Four decades since AIDS epidemic began, but still no vaccine

Covid vaccines began to show promise just months after the novel coronavirus started spreading across the globe. So why have decades of HIV/AIDS research yielded so little progress on a jab to prevent a disease that claimed some 680,000 lives in 2020?

As the globe marks World AIDS Day on Wednesday, there still no vaccine to protect people from the Human Immunodeficiency Virus (HIV), even though some 38 million people across the globe live with the virus.

One answer is that the political will that spurred colossal investment in Covid vaccine development has largely been missing from AIDS vaccine research since HIV was discovered in 1983.

But another lies in the complexity of the science behind HIV. Some would suggest that greedy pharmaceutical conglomerates would rather cultivate recurring sales revenue from treatments than prevent people from getting sick in the first place.

“A lot of money can be made from healthy people who believe they are sick,” said Ray Moynihan, Iona Heath, and David Henry, a team of researchers that provided examples of ‘disease mongering’ and suggested ways to stop the practice of pharmaceutical companies promoting diseases.

“Pharmaceutical companies invest in R&D in anticipation of future profits,” said Phillip L. Swagel in a Congressional Budget Office report. “For each drug that a company considers pursuing, anticipated returns depend on three main factors: the expected lifetime global revenue from the drug (minus its manufacturing and marketing costs), the new drug’s likely R&D costs, and policies that affect the supply of and demand for prescription drugs.”

“With Covid vaccines, researchers worry about the vaccine being able to fend off a handful of variants that have become particularly worrisome,” reads a June report by the International AIDS Vaccine Initiative (IAVI).

“But for HIV, there are millions and millions of different viruses that have resulted from the virus’s stealth ability to rapidly mutate… It is this astonishing level of diversity that any HIV vaccine must contend with.”

Olivier Schwartz, head of the viruses and immunity unit at the Pasteur Institute in Paris, says that while most people can recover naturally from an initial coronavirus infection and thus acquire immunity, this is not the case for HIV.

“HIV mutates much more easily than Covid and so it is more difficult to generate so-called broadly neutralizing antibodies that could prevent infection,” he said.

Only a handful of people naturally produce these antibodies when exposed to HIV.

Research into a vaccine has meant studying those rare responses, understanding how they work, and trying to replicate them in healthy people’s immune systems.

An mRNA jab?

Several dozen vaccines are being studied, with one by US firm Moderna seeking to use the same mRNA delivery method as its popular Covid vaccine.

The June report describing the research explains how the mRNA jab is meant to deliver instructions for a process called “germline targeting”.

This means “guiding the immune system, step by step, to induce antibodies that can counteract HIV”, the report explains.

So far, the technique is complex, involving an initial shot to activate important B-cells before several jabs attempt to spur the body into producing a range of antibodies.

Being able to visualize a way forward has given researchers hope, and some say it’s thanks in no small part to the pandemic.

“These last few years have seen unprecedented growth in our understanding of the immune system,” Serawit Bruck-Landais of French AIDS organization Sidaction told AFP.

But even with seeming breakthroughs, Bruck-Landais says, progress on an HIV jab is “not enough to be able to say we will have an AIDS vaccine soon”.

The US clinical trials for the Moderna vaccine that were set to begin in August are still listed on the National Institutes of Health website as “not recruiting”.

‘Lack of investment’

Researchers looking into vaccines say they are overlooked in terms of funding.

“The market is too weak for pharmaceutical groups and there’s a disappointing lack of investment,” says Nicolas Manel, a research director at the French National Institute of Health and Medical Research (INSERM).

“Many researchers are very motivated, but they have to make do with the funds they have.”

In the absence of a vaccine, the focus has historically been on promoting preventative measures like protected sex, clean needles, and overall better access to healthcare for marginalized populations.

Some 38 million people across the globe live with the virus.

From the time of that first case report in 1981, it took a couple of years for HIV to be identified as the retrovirus that caused AIDS.

It wasn’t until four years later, in 1985, that the U.S. Food and Drug Administration licensed the first test to detect the virus in blood.

Ten years after the first report of what came to be known as AIDS, scientists discovered combinations of drugs that could help keep the virus in check.

Then it took several years until these life-saving medicines made their way to some of the hardest-hit countries in sub-Saharan Africa.

Those timelines stand in stark contrast with the scientific and medical progress in combatting COVID-19.

“This year on World AIDS Day, we are focused on addressing health inequities and inequalities and ensuring that the voices of people with HIV are at the center of our work to end the HIV epidemic globally,” said President Joe Biden, in a proclamation designating December 1, 2021, as World AIDS Day.

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