All of us at AVAC are deeply saddened by the untimely demise of Inviolata Mwali Mmbwavi, a fearless leader who devoted her life to fighting for the right to treatment and dignity for people living with HIV in Kenya. She brought this same spirit as a passionate advocate for HIV prevention.

“I would not wish HIV infection to happen even to my worst enemy. I will do whatever it takes within my ability to speak out and support prevention efforts to stop any single HIV infection where I can,” Inviolata told guests at an HIV Vaccine Awareness Day event in Nairobi last May.

Invio, as she was fondly known, worked closely with AVAC around HIV prevention for women, mentoring an AVAC Fellow, advocating for HIV vaccine research and lately around the COVID-19/HIV intersection. At a media webinar this year she presented the results of interviews she had conducted among Kenyan women living with HIV on how the COVID-19 pandemic was impacting their access to treatment.

As one of the first people in the country to publicly declare her HIV-positive status, Inviolata used her oratory gifts to fight HIV stigma and discrimination, from the rural villages of Kenya to the highest national political levels. She became a role model for positive living for youth and adults alike. Her actions contributed directly to the gradual shift in attitudes and HIV policies in the country.

In her life, Inviolata endured HIV stigma, opposition, ridicule and bouts of life-threatening illness, but always rose again to come back to her life’s work for the benefit of Kenya’s women.

Inviolata was the National Coordinator of the International Community of Women Living with HIV- Kenya Chapter (ICW-K). She launched a 3-year strategic plan for the organization in 2018, and worked tirelessly to fundraise and implement its holistic approach to HIV/AIDS care and treatment for women.

We echo the statement by NEPHAK, where she earlier served as founding executive director: “The history of the response to HIV in Kenya will not be complete without the mention of Inviolata Mmbwavi.”

AVAC sends sincere condolences to Inviolata’s beloved daughter and extended family.

Rest in peace and power, Invio.

Earlier this month, the first ever virtual International AIDS Conference played out over the course of a week. Out of it came both exciting news (injectable PrEP works really well for MSM and transwomen and so does oral PrEP) and disappointing data (we are definitely missing the targets)—all of which will inform AVAC’s advocacy for the months and years to come. For many of us here at AVAC, the week was a whirlwind of adjusting to the new online space, finding the virtual equivalent of a hallway conversation and tracking the firehose of news and session updates from the conference (not unique to the virtual experience).

In this update, we’ve put together news highlights, and links to some of our work at the conference, including recordings of some fun pop-up chats with researchers that were part of AVAC’s Research Literacy Networking Zone (RLNZ) programming. The conversations were a highlight for us—and we hope you find them useful, too!

And please bookmark our AIDS 2020 page, which we’ll update with links to the various session recordings as they become available.

Conference highlights

News and session highlights follow—with the news links courtesy of our friends at aidsmap. For their complete coverage of the conference, click here.

• Greg Millett’s plenary address on on a host of disparities that affect the HIV epidemic, the drivers and proposed solutions is essential watching for everyone.
• Access to PrEP is a powerful tool to bring down incidence at the population level, new data from the SEARCH study show.
• Injectable cabotegravir is highly effective in reducing HIV risk in men who have sex with men and transgender women. Participants in both study arms had low rates of HIV infection, but the difference in infection rates support the conclusion that CAB-LA is “superior” to oral TDF/FTC in terms of HIV risk reduction.
• Need a refresher on HIV prevention research? UCSF’s star researcher Susan Buchbinder provided a fantastic 20-minute lesson in plenary address on why, despite high efficacy, oral PrEP alone can not meet the world’s prevention needs, Biomedical HIV prevention: Beyond daily oral PrEP.
• Confirmation of preliminary data from the ADVANCE trial, which showed significantly higher weight gain in participants (and especially in women), who were in the treatment arm that included TAF. A separate study showed weight gain before and after a switch from TDF to TAF for treatment.
• More data on ARV use and effects in pregnant and breastfeeding women, including a meta analysis of different treatments and additional data from the Tsepamo study on neural tube defects (NTDs) in women using dolutegravir-based (DTG) regimens. Additional data from the Tsepamo study suggest a decreased difference in the number of NTDs between women who do and do not use DTG, compared to earlier study findings. The findings confirm the call for access to DTG-based regimens for all women.
• Study data showed that gay men and other men who have sex with men (MSM) in sub-Saharan African countries where homosexual activity is severely criminalized face nearly five times the risk of HIV acquisition compared to countries that don’t criminalize homosexuality.
• Additional data show that on-demand “2-1-1” PrEP is highly effective for MSM and transgender women.
• The Treatment Action Group (TAG) released its annual Pipeline Report, looking at HIV vaccines, antibodies, PrEP and microbicides.

