What if an AIDS Vaccine was Approved this Evening...
First of all, if you later today hear that a vaccine has been approved, you definitely would have heard that it was on the way for approval a long time ago. With the two current vaccines in final trials (Phase III trials) only halfway so far, there is another 4-5 years before that could occur.
Since it takes several years to set up production facilities for a new vaccine, the companies and institutions behind the two vaccines in final trials are already building them to stand ready if granted an approval. Despite huge investments in facilities that might not be used for the purpose, they will in no way be sufficient for the demand of the vaccine. Therefore, new facilities have to be built, which will take 5-6 years from the approval, to be able to produce the vaccine needed.
It’s today globally recognized that the developer of an AIDS vaccine give up the exclusive rights for the most affected areas such as sub-Saharan Africa, developing Asia and Latin America, compensated by a small license fee from generic drug producers. This is also the case with the developers of the two vaccines in the final trials. The developers will however have the common patent rights for the rest of the world, where they will compete according to current market conditions.
For enough vaccine to be produced and distributed to stop the spread of the virus as quickly as possible, hopes are set to the global guarantee fund for an approved AIDS vaccine. The purpose of the fund is to secure funding for additional production facilities, the production and distribution of the vaccine to a first priority population of about 800 million people, clear the rights thereof and other costs related, once a vaccine has been approved.
The fund is supported by donors, foundations and governments, but has so far only been granted total guarantees of US$16 billion, of the US$28 billion requested. Even though the governmental guarantors of the fund have agreed not to take the guaranteed amounts from their regular aid support, skeptics claim that that anyway will be the case once the vaccine is approved, or they will not supply the guaranteed amounts as promised.
If the governments use their regular aid support to finance the fund, it can cause severe implications for people in critical need in other areas. It can also directly or indirectly harm organizations on which the distribution of an AIDS vaccine is depending.
The governmental guarantors from less affected areas, will also have to deal with providing the vaccine to their own citizens to a much higher price per immunization course. This will however be done through subsidies where the patient bare some of the cost.
Considered that the funding reach the target in time for the vaccine approval, will we come to a quick stop of the virus? No vaccine is 100% effective, and the first generation AIDS vaccine might only reach a 50% efficiency. So even with full production and distribution, we need further research and development for a more efficient vaccine, which will take years before it can be approved.
With a 50% effective vaccine given to 30% of the population could cut the number of new HIV infections in the developing world by more than half in 15 years. This will mean that if a vaccine was approved later this evening, more than 1 million people will still be infected around the year 2040 (remember new facilities were needed for extensive production and takes some years to build). So with this in mind, HIV/AIDS will still be around for probably half a century after they announce an approval of a vaccine.
Since we have been aware of HIV/AIDS now for about 40 years (it was widely recognized in 1981) what else could we have done to better prepare ourselves for a vaccine approval? There are now programs in schools in the US and other parts of the developed world, where the students are in regular contact during three years with schools in the worst affected areas. The sponsored program also include a trip for the students to meet with their far away friends.
This has given the students a better knowledge of the occurrence of HIV/AIDS and how it affect people in their own age in their daily lives. Surveys among the students also shows that they have developed a better understanding of people from other cultures, a much more generous approach to people in need, and even gained better self confidence.
If these programs had been around in 1995 at the peak of US casualties from AIDS, several decision makers now in their 40s, would have been engaged students. This would have left them with AIDS consciousness in their spines, with a better understanding, will to support research etc. and also passing it on to their peers. This release of brain resources in the developed world could have made a big difference in the strive for the AIDS vaccine.
The best way to stop the spreading of the virus is still information of how to protect yourself from getting it or pass it along, and to help the infected, highly active anti-retroviral therapy (HAART) help you stay alive. Although the vast efforts over the last decades, estimates suggests that until year 2030, a total of 180 million people worldwide will have died from AIDS, since it was recognized.
Don’t expect to hear the news later this evening that an AIDS vaccine has been approved. But if you do, it doesn’t mean that the struggle is over, it is only entering a new phase.
Argument: Estimations for the production of an initial AIDS vaccine is based on Breaking the bottleneck by Sheri Fink, MD, PhD. The effect of a first generation AIDS vaccine is based on Estimating the Impact of an AIDS Vaccine in Developing Countries from the International AIDS Vaccine Initiative.
Questions: In what other ways can we prepare for the day when an AIDS vaccine might be available, for it to reach people as quickly as possible? Can we release resources from the developed world in any other ways to help the most affected areas?