Blog AIDS 2014, 19 July 2014

With the passing of HIV Vaccine Awareness Day (HVAC) on May 18th we have witnessed growing hope that we are on the brink of a breakthrough in discovering an HIV vaccine. Mary Marovich, Director of NIH's Division of AIDS Vaccine Research Program stated "The future is bright...we're closer than ever". At AIDS 2012, even failures in research were dubbed as successfully leading to new avenues of research. Early vaccine research attempted to teach the immune system to produce antibodies that would block entrance of HIV into human cells. This failed in clinical trials when antibodies worked against lab-cultured HIV but not wild strains of the virus. Emerging research shifts efforts towards "broadly neutralizing antibodies" to HIV. About 20% of HIV-infected individuals produce these antibodies at too slow a rate. Current vaccine research aims to expedite the process, allowing the body to produce antibodies in a timely manner for effectiveness against HIV.

In moving forward with HIV vaccine research I suggest four areas that are essential to consider: 1) The first is strains of the virus, 2) the second is ethics and side effects, 3) the third is funding and 4) government capacity to purchase the vaccine. Lastly, we must consider vaccines for those already infected in order to pioneer effective vaccine research.

HIV strains differ by region and vaccine research must align with these variations. The two major strains of the virus are HIV-1 and HIV-2. There are nine genetically varied strains within HIV-1. Range of sub types not only has serious implications for treatment, but also for an HIV vaccine. The effectiveness of a vaccine will likely vary between populations and candidate vaccines will have to be tested against various viral strains in high income and developing nations.

Ethics and side effects must be taken into account throughout clinical trials for a vaccine. Although there are very few side effects reported with most clinical trials, it has not been enough time to tell. The largest clinical trial took place in 2009 in Thailand, known as, "RV144" involved 16,000 adult participants and cultivated a safe combination vaccine that prevents 32 percent of new infections. Heading into the future, we must ask ourselves what actions are being taken to ensure the consent, and information about possible side effects being provided to all participants.

With 2015 fast approaching, it is timely to consider the Millennium Development Goals and fulfillment of the Abuja Agreement. In April 2001, African Union nations pledged to allocate 15% of budgets to health care expenditure. They also urged donor countries to target 0.7% of their GNP as Official Developmental Assistance (ODA). Only South Africa and Rwanda have managed to allocate 15% of their budgets to health care and only five countries reached 0.7% of GNI devoted to ODA. African governments continue to focus too much on defense expenditure and not enough on health care, especially in peaceful nations like Namibia. When moving forward with a vaccine, we need to readdress health care spending patterns. Without doing so, nations heavily burdened with HIV prevalence rates will not have the purchasing power necessary to allow widespread provision of the vaccine.

The last area I ask us to consider when moving forward with a vaccine is considering those already infected with HIV. Most research focuses on "preventative" or "prophylactic" vaccines which are extremely essential to controlling the epidemic worldwide. I urge that in moving forward we allocate equal efforts to finding a "therapeutic" vaccine to treat HIV.

I opened with the optimistic words of Marovich. As bright as the future is for a vaccine, we will not see its widespread disbursement to under-served and vulnerable populations without considering the range of strains, ethics and side effects, purchasing power of heavily burdened nations, and people who are already infected with HIV. After Marovich's presentation, Bill Snow of the Global HIV Vaccine Enterprise stated "We need to keep this going forward". In going forward I ask we consider social, ethical, and budgetary aspects of vaccine disbursement. These considerations will be key in determining the success of the vaccine.

By Jennifer Gatsi, Co-founder and director of the Namibian Women's Health Network

Source: Blog AIDS 2014