In Childhood Vaccine Controversy, an Indirect Lesson for HIV/AIDS Advocates

This blog post first appeared on The Body

From all the recent attention to parents' rejection (and some politicians' naiveté) of vaccines and a possible resurgence of measles in the United States, one welcome theme has emerged: Such a controversy could never occur if vaccines weren't so powerfully effective in the first place.

Former Secretary of State Hillary Clinton put it best on Twitter, writing, "The science is clear: The earth is round, the sky is blue, and #vaccineswork."

Melinda Gates spoke for many when, in a widely circulated interview, she said, "We're incredibly lucky to have that technology and we ought to take full advantage of it." She prefaced that by saying that people in poorer countries can truly understand the power of vaccines because they've experienced the devastation that preventable diseases can bring to their families.

The anti-vaccine movement has gained ground in the U.S. in part because vaccines work so well that many parents have never seen the devastating effect of the diseases that vaccines protect us from.

From the beginning of the HIV/AIDS epidemic we've hoped for a vaccine that could help control and eliminate HIV in the same way polio and to a lesser degree measles have been controlled. That hope for and need for a vaccine has stayed with many of us through the rise and spread of HIV treatment, new prevention options and through many setbacks and a few breakthroughs in vaccine research.

It is the power of vaccines -- the seeming magic that can keep disease at bay – that keeps us hoping and working toward an HIV vaccine.

But for many in the global community of advocates, researchers, funders and policymakers seeking to end the HIV/AIDS epidemic, an HIV vaccine has slipped off the list of "must haves" to respond to the epidemic, and even sometimes is left out of the equation when they talk about how to end AIDS.

To be fair, recent advances have altered how a vaccine would fit into the HIV/AIDS response. Within just a few years, we've learned definitively that antiretroviral treatment not only saves the lives of people living with HIV, but drastically reduces their chances of transmitting the virus. We've seen that daily pre-exposure prophylaxis (PrEP) with Truvada (tenofovir/emtricitabine) is highly effective at helping HIV-negative men and women avoid infection. In sub-Saharan Africa, voluntary medical male circumcision is being rolled out widely after studies showed it can greatly reduce heterosexual men's risk of infection. Other new options for women and men are in clinical trials.

But amidst the drive to scale up these options -- enthusiastically supported by this author -- are troubling assertions that current tools might be sufficient to end AIDS.

Most advocates know this isn't true. They realize that today's treatment and prevention options can get us well on our way toward ending the epidemic, but that our work will never be finished until we have an effective vaccine.

The problem is that knowing it isn't enough. We need to continually raise our voices in support of the full range of prevention strategies, including those that still remain to be developed. Beyond the clear need, three critical reasons should drive us all to be advocates for HIV/AIDS vaccine research:

1. An effective vaccine is now more possible than ever. In 2009, a trial showed for the first time that an experimental vaccine modestly reduced the risk of HIV transmission. Now, researchers are testing potentially improved versions of the same approach, known as a pox-protein prime-boost vaccine, while preparing a range of other strategies for clinical trials.
2. Basic science continues to open whole new areas of vaccine discovery. Over the past six years, a remarkable number of basic science discoveries of new antibodies have presented vaccine researchers with entirely new avenues for research and development.
3. With advances occurring in other areas of prevention, the impact of an effective vaccine could be even more transformative. As of 2013, some 2.1 million people were becoming infected with HIV annually. But the number has been declining, and the continued scale-up of treatment, PrEP and other options could greatly reduce that figure in the next decade. By the time a vaccine is available, its role could very well be to drive the number of infections close to zero.

My organization AIDS Vaccine Advocacy Coalition (AVAC) was founded 20 years ago with the mission of advocating for AIDS vaccine research. Since then, we've expanded our advocacy to include many other critical prevention technologies, but our commitment to the vaccine search remains paramount. We urge you to join us.

In the case of measles, antipathy toward vaccines is an unfortunate but not-too-surprising consequence of their stunning success. With HIV, antipathy is simply not an option.