Shannon Hader is Deputy Executive Director for Programming at UNAIDS and an Assistant Secretary-General of the United Nations. David Wilson is Program Director at the World Bank and Task Manager of the World Bank’s Covid-19, health security and HIV work. Kathy Ward is a member of Wilson’s team.
Honestly, the different trajectories are due, in good part, to the fact that HIV is so different from anything we have conquered in the past – a challenging reality that the scientists who have laboured for decades to develop an HIV vaccine know all too well. Unlike coronavirus and other viruses, we don’t have a natural model of people acquiring HIV and then becoming immune to it to build from — the vaccine needs to do what the human body can’t do alone.
But today we have a double reason for hope: both due to the Covid-19 vaccines work and also in the form of a recent HIV vaccine development that received comparatively little press and social media buzz.
IAVI and Scripps Research, both non-profits long committed to HIV research, recently announced that in phase I trials, a novel vaccine approach successfully stimulated the production of the rare immune cells needed to generate antibodies against HIV in 97% of the participants. The numbers were small (48 people), but the results were groundbreaking. This is the best news we have had on the HIV vaccine development front.
This is truly exciting. And the path ahead is even more so. As a next step, the collaborators are working with Moderna to develop and test an mRNA-based vaccine using the approach to develop the necessary immune cells – the same technology we have seen taken to scale for several of the approved Covid-19 vaccines. There are many steps and challenges on the road ahead but this is progress on a scale we haven’t seen before.
Taking advantage of the moment
The news comes at an extremely good time. It comes right when the world is geared up politically and operationally to appreciate the import of vaccine advances and to take the steps necessary to both support the rest of the road to vaccine approval and prepare the groundwork – so that once a vaccine is ready, we can be ready too, having put into place the production and distribution infrastructure and legal frameworks to share it fairly and expeditiously with all.
We need to take full advantage of this moment and aim for double gains from single investments in important areas such as supply chain development and creating the networks of healthcare workers and communicators and facilities needed to deliver the jabs to all in need. We can also learn from the struggles and advances of all who are working so hard now to create more equitable systems for access to the Covid-19 vaccines.
Building on the success of Covid-19 vaccine development
In short, we have an opportunity to build on the momentum for Covid-19 vaccines: helping to shape and cement those gains for years to come, to lay the groundwork for success so we are ready to go as soon as possible so we create the conditions for success for an HIV vaccine sooner rather than later – and perhaps much sooner than we would have dared to hope even a month ago.
In fact, these investments could have an even greater multiplier effect, creating the framework for the distribution of vaccines for other scourges such as malaria, dengue and hepatitis C, which researchers say could also be developed using the same approach.
A new strategy to end the Aids pandemic
Through the UNAIDS partnership that includes implementing agencies, country governments, international organisations (the World Bank is a founding member) and civil society organisations, we have just finished working with partners from every corner of the globe to produce a new global strategy to end the Aids pandemic. This new strategy focuses on addressing the inequalities that leave behind many of the most vulnerable people at the greatest risk from HIV.
While we wait for the heroes in labs around the world to do what needs to be done to bring the vaccine to market – and to find a cure – we can and must do more to assist those living with HIV so they can survive and thrive and also to arm people with the resources and tools they need to protect themselves against infection.
The news from IAVI, Scripps and Moderna is groundbreaking in its promise and the investments being made to roll out the Covid-19 vaccine offer opportunities to consolidate key capabilities and innovations so that they can be used for quick and equitable access for HIV and other vaccines in the future. But if we want that to happen, we need to act now.
We want to highlight two threads that run through the new UNAIDS strategy. First, scientific progress gives us unprecedented tools to improve health and to end HIV as a public health threat. Second, scientific progress must be allied with equitable access, especially for the poorest and most vulnerable.
The road ahead
Within countries, we have seen how Covid-19 has become an illness of the least well-off who cannot shield themselves from exposure: the geospatial distribution of Covid-19 increasingly mirrors the geospatial distribution of income and job insecurity. And we have seen how vaccine inequality threatens global economic recovery.
For those working on Aids, this was all foreseeable – and yet the experience, tools and convictions that continue to drive the HIV response will be an important voice for global Covid-19 and health equality, and for the fight to end Aids.
This is a chance for us to come together to convert hope into a reality of saved lives and better futures around the globe. Let’s recognise what we have now and use it to create the better future we all want and deserve. DM/MC
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