Vaccines can put an end to HIV – African governments must take the lead in developing them

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HIV remains a major global public health challenge.

Nowhere is this more evident than in southern and eastern Africa, where the majority of people living with HIV reside. Here new HIV infections remain alarmingly high despite significant advances in prevention and treatment.

In South Africa, an estimated 150,000 people acquire HIV annually.

This alarming figure highlights insufficient increases and availability of proven prevention tools such as oral and injectable antiretroviral pre-exposure prophylaxis (PrEP).

Although more than 7.5 million people in South Africa are living with HIV, only 5.9 million are on antiretroviral therapy (ART). This means one in four people with HIV are not on treatment.

People living with HIV who take HIV medicine as prescribed and get an undetectable viral load will not transmit HIV through sex.

However, South Africa's treatment gap makes it impossible to achieve treatment-as-prevention goals as this requires widespread ART coverage.

As medical scientists working in HIV prevention, we believe that HIV vaccines will be critical to eliminating HIV transmission. Vaccines help the body learn how to defend itself from disease without the dangers of a full-blown infection.

HIV vaccine research and development should remain a global priority. Africa's scientists should continue to play a pivotal role in developing affordable and durable interventions.

Significant promise, but a high price

Recent advances in long-acting injectable PrEP such as lenacapavir, which has been shown to nearly eliminate sexual transmission of HIV in clinical studies, offer significant promise for reducing new infections.

However, these injectables cost up to US$44,819 (about R800 000) annually per person. This makes them unaffordable for public health systems.

Voluntary licensing agreements with generic manufacturers may make them more accessible. But even scaled-up PrEP coverage alone will not eliminate HIV.

The power of vaccines

The elimination of HIV requires a safe, effective, and affordable vaccine.

An HIV vaccine could provide long-lasting immunity, administered perhaps as four doses over one year.

Vaccines help protect against infectious diseases and their use has been critical in reducing childhood deaths. Smallpox was eradicated because of the widespread use of vaccination, and vaccines have been critical to the control of measles.

To date, despite decades of research and substantial financial investment, no HIV vaccine candidate has shown more than modest protective efficacy.

We believe that continued global investment in HIV vaccine research and development is paramount to attaining theUnited Nations goal of ending AIDS as a public health threat by 2030.

Sufficient investment from African governments is a key missing piece in this global effort.

Africa needs to step up

The continent bears the greatest health and economic burden of HIV. There were about 25.6 million people living with HIV in Africa in 2022.

Yet funding for research and development remains dismally low.

Seventeen years ago, African Union member countries committed to spending 1% of gross domestic product on research and development. By 2019, the continent's average remained only at 0.42% – far below the global average of 1.7%.

Not a single African country has met the 1% target. South Africa, the continent's leader in research and development spending, peaked at just 0.85% of GDP.

For an African-led HIV vaccine initiative to succeed, three elements are critical: scientific and political leadership, domestic investment, and sustained community engagement.

African governments must prioritise funding for vaccine research and development as a public health imperative.

Moreover, empowering local researchers to lead vaccine development initiatives would not only strengthen the science but also build trust within communities.

Global partners have supported Africa's progress in HIV vaccine research and development. Organisations such as the US National Institute of Health's HIV Vaccine Trials Network, the Bill and Melinda Gates Foundation, and USAID have contributed to strengthening clinical research infrastructure and laboratory capacity across the continent.

These collaborations have laid a foundation for high-quality research led by African scientists.

The way forward

Looking ahead, the continent's growing vaccine manufacturing capacity offers hope for an African-produced HIV vaccine.

Recent developments in regional vaccine production facilities in South Africa, Senegal and Rwanda could be used to create a sustainable pipeline for HIV vaccines.

Such efforts would not only reduce dependency on external sources but also ensure that vaccines are developed and distributed equitably.

Ending the HIV epidemic is an achievable goal, but it requires a concerted global effort. Existing prevention tools like long-acting injectable PrEP are valuable, but they cannot replace the transformative potential of a vaccine.

To meet this challenge, both international and African stakeholders must increase their commitment to HIV vaccine research and development.

As Nelson Mandela famously said,

It always seems impossible until it's done.

With bold leadership and sustained investment, we can make an HIV vaccine a reality – and, with it, bring the world closer to ending AIDS.

Glenda Gray receives USAID co-operative agreement for HIV vaccine research and US-NIH funding for HIV vaccines.

Asa Tapley was previously protocol team lead for the now completed HIV Vaccine Trial Network 705 (Imbokodo) study, an experimental HIV vaccine clinical trial. He received salary support from a related non-profit grant to the HIV Vaccine Trial Network (HVTN) helping to fund this trial. He is currently co-chair of two forthcoming HIV Vaccine Trial Network phase 1 clinical trials related to TB and HIV vaccines, respectively. Both roles are uncompensated.

By Glenda Gray, Distinguished Professor, Infectious Disease and Oncology Research Institute, Faculty of Heath Sciences, University of the Witwatersrand, Executive Director Perinatal HIV Research Unit, Chief Scientific Officer,, South African Medical Research Council And

Asa Tapley, Acting Instructor (University of Washington), Research Associate (Fred Hutch Cancer Center), Honorary Senior Lecturer (University of Cape Town), University of Washington