RLNZ Pop-Up Chats

Click below to view sessions with researchers and advocates who discussed hot topics of the day. Have a topic you’d like to see featured in a future pop-up? Let us know!

• <href=”https://www.youtube.com/watch?v=Y9J3cmm4gck&t=1515s”>Long-Acting PrEP for Cisgender Women, featuring Sinead Delany-Moretlwe, Wits RHI
• Long-Acting PrEP for MSM & Transgender Women, featuring Raphael Landovitz, UCLA
• A Look at the Broadly Neutralizing Antibody Pipeline: What happens after AMP results?, featuring Devin Sok & Olayinka Fagbayi, IAVI
• A Conversation with Advocates on Preparing for AMP Trial Results, featuring Shelly Karuna, Fred Hutch Cancer Research Center
• HIV Cure Research, featuring Thumbi N’dung’u, Africa Health Research Institute
• Do Africans Need COVID-19 Research? A Conversation with Advocates and Researchers, featuring Dr. Kathy Mngadi, Aurum Institute, Dr. Sherman Padayachee, Setshabsa Research Centre, Xolani Mndaweni, Klerksdrop CAB, Former Participant
• Advocates Reflect on the Latest UNAIDS Report: What does it mean for research and access?

The satellite recordings aren’t yet up on the AIDS 2020 website, but the conversation at an HIV & SRH integration satellite, co-convened by AVAC and FP2020, was so good that we decided to continue it on a webinar this week. Please watch the recording of One Year After ECHO: Integration in the Time of COVID. And in the meantime, to hear more from the experts on SRH integration, check out our One Expert/One Question/One Minute Campaign mash-up video, and additional videos and resources at SRHintegration.org.

Read about work from AVAC and our partners in various sessions below!

• • Ending the HIV epidemic: Optimism, realism and disparities symposium
  • How did they do it? What successful communities can teach all of us about making dramatic progress against HIV

epidemics and what this means in the age of COVID symposium

• How policy affects practice: policy barriers to provision of HIV biomedical prevention services in Sub-Saharan Africa
• Transnational activism for an effective, comprehensive HIV response: Lessons from the coalition to mobilize power activism, strategy, solidarity (COMPASS) Africa
• Advocates’ perspectives on next-generation HIV prevention trial design
• Understanding ‘silenced health experiences’ of young people accessing HIV services through Body-Map Storytelling

We’ll keep adding new resources and links to our AIDS 2020 page as they become available, and remind you when they’re loaded up! If you have questions, or want to share with us your personal highlights, be in touch—we love hearing from you!

In our latest COVID Action Alert, we put today’s news of a Phase III trial launched by the biotech company Moderna in context. Larger trials mean an even greater need for robust community engagement to support the research and plan for uptake of an eventual vaccine. HIV vaccine and prevention advocates can lead the conversations that pave the way for ethical trials and swift implementation. How so? Read on.

On Monday, Moderna announced that enrollment has begun in a 30,000-person Phase III study of its mRNA SARS-CoV-2 vaccine candidate (mRNA-1273). The Moderna study is one of five large-scale, randomized, controlled efficacy trials currently slated to be conducted in partnership with the new NIH-funded COVID Prevention Trials Network (CoVPN) and with US government funding. At the same time, four other vaccine candidates have already entered into efficacy trials in Brazil, China, South Africa and the UK, and at least five more are expected to progress to Phase III by the end of this year. This work is being conducted through a number of global research collaborations, including the CoVPN.

