Can HIV Vaccine have impact with many prevention tools?

By Esther Nakkazi

A vaccine is still the best shot in the arm for the world’s AIDS epidemic even in the face of progressive combination prevention interventions now available in the research arena, scientists say.

Since 2009, different biomedical HIV prevention tools have been developed like male circumcision, prevention-of-mother-to-child transmission, microbicides, treatment as prevention and Pre-Exposure Prophylaxis (PrEP), which are making an impact on HIV control.

“Advances in HIV prevention strategies, including HIV vaccine are transforming the field,” said Dan Barouch, a professor of Medicine at Harvard Medical School and chair of AIDS vaccine 2012.

In a world where these non-vaccine HIV prevention interventions are combined and steadily scaled up, is an AIDS vaccine still relevant to end the AIDS pandemic in the world?

Vaccines development takes many years even when science gives a proof of concept and a product early, actual design and implementation may not. Meanwhile, new HIV prevention strategies could produce important reductions in the 2.5 million HIV infections occurring each year.

“Depending on the timing and only in a specific context- for control, elimination and eradication of the AIDS epidemic will the vaccine be relevant and make an impact” said Dr. Anthony Fauci, the director National Institute of Allergy and Infectious Diseases at the 2012 AIDS vaccine conference in Boston, USA.

The AIDS vaccine conference, the world’s only exclusive meeting dedicated to exclusively to HIV vaccine research was held from 9-12 September at the Boston Convention and Exhibition Center.

It was attended by more than 1,100 researchers, funders and policy makers with more than 440 presentations on the latest in AIDS vaccine research, development and testing.

As more interventions are discovered, the HIV vaccine faces a challenge. We should support the field as it goes forward and I am glad that this conversation has now started said Dr. Hannah Kibuuka the Director of Makerere University Walter Reed Project (MUWRP) in Uganda.

According to Dr. Fauci, the combination of non-vaccine prevention modalities available today may be able to initially control HIV infection rates in populations but maintenance of this control will require a vaccine.

Just as elimination and eradication of HIV will require an AIDS vaccine and maintenance of these is critical, scientists attending the AIDS vaccine conference heard. For instance many epidemic infectious diseases like yellow fever and malaria have been brought under control using vectors but effective maintenance of this control would require a vaccine.

Researchers also know that the exciting times of the new prevention non-vaccine interventions tools present a daring time for AIDS vaccine clinical trials with benefits and challenges.

It is anticipated that the AIDS vaccine trials will be more complicated- as if they have not been already- since ethically, researchers have to make available the different prevention tools to the study volunteers.

In resource-limited settings, lack of funds; no regulatory framework, limited capacity by ethical committees will be a daunting task to make accessible these preventive interventions to AIDS vaccine study participants. However, on the flip side there are also benefits.

“The good news is that we are in a new arena and vaccine efficacy does not necessarily need to be 95 percent,” said Fauci, meaning that prevention interventions will play a role in control so the effectiveness of the vaccine can be lower.

In the face of the challenge, already advancements in the way things are done around the AIDS vaccine work have changed with more partnerships and collaborations between researchers, policy makers and advocates working on vaccine trials.

For instance, the 2014 AIDS vaccine conference will address all the combined prevention strategies including vaccines. Previously a microbicide conference, male circumcision etc conference would be held.

“We now know more about the challenges and how the different modes of prevention can be used to answer more questions. We have all these people coming together but funding could also be an issue,” said Kay Marshall the Director of Communications, International AIDS Vaccine Initiative (IAVI)

“There are so many developments in bio-medial prevention. The science has pushed us to think about it. People are beginning to think about the similarities and differences more,” says Catherine Hankins the deputy director, Science at the Amsterdam Institute for Global Health and Development (aighd).

Ends.