VOICES

Dear reader,

Launched in March 2021, the UNAIDS 2021-2026 strategy to end AIDS underscores the urgency to end the inequalities that have facilitated the spread of the AIDS pandemic and continue to fuel the spread of HIV globally. Almost four decades since initial reports of the first recognized case of AIDS, it remains an urgent global crisis that is being exacerbated by the emergence of the Coronavirus disease (COVID-19) pandemic. As a result, there is clearly a need to accelerate research and development for more effective HIV prevention technologies, including a vaccine.

In this issue of the VOICES newsletter, communities, researchers, and HIV prevention advocates lend their voices to the call for increased support for HIV vaccine research and development. Citing lessons learned from the COVID-19 response, the voices call for greater financial investment, scientific collaborations, and meaningful community engagement in the race towards finding a safe, effective, and accessible vaccine against HIV. They also remind us that despite the decades-long quest to develop such a vaccine, recent research outcomes indicate that we are now closer than before to success. Most importantly, they urge us not to take our eyes off the target of ending AIDS as a public health threat even as we grapple with a new pandemic.

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Happy reading,

Ethel Makila
Associate Director Advocacy, Policy, and Communications
IAVI
This email address is being protected from spambots. You need JavaScript enabled to view it.

The views and opinions expressed in this newsletter are those of the authors
and do not necessarily reflect the official policy or position of IAVI.

Lessons for HIV biomedical prevention research from the COVID-19 pandemic

By Tian Johnson, head of the African Alliance, co-chair of the AU/African CDC African Vaccine Delivery Alliance Community Engagement Pillar, international civil society observer of the Robert Carr Fund; and Maaza Seyoum, partnerships and communications lead of the African Alliance and head of The People's Vaccine in Africa

Tian Johnson, head of the African Alliance

COVID-19 has shown us what can happen when political will, public investments, civil society voices, and community needs are centred. For decades, our response in Africa has been shaped largely by the powers in the Global North and retrofitted into an existing foreign aid agenda with community voices — to varying degrees — being amplified and making it into final policy and implementation documents. The last decade has seen a shift in this reality, with community advocates taking up our rightful position at decision-making tables and fora that exist to shape and fund the response to a pandemic that has terrorised us and those we love for over four decades while further strangling our collective development agenda. Financing for HIV biomedical prevention and vaccine research does not need to be "unlocked." The response to the COVID-19 pandemic has shown us that financing exists. We don't need more scorecards, more analysis, more motivation. Governments need to prioritise and accelerate research by having the same levels of trust in science and the discovery process as they did with COVID-19. The unprecedented public investment into vaccine research and several successful candidates in less than 12 months clearly displays the existing imbalance in the prioritisation of global health issues.Maaza Seyoum, partnerships and communications lead of the African Alliance

We have learnt that our health systems are fragile, and countries are underprepared for a public health crisis of the magnitude we witnessed. We have learnt that corruption and mismanagement of health finances jeopardise our work to advocate for increased domestic health spending. We have seen wealthy countries and industry stand in the way of access to health solutions for the rest of the world. We have learnt that there is much urgent work to be done to raise the level of consciousness of those in power to understand that their words and deeds can and do put millions of lives on the line.

Partnering for greater access and better health outcomes

Researchers should come out of this pandemic with a clearer appreciation of private sector/industry role as it relates to access. The traditional passive role of researchers in post-trial access issues has changed and needs to evolve further. Researchers must consider eventual access issues at protocol design stage. With the most diverse set of participants backed by world-class science, the best-run trial will all come to nothing and, in fact, be undermined if access issues (which in the final analysis are controlled by industry) are not clearly defined at the outset. This issue resonates with us — for over a decade, we have been asking why we should continue to advocate for our communities’ investment and participation in research if access remains — as it has in so many instances — a pipe dream out of reach for those who need the products of research so desperately.

We have also seen the power of communities and civil society to hold research to account. We have learnt that we need to mobilise better, agitate with even more energy, and fight for transparency and accountability in research to ensure that our response to the access to an HIV vaccine — when it is available — is not rooted in creating profits for the shareholders of pharma in disregard for the enormous contribution of public money and infrastructure to the responses.

We must do better — we have no choice. The same communities in the Global South including Sub Saharan Africa who continue to contribute significantly to research including HIV research and the search for a COVID-19 vaccine now look on as rich countries procure large volumes of the COVID-19 vaccine, some even more than what they need — while they might have to wait until 2023 for meaningful access. These communities will not and should not allow the current status quo. As a global community, we must do better.

