Achieving Universal Access: The Way Forward
IAVI Calls for Strong and Sustained Global Investment
in New HIV Prevention Tools
NEW YORK, December 1, 2009—As we approach World AIDS Day, observed globally December 1, we are reminded that while progress has been made in expanding access to treatment and prevention and that progress has been made toward the development of new prevention tools, the world is still falling short of established targets for providing universal access to HIV and AIDS prevention, treatment and care by 2010. Nearly 5.5 million of the estimated 9.5 million people in need of antiretroviral therapy are still not receiving it. Clearly, prevention efforts are falling short as well, as evidenced by the fact that 7,400 people continue to become HIV-infected every day. For every two people put on treatment, five new HIV infections occur.
The world must continue to expand access to HIV and AIDS treatment and care with the goal of getting these basics to everyone who needs them. At the same time, we must not neglect HIV prevention. Prevention is especially important for women. According to the World Health Organization, AIDS-related illness is the leading cause of death and disease among women of reproductive age in low- and middle-income countries. A continued focus on existing prevention methods and a sustained commitment to the development of new ones will make it much more likely that the universal access targets on treatment and care can be achieved.
A main barrier to increasing access to treatment and care is cost. Recent modeling work conducted by the AIDS 2031 Costs and Financing Working Group predicts that by 2031, more than 20 million more people will become infected with HIV—and that’s the best-case scenario. According to the projections, developing countries would need US $35 billion a year—three times what is spent now—to address the pandemic. Better—much better—prevention tools could bring the price tag down by dramatically reducing the number of people who become infected with HIV and thus require costly treatment and care. Traditionally, vaccines are the most cost-effective, high-impact public health interventions for coping with infectious disease. And an AIDS vaccine offers the best hope of ending, and not just mitigating, the pandemic.
Thanks to the perseverance and hard work of thousands of individuals around the world, significant progress has been made toward the development of an AIDS vaccine in 2009. Unfortunately, these promising advances are occurring just as AIDS vaccine research funding declined for the first time in a decade, dropping 10% globally last year. At this critical moment in science, the world must not step away from but step up to the challenge. That challenge—not just for scientists but for policy makers, leaders of industry and funders—is to make the vital investments to build on the tremendous momentum we’ve seen this year.
In late September, U.S. and Thai authorities announced that an AIDS vaccine candidate for the first time demonstrated efficacy, albeit modest, in humans in a Phase III trial in Thailand. Next researchers will work to determine how, precisely, the candidate prevented infection and how to prioritize ongoing research on the basis of the Thai results. A few weeks earlier, researchers at and affiliated with IAVI announced the discovery of two new antibodies capable of neutralizing a broad range of HIV variants. These were the most potent and broadly neutralizing antibodies to be identified in more than a decade and the first to come from a donor in the developing world. This discovery may accelerate ongoing work to develop an immunogen, or vaccine component, which will elicit similarly powerful antibodies in humans.
And at an AIDS vaccine conference in Paris in October, more promising data were released. New findings shed light on the characteristics of the particular variant of HIV that is transmitted from one person to another. A study of heterosexual transmission demonstrated a bottleneck effect, whereby only a single “founder” virus takes hold in most cases. This may be good news for vaccine design because it could mean that an HIV vaccine would not have to neutralize every variant of HIV but only the viruses that are transmitted from one person to another. Also in Paris, unprecedented results were presented from an animal study of an AIDS vaccine prototype designed to elicit cell-mediated immunity, the part of the immune system that uses T-cells to destroy human cells that have been infected by an invading pathogen such as HIV. In the study, though the vaccinated animals became infected upon exposure to SIV, HIV’s simian cousin, half of them developed undetectable levels of virus in their systems.
For this progress to continue as swiftly as possible to its conclusion, an effective AIDS vaccine for all, the field needs the engagement of dedicated scientists and entrepreneurs, the backing of political leaders, the support of communities that host research, the dedication of trial volunteers, the generosity of funders. On this World AIDS Day, the International AIDS Vaccine Initiative urges those committed to fighting AIDS to redouble their backing, commitment and investment to make an AIDS vaccine a reality. The sooner the world has better HIV prevention tools, such as a vaccine, the sooner infection rates can be lowered, making it more feasible to treat and care for all those affected by the pandemic.
The International AIDS Vaccine Initiative (IAVI) is a global not-for-profit organization whose mission is to ensure the development of safe, effective, accessible, preventive HIV vaccines for use throughout the world. Founded in 1996 and operational in 25 countries, IAVI and its network of collaborators research and develop vaccine candidates. IAVI was founded with the generous support of the Alfred P. Sloan Foundation, The Rockefeller Foundation, The Starr Foundation, and Until There's A Cure Foundation. Other major supporters include the Bill & Melinda Gates Foundation, the Foundation for the National Institutes of Health, The John D. Evans Foundation, The New York Community Trust, the James B. Pendleton Charitable Trust; the Governments of Canada, Denmark, India, Ireland, The Netherlands, Norway, Spain, Sweden, the United Kingdom, and the United States, the Basque Autonomous Government, the European Union as well as The City of New York, Economic Development Corporation; multilateral organizations such as The World Bank; corporate donors including BD (Becton, Dickinson & Co.), Bristol-Myers Squibb, Continental Airlines, Google Inc., Henry Schein, Inc., Pfizer Inc, and Thermo Fisher Scientific Inc.; leading AIDS charities such as Broadway Cares/Equity Fights AIDS; other private donors such as The Haas Trusts; and many generous individuals from around the world. For more information, see www.iavi.org.