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Breaking the Back of the Pandemic

01.01.70

The following is an excerpt from remarks given by Stephen Lewis at the opening ceremony of the AIDS Vaccine 2005 International Conference in Montreal on Sept. 6, 2005. The full text is available at www.stephenlewisfoundation.org/news.

The world needs an AIDS vaccine more urgently than it needs any single medical discovery, and Africa needs it more than any other part of the world. But for some inexplicable reason, the consuming enthusiasm, the obsessive drive, the sheer, unrelenting passion for a vaccine is simply not riveting the world at large as should be and must be the case.

I would argue that the same kind of extraordinary commitment, in country after country, to achieve '3 by 5', and then to progress to universal treatment, is exactly what has to happen in the pursuit of a vaccine. [...]

We clearly need a great deal more money in the quest for a vaccine. As you know, it's estimated that we spent $690 million in 2004, and should be spending a minimum of $1.2 billion every year hereafter, virtually doubling current annual expenditures. Even though there have been new monies committed by the Gates Foundation, and significant additional funds recently announced by Dr. Fauci, we're still several hundred millions of dollars short on an annual basis.

I want to say, categorically, that this state of affairs is unconscionable. There was nothing more than a rhetorical nod in the direction of a vaccine at the G8 meeting in Gleneagles: it's almost beyond belief that the political aristocrats so solemnly gathered couldn't bring themselves to promise an absolute funding guarantee, in perpetuity, until a vaccine is discovered [...]

Which brings me to the second item: allied with the question of resources is the question of broadening the base of scientific enquiry in the search for a vaccine. It seems to be widely accepted that the private pharmaceutical and biotech companies must be brought on board. Their participation hitherto, with one or two notable exceptions, has been, quite simply, paltry.

There are, of course, a number of explanations. The science is supernaturally complex and difficult; the exploratory investments are huge; the monetary risks are great; and undoubtedly the biggest obstacle to urgency of all, the market lies overwhelmingly in the poorest countries of the world. But clearly, the expertise of the private sector, with its successful history of producing vaccines for a vast range of diseases, is desperately needed in a vibrant web of public-private partnerships.

Thus, there has emerged the inventive idea of an Advance Purchase Commitment, designed to guarantee market and price for those companies who discover, manufacture and distribute a vaccine. [...]

While the search for a vaccine continues, there can be no lessening of our determination to resist the virus on every imaginable front. The 3 by 5 initiative has unleashed a galvanizing momentum for treatment: it must not be allowed to abate. What the World Health Organization and UNAIDS have done is to provide the greatest single trumpet of hope in the crescendo of treatment rollout. If, as the G8 suggested, we can attain universal treatment by 2010, we will have broken the back of the pandemic, although we will not yet have subdued it. What is true for treatment must be made to work for prevention (including targets for voluntary counseling and testing, and targets for the prevention of mother-to-child transmission), and what is then true for prevention must be made to work for home-based care. Despite the millions of deaths and new infections every year, we have psychologically shifted gears. The publics of Africa and of the world seem aware as never before of the need to tackle the pandemic: if only we could cross the Rubicon of political will. [...]

The potential Achilles heel is, as always, resources. In 2005, it is estimated that we will allocate $8.3 billion to fight AIDS internationally. UNAIDS released a monograph just last month, in which they noted that $15 billion is needed for 2006; $18 billion for 2007; $22 billion for 2008. We're nowhere near those figures, and those figures are low estimates. What's more, if vaccine research and development is to be fully funded, a minimum of another billion dollars must be added to the total requirement between 2005 and 2007. [...]

It's fascinating how we talk so yearningly of the Millennium Development Goals. And it's right, of course, that we should move heaven and earth to achieve them. But what, I ask you, happens after 2015? What happens to all the countries for whom the goals are a hapless quest? What happens to all the countries still counting the bodies and the infections of a pandemic which has laid waste to their hopes and prospects?

For those countries, a vaccine is the best hope for salvation, because the world doesn't stop in 2015. And if we work collectively, in a fashion at least equivalent to the space initiatives of NASA, then we will launch a working preventive vaccine that will save and protect the lives of millions, right at the point where the MDGs leave off. There can be no greater legacy bequeathed by the scientific community.

I'm an ignoramus when it comes to the nature of vaccines. But I've sat at the feet of Seth Berkeley of the International AIDS Vaccine Initiative, and I've read speeches and articles by Dr. Fauci, and I have a pretty good sense of how incredibly tough the slog will be towards the discovery of a vaccine. We know that when all is said and done, a vaccine is the ultimate answer to this devilish pandemic, and when all is said and done, human ingenuity will one day trump the Machiavellian mutation of the virus. It always does.

My counsel, then, is one of unrelieved hope, and the determination never to give up. [...]

Stephen Lewis is the UN Secretary General's Special Envoy for HIV/AIDS in Africa.

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