About the authors:

• Tian Johnson is head of the African Alliance, international civil society observer of the Robert Carr Fund, serves the South African Ministerial Advisory Committee on COVID-19 vaccines, co-chairs the community engagement work of the African CDC Vaccine Delivery Alliance, and is a founding member of the Vaccine Advocacy Resource Group working globally to ensure that vaccine research is accountable, transparent, and community-owned.
• Maaza Seyoum is partnerships and communications lead of the African Alliance and heads up The People's Vaccine in Africa — a growing movement of health and humanitarian organisations, past and present world leaders, health experts, faith leaders, and economists urging that when safe and effective vaccines are developed, they are produced rapidly at scale and made available for all people, in all countries, free of charge.

The potential for an HIV vaccine through the eyes of the community

Stephen Anguva Shikoli, national coordinator of Network of TB Champions Kenya

By Stephen Anguva Shikoli, national coordinator of Network of TB Champions Kenya, director Pamoja TB Group, and chair of the Community Advisory Board at the KAVI Institute of Clinical Research – Kangemi

I believe an HIV vaccine would significantly reduce inequality because it would help address stigma against people living with HIV. If we could get to a point where there is reduced fear of exposure to HIV infection, I think there would be less of a divide between people living with HIV and those who are not infected.

Having said that, there is still much to be done to ensure we can achieve the dream of a safe, effective, and accessible HIV vaccine. Firstly, there is the issue of adequate funding. The governments of countries that bear a high HIV burden should be champions for developing preventive vaccines. Like we have seen with the current COVID-19 pandemic, the direction taken by heads of state directly affects the communities’ response to public health issues. Where there is support for the uptake of vaccines, more people are queuing to be vaccinated. Likewise, if our heads of state support HIV vaccine development, more resources are likely to be allocated to such research.

Bearing in mind the critical role communities play in vaccine research, projects should also invest more in supporting community actors who are involved in outreach, advocacy, and mobilization. And even as we get communities on board to participate in research, there is need to keep them well informed on the status of ongoing or completed HIV vaccines studies. Keeping community members engaged increases the likelihood that they will be ambassadors for vaccine research. The community's voice is key to unlocking resources that will speed up the development of an HIV vaccine, putting pressure on governments and other funders to step up support for research, and willingness to use the products that come out of the research.

We can only get a safe and effective HIV vaccine if we work together and put the community at the center with meaningful engagement from designing and development to eventual roll-out.

Winfred Ikilai, program development officer, National Forum of People Living with HIV & AIDS Networks in Uganda

By Winfred Ikilai, AVAC Fellow 2020/21 and HIV prevention research and advocacy officer

In my view, an HIV vaccine will be an answered prayer to many endless questions on how to control the virus. It will also solve the problem of existing inequalities, stigma, and discrimination against people living with HIV in Africa and across the globe. Due to their HIV-positive status, some people cannot get employment, are sidelined from social gatherings, have lost their property, and face discrimination from the community

These inequalities are even worse for adolescent girls and young women. Imagine getting infected with HIV because you were raped at 14 years old, and also getting pregnant! How is such a young mother expected to receive the same treatment as her older counterparts during antenatal visits? The tendency is for the health care workers to make assumptions and blame the young girl for immorality and messing up her life at a young age.

If we are to fast-track the progress towards an HIV vaccine, we first need to realize that with the unresolved problem of new HIV infections, we are far from our promise of ending HIV and AIDS by 2030. The task ahead is huge and we cannot allow the COVID-19 pandemic or any other new pandemics to divert us from our goal. With COVID-19 taking center stage in all spheres including research, the world should not forget that we have ongoing epidemics and deadly diseases like HIV!

Just as we saw with the response to COVID-19, we need stronger collaborations between the researchers, pharmaceuticals, and the community. As countries we must strengthen our commitment to financing HIV research. If only we supported HIV vaccine research with the same enthusiasm that COVID-19 vaccine research received, I believe by now we would have an HIV vaccine.

Additionally, communities must be empowered to demand a safe and effective vaccine. Ordinary people like me for whom the vaccine is intended should be educated on why it is important to develop a vaccine and what it takes develop one. Increased awareness and understanding of vaccine development can help deal with the hesitancy we see in some instances.