The Moderna study will be conducted exclusively in the US in individuals “whose locations or circumstances put them at appreciable risk of exposure to SARS-CoV-2 and COVID-19.” The other Phase III trials planned with the CoVPN are expected to be conducted in the US and various international locations.

Anyone can get COVID-19. However, faultlines of racial and socioeconomic disparity run through this pandemic, as with HIV. In order to conduct research in communities and individuals that have been failed by the state and its health system, trials need robust community engagement—meetings with leaders and community members to share information, develop messages, address concerns and answer questions about eventual access plans. As HIV prevention activist Rob Newells said in a Washington Post story over the weekend, “… we have to engage people early in the research end of it, so by the time something gets approved, it’s not something brand new. I think it’s going to take time to talk to people about vaccine research.”

Moderna Phase III participants will be enrolled at 89 sites across the US, 24 of which are affiliated with the CoVPN, which includes groups and researchers with a long history of community-based research engagement. The remaining sites will be enrolled via a clinical research organization called PPD whose commitment to engagement is unknown.

Advocates and activists can take action by:

• Responding to recruitment announcements with a request for information on the local advisory mechanisms.
• Working with communities to develop priorities to inform engagement with research. This can include information on future access and health care for individuals in the trials.
• Push for community-driven inclusion and exclusion criteria. Both the Moderna and Pfizer Phase III protocols indicate that individuals with HIV are not eligible for participation. Many groups, including AVAC, have joined together to raise urgent concerns about how this data gap will impact access for PLHIV, demanding that the trial sponsors review and change the criteria. The trials also exclude pregnant women, raising yet more concerns about how this research will replicate gender gaps that have hindered public health equity for years. Sign-on letters on both issues are in process.
• Sharing experiences. The world needs a COVID-19 vaccine; activists and advocates can help make sure that speedy research is safe, ethical and inclusive by rapidly disseminating what’s working and what isn’t—because if the research process does not build community trust and confidence now, then future vaccine access will be severely jeopardized.

To help ensure these and other steps happen effectively and efficiently, AVAC, ITPC, TAG and other partners have established a global COVID Advocates Advisory Board (the CAAB), that seeks to connect advocates, build power and elevate core issues. If you’re interested in learning more, please email us at avac@avac.org.

More about the Moderna candidate

The Moderna candidate uses an mRNA platform. mRNA is “messenger” ribonucleic acid, a single strand of genetic material that contains instructions for a specific protein. The Moderna vaccine contains a synthetic mRNA sequence that teaches the body to produce a protein found on the outside of SARS-CoV-2. The instructions don’t teach the body how to make the whole virus; there is no chance that the vaccine itself will cause SARS-CoV-2. In smaller trials, people who received this candidate made antibodies against SARS-CoV-2 that blocked viral activity in test tubes. This trial will help evaluate whether the vaccine-induced immune responses do the same in humans. Scientists are enthusiastic about the promise of mRNA vaccines, as they would be relatively easy to manufacture quickly and in large numbers. However, there are no licensed mRNA vaccines as of yet.

In July, Moderna published Phase I data from 45 volunteers, split evenly between men and women, at sites in Seattle and Atlanta. The data showed that the vaccine was safe, though it caused side-effects (chills, fatigue, headaches, etc) in many volunteers, particularly at higher doses. The vaccine was shown to elicit neutralizing antibodies; after two doses volunteers had more neutralizing antibodies than most individuals who have recovered from COVID-19. It is important to note that the level and duration of antibodies required for protection is not yet known. Phase II trials are ongoing, but the data were sufficiently promising to warrant launching the Phase III trial, which will randomize volunteers to receive either a placebo or the vaccine. The trial will primarily be looking to see if the vaccine prevents symptomatic COVID-19 disease, but researchers are also interested to see if it prevents severe disease.

For a snapshot of the larger COVID-19 vaccine pipeline, check out this update done in collaboration with TAG, and stay tuned for details on upcoming webinars on this and other COVID-19 vaccine candidates in development.

