• The scientific challenges facing HIV vaccine research have been well reviewed by several authors [32
]. These include the absence of an ideal animal model, poor understanding of the correlates of protective immunity
, the intense variability of the HIV organism, the virus’ ability to integrate into the host genome, viral efficiency to quickly overwhelm the host’s immune system and establish reservoirs of infection, and the concealment of the conserved antibody targets on the outer envelope. The magnitude of these scientific challenges and the resultant disappointing results from all the HIV vaccine clinical trials except the RV144 Thai trial has understandably generated a lot of scepticism on the feasibility of an effective HIV vaccine [35
]. Such scepticism
makes it difficult to effectively advocate for the continuation of HIV vaccine research especially in resource poor countries of SSA Non-scientific challenges which have hindered effective HIV vaccine advocacy in Africa include:
• Continued negative results from HIV vaccine research studies. In more than two decades of HIV vaccine research, there have been very few exciting moments. One particularly bright moment in the HIV vaccine R&D enterprise was the announcement in 2009 of the results of the RV144 Thai trial [36
], which showed for the first time that an effective HIV vaccine is feasible
. Prior to this time, it had been a series of discouraging news with each succeeding trial showing either a null or a negative effect of the agents tested. The recent discontinuation of HVTN 505 [37
] was another sore moment in HIV vaccine research advocacy. Such failures have led to discouragement and skepticism among HIV vaccine R&D advocates.
• Cost of doing HIV vaccine research: HIV vaccine research is a very expensive venture. From 2005 to 2012, the total funding for HIV preventive research was $7 billion compared to 2.4 billion for research into microbicides, pre-exposure prophylaxis
, adult male circumcision and treatment as prevention combined.Cost considerations could discourage many interested scientists and most of the affected countries to venture into HIV vaccine research, considering that many of these countries have been unable to fund their national HIV response plans.
• Competing interests
: With limited resources and several public health programs such as the millennium development goals (MDG) and other health issues to address, coupled with the surge of excitements from results of PrEP and other HIV prevention research, there is a strong push to stop ‘wasting
’ money on HIV vaccine research but rather invest such funds on proven HIV prevention methods. However, several studies have shown that the cost savings from an effective HIV vaccine will ultimately outweigh the cost of developing the vaccine [38
] (Jennie Aylward, IAVI Policy Briefs, http://pdpaccess.org/wp-content/uploads/2012/11/Aylward_AIDS-Vaccines-Exploring-the-Potential-Cost-Benefit.pdf
, Accessed 04/05/14).
• Lack of strong Leadership in the HIV vaccine research and development (R&D) advocacy efforts in Africa: Anecdotal evidence suggests that there is limited knowledge of the concept of HIV vaccines among key African stakeholders, including policy makers and HIV advocates. Unfortunately, the mechanism to help them understand, and therefore support the HIV vaccine R&D agenda is largely lacking. Previous efforts to bridge this gap has been hampered by vested interests and political subterfuge. This has resulted in the failure to develop an adequate coordinating mechanism for HIV vaccine R&D advocacy in Africa. In North America and Europe, on the one hand, there is a well-organized HIV vaccine advocacy community that is able to effectively articulate
the case for continued support for HIV vaccines. Africa, on the other hand, lacks such a well-organized well-coordinated mechanism. What presently exist are pockets of advocacy activities with very little synergy. Previous international efforts to put such coordinating mechanism in place collapsed for reasons beyond the remits of this brief paper. One of the consequences of the weak leadership in HIV vaccine advocacy efforts in Africa is lack of country ownership and accountability by African governments. Since the advent of the HIV/AIDS pandemic, superior argument by advocates have always driven the response by governments and philanthropists. This is true for access to anti-retroviral treatment [39
], condoms etc. This is also true for microbicide research [40
]. The situation cannot be different for vaccine research. One way to counter the perceived lack of interest by African governments to fund HIV vaccine R&D is to develop a consistent, focused, long-term Africa-led HIV vaccine R&D advocacy. Unfortunately, this level of advocacy has not been allowed to thrive in Africa. There appears to be a lot of ambiguity
and prevarication in the support for Africa-led efforts in addressing these issues especially in the area of advocacy. Such scenario can only breed mistrust which is counter-productive.
• Capacity gaps:
There are several capacity gaps in Africa, including appropriate legal and regulatory frameworks for the conduct of HIV vaccine research. Although many African countries have developed National HIV Vaccine Plans, only few of these plans have been ever implemented. In addition, there is limited human capacity to support the conduct of more upstream research in Africa. While there have been efforts to build the research capacity of Africa, anecdotal
evidence suggests that there is still limited involvement of African research community in HIV vaccine R&D and poor recognition of the efforts of those engaged in one form or another with these efforts.