On the sidelines of the India Africa Health Sciences Meet,Mark Feinberg, Chief Executive Officer of the International AIDS Vaccine Initiative, spoke toVidya Krishnanabout the lack of urgency weakening global HIV interventions. Having spent nearly three decades in HIV research, Dr. Feinberg said the AIDS epidemic was worse than ever but it had become less visible, leading governments to think that the problem had been solved.
Do you think HIV has fallen off the priority?
The epidemic is the worse than it has ever been. It is less visible and governments are paying less focus because of the sense that effective treatment is available. This is a major problem. Providing life-long treatment for millions of infected people is a major, long-term obligation. While there has been progress on getting more people on treatment, we haven’t made any progress in decreasing the number of new infections in any meaningful way. Basically, we are accumulating more and more HIV-infected people every year and that’s going to cost a big bill.
Do you think the ‘end of AIDS’ rhetoric is realistic?
While some people have been projecting that if we simply treat enough people, we will prevent additional infections and eventually AIDS will end, I think that is not a realistic perspective. We need to do that but at the same time, how to prevent new infections? The sense of urgency and the need to respond to HIV in a robust way has gone down. And so, the priority to mobilise resources has also diminished. That is very risky because the problem will not go away just because you don’t think about it. It will get worse. We remember how tragic and terrible the AIDS epidemic was in the earlier days before treatment. We need to redouble our efforts rather than back off. If groups make promises that are not possible to keep, there are going to be serious consequences.
How realistic is the end of AIDS rhetoric, especially with the U.N. General Assembly setting a global 2030 target?
I think that will become apparent in near future. The Global Fund to fight AIDS, Tuberculosis and Malaria (GFATM) is now going through replenishment process. If they do not get enough money that will be a clear signal that we are not going to be able to do the job at hand. Even by their own projections, they are thinking of feasible goals. We need much more than just money, as even now, the HIV community is disenfranchised.
How far away are we from a vaccine?
Major scientific challenges are involved in developing an HIV vaccine. That being said, the science dedicated to HIV vaccine development is remarkable. We have tremendous insights into the biology of developing vaccine and it has transformed how the scientific community thinks about developing vaccine for other diseases as well.
We have promising ideas that are now going to enter clinical trials in the next year or two. If we can show that these ideas are valid there is a path of getting to the vaccine.
Will that happen in our lifetime?
In my lifetime, I don’t know. This virus emerged in my lifetime. I remember a time before antiretrovirals, when the scientific community thought it wouldn’t be possible to treat HIV. Then, remarkable insights came together and we had effective therapy. I still want to be open to the possibility of an HIV vaccine. It will not be easy or fast, but if you are open to serendipity, things can be easier.
What are the most promising HIV vaccine candidates right now?
There are trials in South Africa that are testing important concepts. We are engaging with communities at risk in India and Africa to understand what makes someone at risk of getting HIV — to understand the biology that is responsible for making some susceptible to getting infected. We use that information to design vaccines. In South Africa, we are now testing a monoclonal antibody that is intended to block the infection and make someone resistant to getting infected. We are looking at people infected with HIV to see who of them make potent responses.
We then take specimens from them, identifying those antibodies to better understand what kind of vaccines we need.
