June 5, 2020

Exploring the links between HIV and TB research and COVID-19

Summarizing the impact of COVID-19 on ongoing HIV and TB prevention research.

On May 18 , IAVI was pleased to mark HIV Vaccine Awareness Day by partnering with the International AIDS Society (IAS) to jointly hostcovid 19 cdc homepage1 a webinar focusing on the impact of COVID-19 on ongoing HIV and TB prevention research. Advocates from across Europe joined to learn how HIV/AIDS and TB research is proceeding in the current climate — and how the knowledge and capacity already developed by researchers is accelerating the development of new tools to fight COVID-19.

The event was co-chaired by Hester Kuipers, executive director Europe at IAVI, and Roger Tatoud, deputy director of HIV Programmes and Advocacy at IAS, and began with a short presentation from William Kilembe, project director and study physician at the Zambia Emory HIV Research Project (ZEHRP). William explained that while vaccine research is proceeding at ZEHRP, it’s much more challenging than usual. Thankfully, the HVTN 705 HIV vaccine efficacy trial was already well advanced when the pandemic arrived, and vaccinations at three sites in Zambia were nearly completed before the lockdown. The institute is experiencing shortages of personal protective equipment (PPE) such as masks and plastic gowns. More positively, William also noted that capacity built in partnership with the EU-funded GREAT consortium and partners including IAVI and the Sub-Saharan African Network for TB/HIV Research Excellence (SANTHE) “could potentially now be used to help identify people infected with SARS-Cov-2” (the virus that causes COVID-19), and perhaps to trial a new vaccine. Thanks to their “reputation as a good research organization via community outreach… [organizations like ZEHRP] are in a good position to also help create solutions,” he said.

Following William, Maria Grazia Pau spoke on behalf of Janssen Vaccines & Prevention, a pharmaceutical company which is active in the development of vaccines including for HIV/AIDS and Ebola, and more recently also COVID-19. Maria explained that the company is currently involved in two ongoing efficacy studies (the Imbokodo trial/HVTN 705/HPX2008 trial and the Mosaico HVTN 706/HPX3002 trial), both aimed at eventually delivering a globally accessible vaccine which can protect against HIV in some of the most badly affected regions. Maria explained that the COVID-19 pandemic has inevitably disrupted some research, causing delays. However, there are also exciting new opportunities: Janssen is working in partnership with the U.S. Biomedical Advanced Research and Development Authority (BARDA) to initiate human clinical studies of a coronavirus vaccine candidate at the latest by September 2020 and anticipates the first batches of a COVID-19 vaccine could be available for emergency use authorization in early 2021. They could not have moved as quickly had it not been for the experience gained with developing an HIV vaccine, she said.

Speaking on behalf of the TB Vaccine Initiative (TBVI), Gerald Voss explained the impact COVID-19 has had on TB vaccine research. Two major trials — BCG revaccination and M72 follow-up — are effectively on hold. However, Gerald emphasized there is also good news, including the fact that “most funders are saying they intend to keep supporting non-COVID R&D projects.” He also noted that it is essential to not just invest in building new R&D infrastructure but to maintain what we have, “so research can resume smoothly once the current crisis is over.” Lastly, he noted that past research might help fight COVID-19 — there are, for example, studies suggesting that the BCG vaccination might be effective in reducing the severity of COVID-19.

Switching gears slightly, Tian Johnson from the Vaccine Advocacy Resource Group (VARG) and convenor of the Global COVID-19 Platform for Research & Advocacy for Civil Society, then gave a community and civil society-based perspective on current challenges and opportunities. In emergency situations such as the COVID-19 pandemic, Tian said, there is a risk that meaningful consultations with communities are not sufficiently considered due to time pressures, as he believes happened in the case of the WHO Solidarity Trial in South Africa. Tian began by drawing linkages between the battle against the coronavirus and “the fight we’ve been carrying on for two to three decades,” saying COVID-19 has “brought to the fore structural inequalities which have often been sidelined in the past by governments. COVID-19 research has to be community-owned, otherwise the best science in the world will come to nothing,” he said. “We need to ensure that communities have a seat and voice at the table and that their concerns, hopes, and expectations are accounted for and that they have input at all stages of research, from protocol to product.”

Finally, Helen Rees of the University of Witwatersrand and the South African Health Products Regulatory Authority spoke about the effect that COVID-19 and the related lockdowns have had on research in Africa and elsewhere. She explained that disruption to research in South Africa has been considerable, and that researchers face a range of challenges in ensuring the safety of clinical trial participants. More positively, Helen also noted the many “strong opportunities” to use expertise gained from the fights against HIV/AIDS and TB to help tackle COVID-19. She also encouraged the HIV and TB fields to learn lessons from the current race to develop vaccines and treatments for COVID-19.

In the Q&A session, several speakers noted that COVID-related research could benefit HIV and TB-related R&D — for example, a rapid scale-up in capacity to produce viral vectors could benefit researchers across a range of infectious diseases. Gerald Voss said in the longer term, “once COVID is better under control and the rest of scientific life and activities resume… maybe we can use this experience to create an enthusiasm and sustainability of funding in other areas such as TB and HIV.” Tian Johnson suggested that “we could do well to use this COVID moment as an opportunity to remind foreign donors and governments to invest in civil society — it is an imperative. We don’t want to remain reliant on western donor countries,” Tian said, “but want to enable people to hold their own governments to account.” Finally, several people noted that shortages of funding and time gaps in EU funding are a chronic problem, and that more sustainable investment in R&D is badly needed. Helen Rees ended on a note of optimism, telling advocates that although the COVID-19 pandemic is devastating for many communities, “there’s also a real opportunity to build support for our work.”