The following is a guest blog post by Mitchell Warren, executive director of AVAC – Global Advocacy for HIV Prevention.
Recent news about HIV/AIDS has focused on the good – promising trial results that prove the same antiretroviral (ARV) drugs used to treat HIV can also prevent HIV infections; and the bad – retreats in donor commitment that imperil the substantial gains that have been made in treating global AIDS, at the precise moment that treatment has been recognized as a powerful prevention strategy. Yet in discussions about whether and how we can one day end the AIDS epidemic, scant attention is paid to the search for an AIDS vaccine.
Today, many discussions of AIDS vaccines focus on two questions: whether a vaccine is still needed, and whether the search for an AIDS vaccine is affordable in today’s economic climate.
Researchers and advocates who gathered last week in Bangkok, Thailand, for the AIDS Vaccine 2011 conference had clear answers: yes, we still need a vaccine, and yes, it is wise to continue to invest in AIDS vaccine research.
Thailand was home to the world’s largest AIDS vaccine trial, which two years ago proved for the first time that an AIDS vaccine is possible. The positive results of the RV144 Thai AIDS vaccine trial were not strong enough to move to license and produce a vaccine, but they did prove that a vaccine can prevent HIV infection. Since those initial results, researchers have crossed national and institutional borders to search for clues about how the vaccine provided the protection it did – and how they might make a more effective product. Working with incredibly limited material—a mere three millileters of blood per vaccine trial participant—the international team was able to draw intriguing conclusions about how the vaccine might have worked.
We don’t yet have a blue print for an effective vaccine to roll-out. But, as presented last week in Bangkok, the detailed analysis of the RV144 analysis, combined with a flurry of advances in understanding the development of broadly-neutralizing antibodies against HIV, show that the science of an AIDS vaccine is vibrant and vital.
They also prove that this is exactly the time to re-commit to AIDS vaccine research. Now is exactly the time to hold a steady course in funding for basic science, clinical trials and product development. It’s good business sense: our investments are paying off—and the dividend, in the form of an effective vaccine, would have value beyond our wildest dreams.
But a vaccine alone is not the answer. The best scenario for ending the AIDS epidemic is combination prevention—scaling up proven interventions now, including new options such as pre-exposure prophylaxis (PrEP), treatment as prevention and voluntary medical male circumcision, while continuing investment to develop and deliver microbicides and vaccines as well.
And while funding for additional research for AIDS vaccines and other new prevention options should never come at the price of funding for treatment access, neither can we stop funding research to develop these new options. The solution to the global HIV epidemic is increasingly clear: donors, including governments in both developing and developed nations, must invest in a comprehensive, strategic plan including:
- Near-term strategies, including treatment and care for all who need it and improved access to existing prevention options like medical male circumcision, male and female condoms, clean needles, and prevention of vertical transmission;
- Mid-term strategies, including demonstration projects that will show us how best to implement PrEP and planning for the eventual licensure and roll-out of microbicides, pending the results of ongoing trials;
- Long-term strategies, including basic research and clinical trials for AIDS vaccines and a renewed search for a cure.
There have been many low points in the thirty years that we have been living with HIV, and far too few reasons to celebrate. But the last two years have given us many new reasons for optimism as trial after trial have shown positive results that point us toward ending this epidemic. This run of good science and good luck began two years ago in Thailand with the results of the RV 144 vaccine trial, and now we’re seeing more evidence that will help make an AIDS vaccine a reality.
We still have a long way to go, but with the right resources and the right leadership and with support from communities and the participation of trial volunteers, we can have an AIDS vaccine in our lifetime. And we can end this epidemic.
An AIDS vaccine is one important part of a strategy to end the AIDS epidemic. Read more about how we can end the epidemic and add your support at www.endtheepidemic.org.