an HIV vaccine. But they have also raised critical questions about what could have been if the search for an HIV vaccine had met with the same resources and political will as the coronavirus pandemic.

Consider that between 2000 and 2019, $15.3bn was spent on the research and development of HIV vaccines, according to the Resource Tracking for HIV Research and Development Working Group. According to an analysis by Devex, by August 2020, less than a year into the pandemic, more than $39.5bn was slated for spending on Covid-19 vaccine research and distribution,

As the world marks HIV Vaccine Awareness Day today, it is a chance both to recognize the possibilities that the search for Covid-19 vaccines have created and to demand that those opportunities be seized for HIV vaccine research.

No opportunity is more exciting than that offered by the recent breakthrough in mRNA vaccine technology. For decades, researchers have been considering what would happen if they customized synthetic messenger RNA, or mRNA, to trigger cells to develop a specific protein that simulated part of a virus and then injected the mRNA into people’s bodies.

The theory was that the protein production would trick the body into believing it was infected, triggering an immune response that would ultimately protect people from actual infection.

They were right, as the Covid-19 vaccines developed by Moderna and Pfizer/BioNTech have proven. In transforming this theory into reality, researchers saved countless lives and are helping turn the tide on one of the deadliest pandemics in history.

There is an opportunity now to leverage the mRNA platform for HIV vaccine research.

Excitement

The pharmaceutical manufacturer, Moderna, believes its scientists might be able to manufacture mRNA that can induce specific cells to produce broadly neutralising antibodies that will protect against HIV strains. The company has said it could have two vaccine candidates in tests by the end of the year.

Meanwhile, two large studies of HIV vaccines are already underway utilising an adenovirus platform, the same approach used for the Johnson & Johnson, Oxford/AstraZeneca and Russian Sputnik Covid-19 vaccines.

There is no guarantee that a vaccine leveraging either of these platforms will actually prevent infection with HIV. After all, the bar for creating a successful HIV vaccine is much higher than with Covid-19. It would have to prevent any infection because, unlike the virus that causes Covid-19, any HIV that manages to enter cells will create a chronic, lifelong infection or worse.

Nevertheless, the breakthrough Covid-19 vaccines have excited scientists about the potential for similar advances in HIV vaccine research.

It has also spurred frustration, not least because some of the work that led to the Covid-19 vaccines was initially advanced in the course of HIV vaccine research.

Pursuing an HIV vaccine has been notoriously complex.

“Beginning in the 1980s, the inadequacies of tried-and-true models for making vaccines repeatedly pushed HIV vaccine research beyond conventional boundaries and into the forefront of scientific understanding,” Jeffrey E. Harris explained in a recent working paper for the National Bureau of Economic Research.

Those efforts led science into brand-new arenas, like mRNA, and were met with some support, but never the kind of funding or political will that coalesced around the Covid-19 vaccine efforts. If HIV scientists had been given the resources to match their ambitions, who knows how much further they could have advanced their own research and immunology more broadly.

Instead, the status of HIV vaccine research was relatively woeful before the arrival of Covid-19. The most promising recent candidate was shown to be ineffective when it moved to large-scale trials in South Africa after demonstrating 31% efficacy in earlier trials in Thailand. The South African trials were shut down in February 2020. Before that, the last late-stage trial of a vaccine candidate ended in 2007.

Yet, the need for a vaccine remains as pressing as ever: An estimated 690 000 people died of Aids-related illnesses in 2019, according to UNAIDS. That brings the total number of deaths from Aids-related since the start of the epidemic to 32.7 million.

In addition to its advances in science, it is critical that the successful race for Covid-19 jabs leaves an additional legacy: An understanding that scientific miracles are possible if political leaders are willing to prioritise – and fund – the research needed to save people’s lives.

Even now, governments are talking about taking steps to compress the timeline for developing vaccines in future pandemics to less than 100 days.

If those same instincts were brought to bear on HIV vaccine research, next year’s HIV Vaccine Awareness Day could be a celebration of what has been accomplished rather than a consideration of what could be. After all, if the Covid-19 pandemic has taught us anything, it is that a year is more than enough time to accomplish the previously unimaginable.

And just like with Covid-19, it will be activists, civil society and communities who will agitate for and demand action – now that we have seen what is possible.

*Tian Johnson is a queer African activist and founder of the African Alliance, a global non-profit working on a range of health rights issues

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