Telescope: The New AIDS Epidemic is a deep-dive investigation into the modern face of a disease that transformed the world and changed the most intimate aspects of our lives.

By Sarah Wheaton | @swheaton | Send tips here | View in your browser

Purely by coincidence, this latest edition of POLITICO Telescope: The New AIDS Epidemic is landing in your inbox on HIV Vaccine Awareness Day.

This year, it’s especially bittersweet. The growing portfolio of successful coronavirus jabs is giving HIV scientists and advocates hope — and FOMO. 

“For me, the battle is how to communicate this to the communities we serve,” said Definate Nhamo, a senior program manager of the Pangaea Zimbabwe AIDS Trust. “We’ve spent about three decades looking for an HIV vaccine, and still going. With COVID, it has just taken a year,” Nhamo continued, speaking at an AVAC webinar last week.

In many ways, especially when it comes to the science, the failed HIV vaccine efforts paved the way for the coronavirus shots. At the same time, today’s rollouts offer their own signposts for an (eventual?) HIV jab.

“The world will never be the same again, because the genie’s out of the bottle,” Linda-Gail Bekker, director of the Desmond Tutu HIV Centre in South Africa and one of today’s most prominent HIV vaccine researchers. “Now we know what we can do when we put our hearts and our minds to it.”

– All about the money: Amazing what science can do when the world’s R&D resources flow into one thing! According to one estimate, about $15 billion was spent on HIV vaccine R&D between 2000 and 2019, while $39.5 billion is thought to have gone toward coronavirus immunization research and distribution just last year. 

— Prepare for the best, and the worst: So let’s say an HIV vaccine is discovered. Will people trust it? 

“It is so critically important to start building demand,” said Matthew Rose of Health GAP, which aims to improve access to HIV drugs in the global South. With the coronavirus, some (wealthy) countries are starting to plateau at 50 percent vaccination rates, he added, “and that’s for a virus that has a much more immediate impact. There’s still a lot of stigma that we’re going to have to overcome.”

— Unlearned lesson? Then again, most countries are having the opposite problem: Not enough coronavirus vaccines to go around. Major fights over disparate access to lifesaving HIV drugs between rich and poor countries played out in the late 1990s. And they’re playing out with coronavirus vaccines in the 2020s. Will this history keep repeating? 

Further reading: 

— HIV is a much more complicated virus than SARS-CoV-2. We looked at why it’s been so hard to find a vaccine or cure in Season 1 of Telescope: The New AIDS Epidemic. 

— A recent paper for the U.S.’s National Bureau of Economic Research tracked how the history of HIV vaccine research laid the groundwork for coronavirus shots, in geeky detail.

French Presidency of the EU: a key role to play to end the HIV epidemic

When I was going over interview notes for our latest case study, I had to send a follow-up question, because one thing didn’t make sense. “Of the more than 20 antiretrovirals found to be effective over the years, only one is licensed in pregnancy,” said Nneka Nwokolo, a longtime HIV clinician in London, “and the vast majority have never been studied in pregnancy.” Surely, I thought, the doctor I’d been speaking to must have been using hyperbole for dramatic effect. 

But it’s true, confirmed Nwokolo, who is now a senior global medical director at ViiV Healthcare. I was even more surprised when she told me which drug that is: AZT. It was the first antiretroviral to be approved for HIV — but it’s rarely prescribed these days, especially not alone, since newer drugs now work better and are easier on the body. 

How did we get here? A desire to protect women and their fetuses from unknown effects of experimental drugs mean they’re often excluded from clinical trials. But researchers, advocates and women themselves increasingly point out that the logic doesn’t hold in practice: Rather than a few women making the choice to be studied in a controlled way, we just wait and see what happens when pregnant women start using the drug in the real world. Problems only become clear when they happen to enough women or babies that they show up in post-market monitoring data. 

The issue isn’t unique to HIV drugs. We’ve seen the debate play out this past year over coronavirus vaccines. But a recent clinical trial of a new, improved HIV drug in pregnant women offers a path to overcoming the ethical and regulatory barriers to this type of research. Read the latest POLITICO case study here. 

Gilead: a committed partner in tackling HIV in France during the COVID-19 crisis

This article is produced with full editorial independence by POLITICO reporters and editors. Learn more about editorial content presented by outside advertisers.

You received this email because you signed up for newsletters from Telescope: The new AIDS epidemic, the first installment of POLITICO’s Telescope series, presented by Gilead.