HIV continues to pose a significant threat to global public health, particularly in southern and eastern Africa, where the majority of the world's HIV-positive individuals reside. Alarmingly, new infections remain high despite notable advances in treatment and prevention efforts.

In South Africa alone, around 150,000 individuals are diagnosed with HIV each year. With over 7.5 million people living with HIV in the country, only 5.9 million receive antiretroviral therapy (ART). This shocking disparity reveals that one in four individuals with HIV is not receiving the treatment they need, further exacerbating the public health crisis.

Effective HIV treatment can lead to an undetectable viral load, meaning that individuals on consistent medication won't transmit the virus during sexual activity. Yet, the treatment gap in South Africa prevents the nation from achieving crucial treatment-as-prevention objectives that rely on broad ART coverage.

Experts in the field of HIV prevention advocate for the urgent need for an effective HIV vaccine to eliminate the disease's transmission. Vaccines train the immune system to combat infections without the risks associated with actual disease exposure. Thus, investing in HIV vaccine research and development must remain a global priority, with African scientists playing a decisive role in creating affordable, long-lasting solutions.

The Promise of New Technologies—and Their Price Tag

Recent innovations such as long-acting injectable PrEP, like lenacapavir, have shown remarkable potential in preventing sexual transmission of HIV, with clinical studies indicating nearly complete elimination of transmission. However, the staggering cost—up to US$44,819 per year—renders these treatments inaccessible for many public health systems across the continent.

Discussions about voluntary licensing agreements with generic manufacturers hold promise, yet even extensive PrEP implementation alone cannot wholly eradicate HIV. A safe, effective, and affordable vaccine is essential for eliminating this epidemic.

HIV vaccines could provide long-lasting immunity through a straightforward regimen, potentially involving four doses over one year. Historically, vaccines have played a critical role in reducing infectious diseases, with smallpox eradicated thanks to extensive vaccination efforts. Viruses like measles also see reduced transmission due to similar initiatives.

Despite decades of research and substantial financial input, no HIV vaccine candidate has surpassed modest protective success. Continuous, significant investment in HIV vaccine research is vital to meet the United Nations' 2030 goal of ending AIDS as a public health threat.

Africa Must Lead the Charge

Africa bears the lion's share of both health challenges and economic burdens related to HIV, with approximately 25.6 million individuals living with the virus as of 2022. Alarmingly, funding for research and development within the continent continues to stagnate.

The African Union made a commitment seventeen years ago to spend 1% of GDP on research and development, yet by 2019, actual spending had fallen to just 0.42%—well below the global average of 1.7%. No African country has met the initial target, with South Africa barely reaching 0.85%.

To ensure the success of an African-led HIV vaccine initiative, three critical elements must be addressed: strong scientific and political leadership, domestic funding, and ongoing community involvement. African governments need to recognize the urgency of prioritizing HIV vaccine research funding as a public health imperative.

Empowering local researchers to spearhead these initiatives will not only enhance scientific output but foster trust within the communities they serve. Global partnerships, including those with entities like the US National Institute of Health’s HIV Vaccine Trials Network, the Bill and Melinda Gates Foundation, and USAID, have bolstered research capacities across Africa, laying the groundwork for high-quality research led by African scientists.

A Hopeful Future Ahead

Looking toward the future, Africa’s expanding vaccine production capabilities ignite optimism for developing an HIV vaccine manufactured on the continent. Initiatives in countries like South Africa, Senegal, and Rwanda could establish a sustainable production pipeline for vital vaccines, ensuring equitable distribution while minimizing dependency on outside sources.

Ending the HIV epidemic is not just an idea; it's an attainable goal that requires solidarity and concerted effort from both international and African communities. Although treatment options like long-acting injectable PrEP are valuable, they cannot overshadow the transformative potential that a vaccine offers.

In the wise words of Nelson Mandela, "It always seems impossible until it’s done." With determined leadership and steadfast investment, creating an HIV vaccine can transition from a distant dream to a tangible reality, bringing us significantly closer to ending AIDS for good.