July 20, 2009
Shifting scientific, health priorities and global economic downturn impact investment in HIV prevention R&D
Cape Town – A new report on investment in HIV prevention research in 2008 finds that HIV vaccine research funding levels decreased for the first time since investment trends have been tracked. This may have been influenced by shifts in scientific priorities, the declining economy and competing priorities in the larger global health agenda. Despite this decrease, the overall trend since 2000 has been of increasing investment for experimental biomedical prevention strategies.
The report, Adapting to Realities: Trends in HIV Prevention Research Funding 2000 to 2008, was released at the 5th International AIDS Society Conference on HIV Pathogenesis, Treatment and Prevention in Cape Town South Africa by the HIV Vaccine and Microbicide Resource Tracking Working Group. It is available online atwww.hivresourcetracking.org.
The report identified investments of almost $1.2 billion in HIV prevention research in 2008, of which $868 million supported vaccine R&D, and $244 million supported microbicide R&D, while other HIV prevention R&D received much lower levels of funding. AIDS vaccine research declined for the first time since 2000, falling by ten percent from 2007 levels. At the same time, funding for both microbicides and pre-exposure prophylaxis (PrEP) increased by eight and 13 percent, respectively.
Funding for HIV prevention research remains a relatively small percentage of the overall response to HIV/AIDS. A recent report released by the Kaiser Family Foundation and UNAIDS documented commitments from the developed world for HIV/AIDS treatment and prevention programs in developing countries of $8.7 billion in 2008, up from $6.6 billion the previous year.
"Research to develop new HIV prevention tools and strategies is essential to prevent new infections, and an HIV vaccine still holds the greatest hope to ending the epidemic," said Michel Sidibé, Executive Director of UNAIDS "It is vitally important that investments into research for HIV prevention be sustained and increased for as long as it takes to reach those goals."
The Resource Tracking Working Group identified a critical need in this time of shifting budget priorities and economic uncertainty for the HIV prevention research field to identify funding needs and put in place scientific plans to help guide research decisions. These steps will ensure that there is no duplication of efforts and that funding can be linked efficiently to scientific priorities.
"Support and interest in HIV prevention research from public, private and philanthropic funders over the last decade has supported key R&D priorities, moved the field forward and brought us closer to new HIV prevention options," said Mitchell Warren, executive director of AVAC. "We face tremendous challenges – both scientific and economic – over the coming years, but we must not lose the momentum we have gained. The field needs sustained support from a range of funders. The AIDS epidemic shows no signs of slowing, and the desperate need for new HIV prevention options will not change."
Levels of funding in 2008 reflected key shifts in the HIV prevention research field. The halting in late 2007 of the Step and Phambili vaccine trials, which were testing a candidate vaccine developed by Merck, ended one of the only pharmaceutical company partnerships for HIV vaccine R&D. This slowing in industry involvement is reflected by a decline in industry funding levels in 2008. Pharmaceuticals and biotech companies in 2008 accounted for only four percent of HIV vaccine research funding. Levels were even lower across other HIV prevention research priorities. Nevertheless, the commercial sector contributes to the development of HIV prevention research in a number of ways through pharmaceutical company support. A number of companies have provided ARV compounds for development as potential microbicides, and as oral PrEP, along with technical support to microbicide product developers.
"The worldwide economic crisis has fueled debate about the best way to invest in global health, with some arguing that AIDS takes up resources at the expense of efforts to deal with other diseases and to improve health systems in the developing world. But given that AIDS is the number one killer in sub-Saharan Africa, and number four in the world, it is imperative that we reverse this pandemic, and that can only be done through improved methods of prevention, including a vaccine. If we can conquer AIDS, we will be able to invest resources in other pressing priorities," said Seth Berkley, President and CEO of the International AIDS Vaccine Initiative.
It is important to note that HIV vaccine research and development is continuing to move forward. Just today, the South African AIDS Vaccine Initiative announced the start of a trial to study a vaccine candidate developed by local South African scientists. Results are also expected later this year from the largest vaccine trial ever, which successfully enrolled more than 16,000 participants. In addition, researchers around the world are developing new vaccine approaches and conducting basic research to inform vaccine development.
The report notes that increased investment in microbicide R&D may reflect increased interest in research on antiretroviral (ARV)-based candidates. Investment increased in microbicides overall at the same time that the field intensified its focus on ARV-based approaches to microbicide development. "Increased funding for microbicide R&D over the past decade has fostered a major expansion for the field; clinical trials of microbicide candidates have been conducted in 27 countries around the world; and pre-clinical research has yielded important scientific information. Support from public, private and philanthropic funders is essential to increase R&D for new microbicide candidates," said Polly Harrison, Director of the Alliance for Microbicide Development.
The U.S. government was once again the primary funder for HIV prevention research, supporting 71 percent of HIV vaccine R&D, 63 percent of microbicide R&D, and providing 46 percent of funding for PrEP prevention research in 2008.
A decrease in investment from the U.S. National Institutes of Health contributed to the overall decline of funding for HIV vaccine R&D. The U.S. government investment fell by $39 million, a six percent decrease. Other governments also decreased funding for HIV vaccine research in 2008: European government funding fell by 13 percent and total funding from other countries (including Brazil, Canada, India, South Africa, and Thailand) fell by 16 percent.
The report authors caution that while it is too early to attribute all of the funding decreases to the financial crisis, there is concern that a prolonged global recession could have a major impact on public investment in all HIV/AIDS programs. A recent report from UNAIDS and the World Bank found that the economic crisis has already affected levels of funding for treatment and prevention programs in some developing countries.
The Working Group also reported on investment in operational research related to proven biomedical HIV prevention research interventions – medical male circumcision and ARVs for prevention of vertical transmission of HIV from mother to child. These efforts are being funded at much lower levels that other HIV prevention research, with $11 million supporting research related to rollout of male circumcision and $21 million supporting operations research for prevention of vertical transmission.
The HIV Vaccines and Microbicides Resource Tracking Working Group was established in 2004 to generate and disseminate high-quality, detailed and comparable data on annual investments in preventive HIV vaccine and microbicide research and development (R&D), and policy and advocacy activities. These data can be used to monitor current levels of effort; identify trends in investment, spending, and research focus; identify areas needing more resources and effort; assess the impact of public policies aimed at increasing investment in new prevention technologies (NPTs); and provide a fact base for policy advocacy on R&D investments and allocations. The Working Group is comprised of the AIDS Vaccine Advocacy Coalition (AVAC), the Alliance for Microbicide Development (AMD), the International AIDS Vaccine Initiative (IAVI) and the Joint United Nations Programme on HIV/AIDS (UNAIDS). More information is available online at www.hivresourcetracking.org.