World AIDS Day 2020 (December 1) will be like no other. COVID-19 is threatening the progress that the world has made in health and development over the past 20 years, including the gains made against HIV. Like all epidemics and pandemics, it is widening the inequalities that already existed.
At end 2019, 38 million people globally were living with HIV and 25.4 million people were accessing antiretroviral therapy. Another 1.7 million people became newly infected with HIV in 2019 and 690,000 people died from AIDS-related illnesses in the past year. Since the disease was identified in the early 80s, 32 million people the world over have died of it. More than 12 million people are still waiting to get on HIV treatment.
With this in mind, this year the theme of World AIDS Day is “Global solidarity, shared responsibility”.
COVID-19 has demonstrated that, during a pandemic, no one is safe until everyone is safe. Eliminating stigma and discrimination, putting people at the centre and grounding responses in human rights and gender-responsive approaches are key to ending the “colliding pandemics” of HIV and COVID-19.
In a new report, “Prevailing against pandemics by putting people at the centre”, UNAIDS, the UN body dealing with HIV/AIDS, has called on countries to make far greater investments in global pandemic responses and to adopt a new set of bold, ambitious but achievable HIV targets. If those targets are met, the world will be back on track to ending AIDS as a public health threat by 2030.
We have seen how the COVID-19 crisis has exacerbated the challenges faced by people living with HIV, women and girls and key populations, including in accessing life-saving health care, and how the crisis has widened the social and economic inequalities that increase the vulnerability of marginalized groups to HIV. However, this crisis has also been a wake-up call and an opportunity to do things differently. In many respects, the defeat of AIDS as a public health threat depends on how the world responds to COVID-19.
The logistical disruptions caused by COVID-19 has been a nightmare to people suffering from HIV and many other diseases, as international pharma supply routes have been suspended. In many countries, HIV prevention, testing, and care have been disrupted because of strict lockdown policies and breaks in medicine supply chains.
Modelling data published in The Lancet Global Health show that severe treatment disruptions in high-burden settings could increase HIV mortality by 10 percent within five years. The HIV Modelling Consortium has shown that severe treatment disruptions in sub-Saharan Africa—e.g., preventing HIV treatment for 50 percent of patients for six months—could lead to an excess of 296,000 HIV deaths within a year. However, some countries are taking measures to accelerate the scale-up of differentiated service delivery for HIV by expediting multi-month dispensing of HIV medicine, which they otherwise may not have done.
Incredibly, the whole world came together to bolster efforts to find a COVID-19 vaccine and we already have three promising vaccine candidates in less than one year. However, the world still does not have a vaccine for HIV. Since 2015, research groups in Europe and elsewhere have been working together to speed up the process and increase the chances of success. The European AIDS Vaccine Initiative 2020 project has developed a number of prototype RNA vaccines that show promise for HIV treatment.
The biggest hurdle is the development of a single vaccine that can prevent infection from the wide range of circulating HIV strains. To make things worse, HIV can persist in infected individuals and nobody has ever been cured through a natural immune response. This contrasts greatly with COVID-19, which is currently driven by a single viral isolate showing minimal diversity and where most individuals naturally recover from the infection and eliminate the virus.
In short, an HIV vaccine would be unlike any vaccine previously developed against infectious threats. Scientists say the best approach would be to develop a combination vaccine that would contain a minimal set of HIV envelope proteins to provide a diverse antibody response, as well as T-cell immunogens to engage both antibody and cellular arms of the immune response. Thus, it is increasingly likely that the world will see an HIV vaccine in the next few years, having received a boost by the COVID-19 vaccine research techniques as well. Again, developing an HIV vaccine calls for Global Solidarity as it is a Shared Responsibility.
The World must come together to strengthen the Global Fund for TB, Malaria and HIV, the biggest killers in the world in that order. TB alone kills 1.5 million people a year despite the availability of a vaccine. A malaria vaccine too could be available within the next few years. But there should be a bigger focus on these three diseases as well, even as we fight COVID-19. This is indeed a shared responsibility of the whole world.
