First celebrated in 1998, a little more than a decade after the launch of the very first HIV vaccine study, HIV Vaccine Awareness Day (HVAD), observed each May 18, is an opportunity to spotlight the ongoing global efforts to develop a safe and effective vaccine against HIV.
We need a safe and effective HIV vaccine. While we have developed, and are developing, exciting new choices for the HIV prevention buffet, an HIV vaccine is still not on the menu.
According to UNAIDS, 1.7 million people across the world were infected with HIV in 2019, and 700,000 died from HIV-related illnesses. The number of new HIV infections in the United States has been trending downward, slightly, over the last few years, with approximately 38,000 diagnoses in 2018.
However, Black gay, same-gender-loving, and bisexual men, as well as Black women, inclusive of transgender women, Latinx gay and bisexual men, remain disproportionately impacted. From 2014 to 2018, HIV diagnoses decreased 7 percent among gay and bisexual men overall, but rates remained stable among Black and Latine gay men. Approximately 1.2 million people are living with HIV in our country.
In case you’ve been thinking about other things the rest of the year, HVAD is a day to thank the many thousands of volunteers who have participated in HIV vaccine clinical trials. It is a day to recognize the 24/7/365 efforts of countless scientists and health care workers conducting these trials, and to thank the Goddess for the loudmouth activists and advocates who play critical roles in engaging communities and holding the research enterprise accountable.
It is a day to show gratitude to the funders – dominated by the United States government but including other nations, philanthropic and private support – who have pumped over $15 billion into the quest for over 30 years. And it’s a day to demand more.
Every day. More. More. More.
More money. In 2019, $848 million was spent on HIV vaccine research and development. While this level of investment has been essentially flat since 2008, it’s a decent chunk of change, dwarfing the $300 million spent in the same year across all other HIV prevention technologies. The U.S. public sector – I’m looking at you fellow taxpayers – contributed three-fourths of that global funding, equaling $871 million of the $1.14 billion total on all prevention research.
All that looks like chump change, unsalted peanuts even, when you consider that we – the royal planetary we – dedicated $39 billion to COVID-19 vaccine research and development in 2020. In one short (and insanely long) year, we spent more than double what we’ve spent on HIV vaccines for more than three decades. This unparalleled investment, significantly buoyed by expertise and learning developed in the pursuit of an HIV vaccine, produced several safe and effective vaccines against novel SARS-CoV-2, three of which have been approved for use in the U.S. Not only were unparalleled mounds of cash committed, but the global research community also engaged in unprecedented and incredibly focused coordination, cooperation, and collaboration.
Is the answer to an HIV vaccine all about the money, honey? Well, for sure, flat funding won’t get us to the promised land – more robust investments from our government and other funders are essential. HIV is an especially tricky beast of a virus, wilier a foe than COVID in a few key ways. HIV targets and kills the very immune cells (t-cells) the body uses to defend against disease, so our immune system is not able to mount an effective response and get rid of HIV on its own.
When making an HIV vaccine, this means scientists must develop a vaccine that stimulates a stronger immune response than what the body can mount on its own. The virus also mutates and can learn how to avoid the effects of a vaccine. The mutation also leads to different subtypes (or clades) of the virus throughout the world. Each subtype reacts differently to different vaccine candidates. For this reason, testing in many countries is necessary. As I said, HIV is very tricky. Diabolical, really.
So, get on the phone and call your elected officials – your representative, both senators and Uncle Joe – and tell them you want more of your tax dollars spent on HIV vaccine research. Get their phone numbers here.
Better yet, tell them you want to see more of the U.S. budget spent on all activities supporting the research and development of new HIV prevention technologies writ large, including other interventions in addition to vaccines like long-acting injectable formulations, monthly pills, quarterly vaginal rings, yearly implants, and rectal douches you can use for booty freshness and protection when the time is right – with Mr. Right or Mr. Right Now.
Here is a quick list of talking points you can use, based on lessons from COVID-19 vaccines, courtesy of my friends at AVAC with a little extra fluffing and folding on my part.
1. Communities must continue to be placed at the center of all new research into HIV prevention technologies. Nothing for us without us – periodT.
2. We need sufficient and diversified research funding for HIV vaccines and other new HIV prevention technologies.
3. We must improve global coordination and collaboration in the quest for HIV vaccines as well as new molecules and modalities to prevent HIV, from long-acting, systemic choices to short-acting, localized, user-controlled methods.
4. In an era with a prevention buffet featuring new and effective choices, we must support research innovation and novel trial designs – the buffet is still lacking.
5. Political commitment and urgency must be strengthened.
6. Planning for success and equitable access must start early – like yesterday. Most of the planet’s inhabitants have yet to be vaccinated against COVID-19 – and many will likely wait years. This is wholly unacceptable and means none of us are out of the woods. Similarly, we won’t end the HIV epidemic here, there, or anywhere if people don’t have access to all the care and prevention tools we have.
Now is a good time to call those elected officials. Remind them you are a voter and a taxpayer. There’s nothing like the present.
Jim Pickett is the Senior Director of Prevention Advocacy at the AIDS Foundation Chicago (AFC).