Choosing the Worst Time to Scale Back AIDS Research

May 18, 2015

Today is HIV Vaccine Awareness Day. For our full 2015 Toolkit, click here. This blog, by Mitchell Warren AVAC’s Executive Director, first appeared on The Hill.

In 1995, nine HIV treatment activists joined together to speed the search for an AIDS vaccine. With the global epidemic raging and truly effective HIV treatments still unavailable, they focused their advocacy on the research institutions best positioned to drive new breakthroughs, especially the US National Institutes of Health (NIH).

Two decades later, the movement they started has achieved remarkable success. The search for an effective vaccine is in its most promising phase ever, with some 30 different candidates in the pipeline reflecting an exciting array of scientific approaches. A series of related advances – from early antiretroviral therapy (ART) to a daily prevention pill – are already transforming the global AIDS response and saving lives. For the first time, we can honestly talk about how to end the AIDS epidemic – and we have not only researchers, advocates, and trial participants to thank, but also American taxpayers.

But we don’t yet have all the tools we need. That’s why it is dismaying that some members of Congress have chosen this moment to call for scaling back the nation’s investments in HIV research. Instead, we should be looking for ways to make these investments even more impactful, to continue leading the world into a future without AIDS.

The threat to research investments is partly the product of their success. In 2005 and 2006, NIH-funded trials found that male circumcision can reduce a man’s risk of HIV infection by nearly two-thirds. In 2011, a landmark NIH study found that ART slashes the risk of HIV transmission by 96 percent. Beginning in 2010, a series of trials backed by NIH and the US Centers for Disease Control and Prevention showed that daily use of an HIV treatment medicine by people who are HIV-negative can reduce their risk of becoming infected by 90 percent or more.

It’s these advances that led to widespread talk of the “end of AIDS.” In hindsight, that talk might have backfired, creating the misperception that we can begin to ease up on the accelerator.

In fact, about 2.1 million people still become infected with HIV every year, including 50,000 in the United States. With current prevention options we can get that number way down – but nowhere near zero. The NIH’s own Anthony Fauci has spoken compellingly about how, in any realistic scenario, an effective vaccine and other new prevention tools are still essential to halt new HIV infections.

A vaccine isn’t just needed, it’s also very possible. Just this year, researchers launched studies that could lead to the first vaccine licensed for use. While it won’t be the perfect vaccine, it could make a real difference if proven to be even partially effective.

Meanwhile, basic science is opening up whole new areas of vaccine discovery, such as use of “broadly neutralizing antibodies.” These are immune system proteins that emerge in some people who are already infected HIV. Now, researchers are figuring out how to engineer them in the lab and offer them to HIV-negative people as a way to protect against infection. A whole range of other strategies are also in development, in the lab or in early human trials.

Dr. Fauci has done an admirable job of arguing for sustained research into AIDS vaccines and other approaches. But we can’t rely on any single voice to make our case. The entire AIDS community needs be speaking out in support of smart, strategic and well-funded HIV prevention research programs.

Within Congress itself, remaining backers of HIV research must stand up for the programs they’ve supported in the past. They need to make the case to colleagues, and the nation, for sustaining this work until the job is done. And they need to hold the research community accountable for making the most strategic use of taxpayer resources.

My organization is the product of the nine advocates who came together 20 years ago. Like HIV prevention itself, we’ve changed in unexpected ways. But the basic idea remains the same – that an effective AIDS vaccine is essential to ending one of modern humanity’s greatest tragedies. This is an idea we’ll be repeating on HIV Vaccine Awareness Day, May 18, and throughout the year.

The future path of science is never clear. But we can be certain that slowing down now would be a huge mistake – for American scientific leadership, and for millions of people whose lives depend on it.

Warren is Executive Director of AVAC, an advocacy organization for the elimination of HIV/AIDS.