Welcome to the first in a periodic series of “COVID Action Alerts” from AVAC—these alerts are for HIV advocates whose expertise, interests, skills and voices are needed to influence and expedite an ethical, equitable and effective COVID-19 pandemic response. To start, we highlight emergent vaccine trial design issues, and the need to learn from history and apply best practices as the search for a COVID-19 vaccine proceeds with unprecedented speed. This week, a team at Oxford University announced safety data from a Phase I/II trial of its chimp adenovirus candidate that’s also in efficacy trials; next week Moderna is scheduled to begin enrolling 30,000 volunteers in a trial of its mRNA vaccine candidate.

Speed is essential, but not at the expense of cutting corners with ethics, safety, equity, access, peer review, and active, authentic engagement. And HIV vaccine advocates have a critical role to play in guiding the conversation.

One issue we are tracking is the ethics of and community perspectives on “human challenge experiments”. Click here to read and consider a sign-on statement on this issue, co-authored by AVAC and TAG, and read on for more information.

The Oxford University team just released safety data from an ongoing Phase I/II trial of a COVID-19 vaccine candidate. The trial found that the vaccine candidate, which is already in Phase II/III trials in Brazil, South Africa and the UK, was generally safe and that it induced both cellular and humoral immune responses. This trial team is one of many working to find an effective vaccine with all possible speed, and this vaccine candidate is one that is being considered for large-scale, randomized, controlled efficacy trials in the new NIH-funded COVID Prevention Trials Network (CoVPN). At the same time, one of the options the Oxford team is discussing is a human challenge trial—a proposed design that has received backing from more than a thousand scientists and researchers.

As background, challenge trials involve deliberate exposure to a pathogen in order to test vaccines. Typically, they involve pathogens for which treatments are available (malaria challenge studies are probably the best-known example).

AVAC feels that a human challenge with SARS-CoV-2 is not justified given the lack of effective treatments and the poorly understood potential consequences of infection, even in young people. Given the current state of the pandemic, which makes traditional, blinded, placebo-controlled efficacy trials quite feasible, it is not clear that challenge trials would speed the development of a safe and effective COVID-19 vaccine. In order to conduct a challenge study, the trialists would need to develop a stock of standardized virus—a process that could take months. Controlled human infection studies might contribute to vaccine development, but they will not automatically accelerate SARS-CoV-2 vaccine development timelines.

AVAC, TAG and its partners have spent more than two decades tracking trial design issues as they impact people at the epicenter of pandemics, who are also often neglected by the health systems that are supposed to serve them. AVAC and TAG issued a joint statement in May, when the idea of human challenge trials was first proposed in a WHO document, and further drafted guiding principles for choosing a challenge study design.

Now, AVAC and TAG have developed this sign-on statement to provide an expanding group of advocates and activists with a shared platform for articulating priorities and concerns. We hope you’ll add your name and/or organization.

The sign-on statement is just one part of our approach to ensuring HIV expertise and advocacy experience is brought to bear on this new pandemic. And the development of a challenge model, and the debates around them, should not delay the urgency of well-designed clinical trials and robust stakeholder engagement throughout the process.

Next week, a large efficacy trial of a vaccine candidate developed by Moderna (mRNA-1273) is scheduled to begin enrolling 30,000 volunteers in collaboration with the CoVPN. The CoVPN is also collaborating with AstraZeneca, Janssen, Novavax and Sanofi, each of which is expected to begin enrolling 30,000-person Phase III vaccine trials by the end of this year. Each of these trials uses a traditional design, not a human-challenge approach. Community engagement to ensure support for and access to the results of research are essential.

As such, AVAC, TAG and ITPC have launched a global COVID Advocates Advisory Board, which brings years of research engagement best practices to the context and considerations of COVID-19 research and development—-an area that evolves every day. And with the first of five 30,000-person efficacy trials beginning next week, we need a CAAB now, more than ever.

