We’ve all pondered the eternal question: If a tree falls in the forest, and no one is there to hear it, does it make a sound?
Well, what if researchers developed a vaccine for HIV and no one had access to it because of cost and/or distribution issues?
Frankly, it’s a query no one involved in the treatment of HIV, or those engaged in working with at-risk populations, wants to ask, although they know they must. Such is the reality in the global health environment, where drug and vaccine development often outpaces solutions to the larger, societal problems that can limit access to optimal care.
As reported online on February 27, 2018, by the journal Nature, the World Health Organization’s (WHO) Initiative for Vaccine Research (IVR) organized a meeting of researchers, activists, and policymakers in Geneva, Switzerland, to discuss strategies for ensuring that a viable HIV vaccine, once developed, would reach the very people who would benefit most from it. A WHO spokesperson told Contagion® that more than 75 people “representing important stakeholders in vaccine development, including individuals from academia, international not-for-profit organizations supporting HIV vaccine development, regulators, funders, civil society representatives from all world regions, and representatives of industry” attended.
Unfortunately, any initiatives resulting from the discussion were not immediately made public, although a report is expected soon.
“WHO IVR aims to provide guidance on vaccine development pathways to ensure that products meet global public health needs and clinical research data support robust policy decision on implementation and use,” the WHO spokesperson said. “The meeting aimed to discuss the pipeline status of vaccines and monoclonal antibodies for HIV prevention and consider the pathway between proof of concept and availability and use.”
He added that the special meeting ended with a session closed to industry representatives in which the other attendees discussed “overall coordination and the way WHO may contribute to define product preferences and key characteristics that will drive successful contribution to global public health.”
At present, multiple candidates are in various stages of research and development, including cabotegravir, which is currently in phase 3 trials, and vaccines based on broadly-neutralizing antibodies. The WHO adds that other vaccine platforms have been “strategically designed to build on findings from the Rv144 study in Thailand.”
The IVR meeting comes at a time when research is suggesting that, despite gains in HIV prevention with existing modalities, significant challenges remain, particularly in the developing world. On March 10, 2018, which was National Women and Girls HIV/AIDS Awareness Day in the United States, the Centers for Disease Control and Prevention (CDC) reported that new HIV diagnoses are down among women overall and declined 20% among African-American women and 14% among Hispanic/Latina women from 2011 to 2015. However, a CDC study presented March 6, 2018, at the Conference on Retroviruses and Opportunistic Infections (CROI), found that fewer than 10% of the 1.1 million Americans who could benefit from HIV pre-exposure prophylaxis (PrEP) actually receive prescriptions for it.
According to Nature, approximately 1.8 million people worldwide were diagnosed with HIV in 2016.
“Experience shows that the pathway to new vaccine implementation can be long, and early planning is required to avoid delays in access and use,” the WHO spokesperson told Contagion®. “The risk of such delays depends on the complexity of the product, availability of delivery systems, financing mechanisms, among other important factors. Early engagement of regulators and policy decision makers can help inform vaccine development strategies. A comprehensive assessment of public health value according to key product attributes, taking into account existing and pipeline interventions, health economic evaluation, societal impact, ethics, would be useful in guiding decision making in product development and assessment pathways.”
Contagion® reached out to several experts on ongoing HIV vaccine research for insights into the WHO meeting, which was organized in conjunction with UNAIDS; however, all of them wanted to reserve comment until the results of the deliberations are made public. And, indeed, it will be interesting to see what, if anything, comes out of the Geneva gathering. Because it goes without saying: A vaccine for HIV will only be effective if it’s made available to those who need it.
Brian P. Dunleavy is a medical writer and editor based in New York. His work has appeared in numerous health care-related publications. He is the former editor of Infectious Disease Special Edition.