A vaccine could offer a cost-effective path to a post-HIV pandemic future. It could markedly reduce the number of new infections lessen the number of people requiring lifelong treatment.
Over the past 20
years we have seen great progress in the HIV response; as of 2024 more than 30
million people were accessing antiretroviral treatment, accounting for more
than 76 per cent of all those who need care around the world.
In Kenya, more
than 97 per cent of people living with HIV have been initiated on treatments
that are able to extend their lives and prevent them from transmitting the
virus to others. This has contributed to an 80 per cent reduction in the number
of new infections reported annually over the past 15 years.
Sustained
investments in the HIV response through the United States President’s Emergency
Plan for Aids Relief (Pepfar), The Global Fund to Fight Aids, Tuberculosis and
Malaria and other governmental and non-governmental initiatives have enabled
incremental success over the past two decades.
The shift in
priorities away from supporting the Pepfar programme and the changing landscape
for provision of global aid presents new risks including the possibility of
interruptions to care and treatment programs and reduced availability to
currently recommended prevention methods. This has the potential to destabilize
the global HIV response. New strategies led by national governments and
regional bodies will be necessary to ensure that the needs of the most
vulnerable people around the world continue to be met.
In addition to ensuring
the continuity of care and treatment programs, ensuring effective options for
the prevention of HIV are available is more important than ever. In addition to
condoms, voluntary medical male circumcision and daily oral pre-exposure
prophylaxis (PrEP) drugs, there are several long-acting PrEP products that have
shown remarkable results: trials of injectable lenacapavir, for example, have
shown nearly 100 per cent efficacy in preventing HIV when the drug is
administered every six months.
We need this and other new tools, including
cabotegravir, a bimonthly injectable, and the dapivirine vaginal ring, to be
made available to individuals and communities vulnerable to HIV around the
world.
In order to
progress beyond control of the HIV pandemic towards elimination of HIV as a
public health threat, an
effective vaccine that can provide durable immunity to wide portions of the
population will be required. New evidence is demonstrating that we are on the
right path in the development of a HIV vaccine.
Recent scientific
breakthroughs have increased knowledge of the virus and how it interacts with
the human immune system. Scientists
at IAVI and our partners are currently testing a novel approach called
germline-targeting vaccine design which has shown significant promise.
This approach coaches the immune
system to generate broadly neutralising antibodies (bnAbs), which hold the
potential to prevent HIV acquisition and overcome the virus’ defence
mechanisms. The identification of bnAbs has given us a target for vaccine
development, enabling the development of a roadmap for vaccine design.
In addition to shoring up our HIV
prevention, care, and treatment programmes, we must continue to support
research into the new tools that can eventually bring the HIV pandemic to a
permanent end.
A vaccine could offer
a cost-effective path to a post-HIV pandemic future. The opportunity to provide
long-term immunity could markedly reduce the number of new infections lessen
the number of people requiring lifelong treatment. This intervention could help
manage the mounting costs and ensure that HIV interventions implemented through
national programs are sustainable over time.
Scientific
advances, including vaccine development, can take place on a longer time
horizon than any of us would prefer, but these efforts can bear remarkable
fruit. It took scientists over two decades to develop the polio vaccine, which
has today driven us towards eradication of the virus. With HIV vaccine
development we are also playing the long game. If we press on with HIV vaccine
development, we will indeed someday look back on HIV as a pandemic of the past,
relegated to history.
Dr Vincent
Muturi-Kioi leads IAVI’s efforts to develop an HIV vaccine. He has
worked in vaccine development for over 16 years and is based in Nairobi.