Are you in a community where trials are ongoing, or proposed? If you’d like additional information, background or advocacy support in learning more or gathering views, please let us know!

Click here to sign the statement.

Two recent developments have brought renewed publicity to proposals to conduct human challenge studies to test COVID-19 vaccine candidates: an open letter from the organization 1DaySooner and media reports that Adrian Hill’s Oxford University research group is planning a challenge study, taking advantage of the lack of regulatory oversight of human challenge experiments in the United Kingdom.

The open letter is addressed to Francis Collins, Director of the US National Institutes of Health, and signed by many eminent signatories including Nobel Laureates. It offers three short paragraphs that attempt to explain how challenge studies might accelerate the development of a vaccine for COVID-19, before entering into a much lengthier and more detailed discussion of how challenge studies should be executed.

This imbalance highlights the critical problem with proposals for human challenge experiments: the ethical justification for their conduct relies entirely on the premise that they would speed the development of a safe and effective COVID-19 vaccine. The evidence supporting this premise is thin to non-existent.

For good reason, regulatory agencies require safety data from large numbers of vaccine trial participants over a long period in order to consider licensure. The US Food and Drug Administration (FDA) guidance on COVID-19 vaccine development specifies thousands of participants followed for at least six months after receipt of all immunizations.

It is not clear if the 1DaySooner open letter is proposing challenge studies of this size—the logistics would be daunting, and it is extremely unlikely that they would significantly accelerate vaccine development given efficacy trials are already underway, with several more due to start soon. These large studies will provide data on safety and efficacy in the real world, where a licensed vaccine would be used. Challenge studies would occur in a controlled setting where it would be unknown whether the virus exposure was mimicking how transmission occurs in nature.

Adrian Hill is one of the signatories of the 1DaySooner open letter. Hill’s plans to conduct human challenge studies were disclosed in an article in the Guardian, which offers very little information what the justification might be, stating only:

“Hill said that the challenge trial, beginning either after or in parallel with the phase three trial, could provide complementary information about optimal dosing and administration of the vaccine, as well as being a way to test how long immunity to the virus endures after exposure or vaccination.”

These hypothetical suggestions of what a challenge trial “could” do are unconvincing. There are other—albeit possibly more expensive—ways to optimize dosing and administration and evaluate the duration of immunity.

As community-based organizations that work to promote scientific research literacy and broaden informed participation in clinical trials, we are concerned that proponents of human challenge studies fail to appreciate the potential to exacerbate mistrust of science. This mistrust is widespread and not necessarily irrational—there is a grim historical record of abuse in research, particularly of people of color. The apparent eagerness to embrace putting people at risk of death or other complications—both known and as yet unknown—from COVID-19 threatens to undermine the critical tenet that science now places the highest priority on the welfare of research participants.

Without sound, detailed evidentiary support for the claim that challenge studies will accelerate the development of a safe, effective, accessible vaccine, we strongly believe there is no ethical justification for human challenge experiments.

The one scenario that might alter the ethical equation is global declines in community spread of COVID-19 that would preclude the conduct of real-world vaccine efficacy trials. This scenario is alluded to in the 1DaySooner letter and explicitly considered in a recent paper from researchers involved in the NIH Accelerating COVID-19 Therapeutic Interventions and Vaccines (ACTIV) Vaccines Working Group. Two of our organizations—AVAC and TAG—have proposed Guiding Principles on the Ethical Conduct of SARS-CoV-2 Vaccine Challenge Studies that address this possible future context.

But much as we wish that this was currently an issue, the disastrous mismanagement of the response to the COVID-19 pandemic in the US and a number of other countries means that efficacy trials are going to be feasible for the foreseeable future. Promoting the ethical conduct of scientifically rigorous vaccine efficacy trials should, therefore, remain the priority.

Sign the statement.

There has never been an AIDS conference like the one currently underway this week—AIDS 2020 Virtual. As a global collective of people concerned with HIV, we also check the daily updates on COVID-19. Both demand real, urgent solutions. Here is AVAC’s take from the early sessions of AIDS 2020 Virtual and the actions that can make a difference right now, and in the future.

