Global Health Progress

by Seth Berkley, Chief Executive and President of the International AIDS Vaccine Initiative

We are still losing the fight against AIDS, badly. But there are good reasons to think we can win, with the tool that holds the hope of eliminating, and not just curbing the epidemic: a preventive vaccine.

If we want to end the spread of HIV, we need a vaccine. No major viral epidemic has been defeated without one.

About 39 million people are HIV infected; 3 million die annually of AIDS. To date, AIDS has killed at least 23 million people and is the world’s fourth-leading cause of death.

Twenty-four years ago, when a virus was found to be the cause of AIDS, there were only a few licensed medicines for use against any virus, and scientists thought it implausible to develop drugs against HIV. Today, we have more drugs to treat HIV than for all other viruses put together. That’s what we can do when we focus the power science.

It took 47 years after the virus responsible for polio was identified before scientists developed a vaccine for the disease. That we are free from iron lungs as well as a range of other infectious scourges is a debt we owe to the persistence and optimism of previous generations. Now it is our turn.

We have much better tools at our disposal than early vaccinologists had, but we’re still in the early stages. That an AIDS vaccine is possible is strongly suggested by the fact that most people’s immune systems hold HIV in check for years before they develop AIDS. A small number of infected people seem never to develop the disease. We also know, from studies in nonhuman primates, our closest relatives, that vaccines can protect from infection with SIV, HIV’s cousin in monkeys.

Life-prolonging treatments for AIDS have improved and have become more available and affordable even in poorer countries. But the epidemic outpaces these strides. For every person who began antiretroviral treatment last year, nearly four others became HIV infected.

UNAIDS has estimated that it would cost at least $45 billion a year by 2015 to achieve the Group of Eight’s goal of providing a comprehensive package of AIDS prevention, treatment and care to everyone who needs it in the developing world. Even with a drop in infection rates, AIDS spending, barring a revolution in giving, would have to go from one-tenth to one-quarter of all foreign aid to achieve the G-8 goal.

Focusing on the long-term goal of creating an AIDS vaccine is undeniably hard. The world is spending some $900 million a year on the effort, up from less than $200 million a decade ago. It is still a minimal investment, but it is one that will ultimately prove cost-effective: A preventive vaccine is the only intervention that could ultimately eliminate the need for all others.

This article was adapted from op eds published in the Los Angeles Times on September 27, 2007, and The Washington Post on December 18, 2007.

About IAVI:

IAVI is a global non-profit dedicated to ensuring a safe, effective, accessible AIDS vaccine for use throughout the world. IAVI was founded in 1996 as the first modern biomedical public-private partnership (PPP); its industrial style approach has been emulated by many subsequent product development PPPs in global health. The goal of IAVI’s R&D program is to ensure the development of HIV vaccines capable of preventing the establishment of persistent HIV infection, slowing the progression to AIDS and reducing transmission of HIV. IAVI has calculated that even a partially effective vaccine could avert from 5.5 to 28 million new infections over a 15 year period.