We know that the first vaccines will not be available for between 5 to 7 years at the earliest. Vaccine development is resource intensive and most research is in the rich world. Such vaccines may not be appropriate or affordable for the poor world. The challenge is to find a solution that is acceptable, effective, affordable and deliverable. It is necessary to persuade major pharmaceutical companies to pursue vaccine development with the enthusiasm they have devoted to anti-retroviral development. Uncertainties associated with development of suitable vaccines include:
International partnerships form an important component of vaccine development, as do public-private sector collaborations. It may be that SCF has a role here.
- The difficulty of establishing levels of immune response without human efficacy trials.
- The existence of sub-types of HIV and the fact that developing world strains are very different from those in the developed world.
- High-risk behaviours associated with HIV infection are practised over an extended period. Any vaccine would need to induce a long lasting immune response or involve regular boosters.
- The lack of trained specialists and adequate infrastructure in poor countries for trials. Additionally few countries will participate in trials unless they have access to the final, successful vaccine.
There is also no cure for AIDS at the moment. However HIV positive people are not without care and there are a number of things that can be done at various stages in an illness. Initially people can вЂњlive positivelyвЂќ eating nutritious food, stopping smoking and making lifestyle changes; when opportunistic infections occur they can be treated effectively and inexpensively; prophylactic treatments can be provided to prevent a number of common illnesses; and when these treatments fail then ART can be introduced. This last is what has hit the headlines in recent months. ART is effective at reducing viral load which allows peoplesвЂ™ immune systems to recover, but this is not a cure, and since it has only been available for four to five years we do not know how effective it will be or for how long. It is also expensive and is only available from the private sector, costs range from R1000 to R2500 per month at the lower range, although in theory it should be possible to provide it for as little as R500 per patient per month.
There is no suggestion that the public sector will provide this therapy in the short term. In South Africa the government is making it available for rape survivors and pregnant women. In Botswana there is the likelihood that it will be made more generally available through the Secure the Future initiative and generosity of a number of donors including the Gates Foundation. These are however the exceptions and for the vast majority of infected Southern Africans treatment with ART will remain an unobtainable dream. This is not to say that they cannot be treatedвЂ”as outlined above they can and this is clearly an area for SCF action.