We need an HIV vaccine. People are tired of being alienated because of their HIV status. People are tired of having to keep up with swallowing the life-extending antiretroviral drugs daily. People are tired of depression, being abandoned or neglected because of the virus. While the existing treatment options have helped reduce community transmission, we still have too many new HIV infections. With an effective HIV vaccine in place, the virus will practically be defeated in the same way other infectious diseases such as smallpox have been defeated.

Unpacking the results of the Antibody Mediated Prevention (AMP) trials

Daisy Ouya, ‎communications advisor, ‎AVAC

By Daisy Ouya, ‎communications advisor, ‎AVAC

The results of the Antibody Mediated Prevention (AMP) trials have shown us, once again, just how complex the HIV virus is. The AMP trials, which sought to determine whether an infusion of antibodies is safe and can prevent HIV infection, seem to have answered some questions and left many others for us to unpack. For instance, we learned that the broadly neutralizing antibody VRC01 used in the study could only partially protect against 'susceptible' HIV strains. There is also the confounding issue of the presence of the antibody in the blood potentially suppressing the production of detectable levels of HIV antibodies, thereby 'masking' infection from standard HIV tests.

However, the results do represent a stride in our understanding of antibody-driven HIV prevention. AMP, for instance, suggested that a single antibody will unlikely be able to prevent HIV. The trials also highlighted the need to map the HIV strains circulating in various parts of the world more closely.

I’m excited that research into combinations of antibodies to prevent HIV infection is getting off the ground. Also exciting are the promising early findings from IAVI’s G001 Phase I study, on the first vaccine candidate designed to shepherd the immune system into making broadly neutralizing antibodies. Besides HIV, antibody research can also be applied to research into new pathogens such as SARS-CoV2, as well as some of the old, neglected diseases that occur in parts of the Global South.

As research continues to evolve, there is a great need to ramp up research translation efforts, so everyone can engage and contribute more strongly to the antibodies-for-prevention agenda. The PxPulse podcast on AMP that AVAC released recently (featuring Devin Sok of IAVI, Gail Broder of the HIV Vaccine Trials Network, and HIV prevention advocate Mark Hubbard), the special issue of IAVI Report published in May, and the IAVI explainer video on the findings of the G001 study are just three examples in this effort. Overall, we can look forward to seeing the antibody field move forward with well designed, well-funded, ethical trials with the full participation of communities and civil society. And to the day we'll have an antibody-based method for HIV prevention that expands choice for people in real-world settings!

To realize an effective HIV vaccine, we must collaborate

Thandeka Moyo-Gwete, senior medical scientist, National Institute for Communicable Diseases Division of National Health Laboratory ServiceBy Thandeka Moyo-Gwete, senior medical scientist, National Institute for Communicable Diseases Division of National Health Laboratory Service

The HIV pandemic has evolved rapidly over the last 40 years. While HIV began as a little understood virus with no known means of controlling it, years of extensive research has greatly contributed to its current treatment and prevention toolbox that includes antiretroviral therapy (ART) and pre-exposure prophylaxis (PrEP), among others. While this has re-ignited hope for people living with HIV, the African continent continues to carry the HIV burden disproportionately. Undoubtedly, the most significant solution in sight to end the HIV/AIDS pandemic would be an effective HIV vaccine, which African scientists must work together towards its realization.

As a young researcher, I am fortunate to have been mentored by exceptional scientists in the field of HIV vaccine research and development. This includes Dr. Jeffrey Dorfman for my Ph.D., and Prof. Lynn Morris and Prof. Penny Moore for my postdoctoral research. By working with these phenomenal scientists, I have grown optimistic of a future where an effective HIV vaccine is readily available, accessible, and affordable to all who need it. A key lesson I have learnt from my mentors is the infinite value of collaboration. Indeed, if we are to realize an effective HIV vaccine, it will not be through the isolated work of one research team. Instead, it will be as a result of the 40 years of hard work of numerous laboratories working across the world, collaboratively. With novel vaccine platforms showing efficacy for preventing other viruses and researchers discovering more and more vulnerabilities in HIV, the future of a world with an HIV vaccine may be closer than we think.

Editorial Team

Dr. Morenike Ukpong-Folayan – Coordinator, New HIV Vaccine and Microbicide Advocacy Society
Ethel Makila – Associate Director Advocacy Policy and Communications, IAVI

Questions/comments? Email Ethel Makila at This email address is being protected from spambots. You need JavaScript enabled to view it.

DISCLAIMER:
The views and opinions expressed in this newsletter are those of the authors
and do not necessarily reflect the official policy or position of IAVI.