HIV remains one of the most pressing global public health challenges, particularly devastating in southern and eastern Africa, where a significant proportion of the world's HIV-positive population resides. Unfortunately, new HIV infections in these regions remain alarmingly high, despite advances in prevention and treatment strategies.

In South Africa alone, approximately 150,000 individuals become newly infected with HIV each year. This staggering statistic shines a light on the inadequate availability and utilization of proven preventive measures, including oral and injectable antiretroviral pre-exposure prophylaxis (PrEP). While over 7.5 million South Africans are living with HIV, only 5.9 million are currently receiving antiretroviral therapy (ART), indicating a critical treatment gap where one in four HIV-positive individuals are missing out on lifesaving care.

People living with HIV who adhere to their treatment can achieve an undetectable viral load, which means they cannot transmit the virus through sexual contact. Thus, increasing ART coverage is vital for turning treatment into a preventive measure; however, South Africa's current shortfall makes this goal elusive.

As advocates for HIV prevention, we recognize that developing effective vaccines could be pivotal in halting the transmission of HIV. Vaccines educate the immune system on how to combat diseases without the risks associated with full-blown infections. Continued research and development of an HIV vaccine is crucial and should be a global priority, especially with African scientists at the forefront of creating affordable and long-lasting solutions.

The Promise vs. the Price of New Options

Recent breakthroughs in long-acting injectable PrEP, such as lenacapavir, show incredible potential in minimizing the risk of sexual transmission of HIV, with clinical studies suggesting near-elimination rates. However, these treatments come with a hefty price tag, soaring to nearly $44,819 annually—an unattainable expense for most public health systems in Africa.

While voluntary licensing with generic manufacturers might improve accessibility, relying solely on PrEP will not suffice to eliminate HIV. The reality remains that we urgently need a safe, effective, and affordable vaccine. Imagine a vaccine that could grant long-lasting immunity, requiring merely four doses over a year!

Vaccines have proven their worth across various infectious diseases, significantly lowering childhood mortality rates, and contributing to the eradication of smallpox. Yet, despite decades of research and hefty investments, no HIV vaccine candidate has yet demonstrated sufficient efficacy to take on the virus robustly.

To meet the United Nations goal of eradicating AIDS as a public health threat by 2030, a substantial increase in global investment for HIV vaccine research and development is essential. A notable missing piece in this puzzle is the commitment from African governments to invest adequately in such initiatives.

Africa Must Take Charge

As the continent facing the brunt of HIV's health and economic repercussions—around 25.6 million people were living with HIV in Africa in 2022—funding for research and innovation remains disappointingly low. In 2006, African Union member countries pledged to allocate 1% of their gross domestic product to research and development, yet by 2019, the average investment stood at a mere 0.42%, well below the global average of 1.7%. South Africa, the continent's leader in R&D spending, still only allocated 0.85% of its GDP to this critical effort.

For an African-led initiative on HIV vaccines to thrive, three key elements are needed: strong scientific and political leadership, local investment, and persistent community involvement. It's imperative that African governments prioritize funding for vaccine development as a public health necessity. Furthermore, empowering local scientists in vaccine research can foster trust and enhance credibility within communities.

Global partnerships have bolstered Africa’s HIV vaccine research landscape, with organizations like the US National Institute of Health and the Bill and Melinda Gates Foundation aiding in the development of robust clinical research and laboratory infrastructures. These collaborative efforts set the stage for high-quality research conducted by African scientists.

The Path Forward

Looking ahead, Africa's escalating capacity for vaccine manufacturing offers a promising horizon for the development of an indigenous HIV vaccine. Recent advancements in regional production facilities in nations like South Africa, Senegal, and Rwanda could pave the way for a sustainable supply chain for HIV vaccines, reducing reliance on foreign sources and ensuring equitable distribution.

The goal of eradicating the HIV epidemic is feasible but demands a united global effort. While current prevention options like long-acting injectable PrEP are invaluable, they are no substitute for the transformative power an effective vaccine could provide.

International and African stakeholders must intensify their collective efforts in investing in HIV vaccine research and development. As Nelson Mandela wisely articulated, “It always seems impossible until it's done.

With decisive leadership and sustained financial commitment, we stand on the brink of making an HIV vaccine a reality—and with it, moving ever closer to the end of AIDS!