As the world works to make sense of the news from AIDS 2020 news, advocates, activists, scientists and global leaders must ensure that COVID-19 doesn’t further exacerbate or distract from the primary prevention crisis in HIV.

UNAIDS’ annual update, released yesterday, shows no change in the global total of new HIV infections. There were roughly 1.7 million infections last year. Five years ago, UNAIDS’ Fast-Track campaign set global sights on slashing rates of infections to 500,000 per year worldwide. At that time, there were roughly 2 million infections per year. Instead of meeting the goal, the world has made marginal progress—a reality that’s been clear for some time. While there are pockets of progress, the picture—even before COVID-19—is one of crisis and unfinished business.

To effect immediate change, AVAC calls for the following five actions:

1. UNAIDS and WHO must lead the call for a “Pandemic Policy-Change Agenda” in which law- and policy makers remove policies that criminalize sex work, drug use, same-sex behavior and HIV status. These policies are barriers to HIV prevention and to accessing prevention and treatment for other pathogens, including COVID-19.

2. National AIDS programs—working with WHO, PEPFAR, GFATM and civil society—must develop and implement differentiated service delivery of oral PrEP, including multi-month scripting with provision of self-test kits at each refill, using the same supply points to offer male and female condoms and contraceptive refills. As just announced new data from the SEARCH study show, access to PrEP is a powerful tool to bring down incidence at the population level. For more on differentiated service delivery (DSD) and the advocacy to go with it, see the satellite session convened by AVAC, IAS and PATH: Bringing PrEP closer to home: Why is now the time for differentiated PrEP?, available on-demand at aids2020.org. And read our recent blog entry on the topic.

3. UNAIDS must coordinate the funding and implementation of a rapid assessment of best practices to expand local community health cadres. Among these cadres, peer networks of people living with HIV are especially important to provide safe and local capacity to offer adherence support and to help connect people to food and income assistance and other social support in the context of concurrent pandemics. This rapid assessment should be used to drive funding to civil society and activist groups to implement strategies adapted for local contexts. At AIDS 2020, AVAC is proud to be presenting work from the COMPASS coalition, a vibrant locally grounded, transnational activist effort that provides a model for tying this type of data-driven work to action. (See a related poster to this work, Translational Activism for an Effective, Comprehensive HIV Response, at the On-Demand Poster Channel Track F.)

4. WHO, ViiV and other product developers, must work with regulatory agencies to advance a comprehensive, clearly articulated plan for acting on promising research findings. AIDS 2020 brought news that injectable cabotegravir is highly-effective in reducing HIV risk in men who have sex with men and transgender women. In the HPTN 083 study, participants who received the injection had significantly fewer infections compared to those who received daily oral PrEP—even though early analysis suggests relatively high rates of oral PrEP adherence. This is exciting and challenging news given that current data have yet to show efficacy in cisgender women, and rates of new HIV infections in adolescent girls and young women are persistently high. (A study in that population, HPTN 084, is underway.) Recently, the US FDA licensed F/TAF for people excluding those who have vaginal sex, prompting confusion and concern. It also spurred mobilization, led by cisgender women seeking clarity and equity in HIV prevention. At the same time, the EMA’s regulatory review of the dapivirine vaginal ring for HIV prevention is ongoing for this important prevention tool. For products that work in all bodies and all genders to reach the people who want and need them, the following must happen:

• Product developers must work with communities to ensure that introduction plans developed for CAB-LA and the dapivirine ring are clear, comprehensive and contextualized—so that the knowns, unknowns and timelines are explicit for the growing array of PrEP options available for different groups.
• ViiV, the manufacturer of CAB-LA, must move quickly to work with regulatory agencies. This work should be shared with community and reflect that input on plans for seeking review and developing a timeline for incorporating data from the ongoing HPTN 084 study of CAB-LA in cisgender women.
• WHO must simultaneously launch a parallel consultative process to support guidance for CAB-LA and the dapivirine ring, so there will be no delay in rolling them out once regulatory review is completed.

5. Civil society engagement must be regarded with the same urgency as the research itself for COVID-19, HIV and more. Clinical trial results don’t translate into action without meaningful stakeholder engagement at every stage of a trial, including design, implementation, data analysis, and eventual access to new interventions. AVAC is working with numerous partners on the leading edge of engagement for COVID-19 research to apply the Good Participatory Practice Guidelines and establish a COVID Advocates Advisory Board for these critical times. It is essential for civil society and national governments to have the funding and the space—virtual or otherwise— to make this vital work a success.

In the coming days, AVAC will be bringing more updates on AIDS 2020 news and its relationship to these core recommendations. In the coming months and years, we will be working with advocates worldwide to ensure that the critical issues raised in this moment of “virtual” convening and “paused” activities translate into real and dynamic change.

AVAC, Health GAP and the Treatment Action Group (TAG) strongly condemn the Trump Administration’s withdrawal from the World Health Organization (WHO). Today’s announcement formalizing the President’s threats from earlier this year is short-sighted and dangerous, and will cost more lives and deepen economic devastation in the United States and around the world, which are already reeling from the ongoing COVID-19 pandemic.

“This virus respects no borders; COVID-19 anywhere can quickly become COVID-19 everywhere. Global health emergencies require global leadership, and that requires a strong and supported World Health Organization,” said Mitchell Warren, AVAC’s Executive Director. “The Administration is playing politics with people’s lives here in the US and around the world. We will be left behind as the world comes together to collaborate and coordinate science as the best strategy to counter the pandemic, and we will lose ground in our historical investments to end HIV, TB, hepatitis C and other health issues.”

The COVID-19 pandemic has brought unprecedented global cooperation among researchers and funders, with WHO playing a critical role in coordinating both the overall global response and many of the global research initiatives. Global cooperation on public health policy, science, data and information sharing is needed more urgently than ever before. The Trump administration makes a dangerous gamble in thinking that the US can act alone in the response to COVID-19.

“We are seeing the disastrous effects of the US federal government’s lack of strategy playing out every day in increased COVID cases and deaths of Americans, particularly in the Black community,” says Suraj Madoori, TAG’s US and Global Health Policy Director. “Withdrawal from WHO will only compound the issues for our nation and for the world by further retreating on shared responsibilities in public health governance.”

The COVID-19 epidemic is devastating already constrained health systems in low- and middle-income countries where COVID-19 is surging, and has further weakened the US healthcare system as well. At the same time, this new pandemic is already having profound implications on responses to HIV/AIDS, TB, viral hepatitis, malaria, vaccination and contraceptive programs and all other public health responses.

WHO plays a key role in coordination, guidance development and mobilization of these public health responses in countries struggling with COVID-19 in addition to limited resources, conflict and other humanitarian and ecological disaster-related crises. As governments and stakeholders position resources against COVID-19, the WHO has taken the lead in forming the Access to COVID-19 Tools (ACT) Accelerator, a new and needed global collaboration to accelerate development, production and equitable access to COVID-19 tests, treatments and vaccines.

The US, as a historic leader and funder of global public health initiatives, and the largest funder of WHO, has a moral responsibility to help ensure an equitable global response to the COVID-19 pandemic. Terminating the US relationship with WHO starves the organization of funding, US staff and US expertise. It likely prolongs the pandemic and will force WHO to cut critical funding and support for other health programs, including those responding to HIV/AIDS, TB, viral hepatitis, and sexual and reproductive health.

“The Trump administration is shameless in its extreme nationalism at the expense of people’s lives. The WHO performs a vital role in getting new HIV treatments to people around the world safely and quickly and providing key technical assistance to strengthen health systems in vulnerable countries. Trump pulling the US out of the WHO is yet another demonstration of his disregard for people living with HIV around the world,” said Matthew Rose, Director of US Policy and Advocacy for Health GAP.

AVAC, Health GAP and TAG call for the Trump Administration to immediately reverse this disastrous decision, restore and protect funding to WHO and work to ensure global cooperation in the pandemic response.