Center for Global Health R&D Policy Assessment

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Investing in an AIDS Vaccine for Sub-Saharan Africa—it just makes sense

An R4D paper emphasized the importance of investing in AIDS vaccine R&D

This is a joint post with Jared Augustein.

In the years since AIDS was first identified, it has killed over 30 million individuals. The thirtieth anniversary of AIDS offers a time to reflect on these tragic losses and reevaluate how we will continue to fight this disease in the upcoming years. Despite significant progress in prevention and treatment, the epidemic continues – an estimated 7000 people are newly infected each day, and 33.3 million are currently living with the disease. Africa shoulders the burden of the epidemic, with 1.9 million AIDS deaths and another 1.5 million newly infected in 2009 alone. As we look to the next decade amid flattening donor funds and increasing prevalence, the question remains: how should we fight AIDS in the future?

In early 2011 the Rush Foundation asked our team, led by Robert Hecht and Dean Jamison at the Results for Development Institute, to participate in the ReThink HIV project. This international exercise conducted by the Copenhagen Consensus Center aimed to identify the most cost-effective ways to tackle the AIDS epidemic in Sub-Saharan Africa. Our topic–AIDS vaccine research and development–was one of 18 different interventions analyzed, including treatment, sexual prevention, and health systems strengthening.

Is AIDS vaccine research and development (R&D) likely to be cost effective? This is a critical question, considering the enormous price tag associated with vaccine development, and the recent pattern of decreased funding to AIDS. With nearly $8 billion spent between 2001 and 2009, and another $857 million tacked on in 2010, AIDS vaccine R&D is a hefty investment – particularly for the US government, which fronts over 70% of the funding. Now that we are fighting AIDS on many different fronts – political, social, and biological – is it worthwhile to spend our time and money on the development of a future vaccine? How soon can the vaccine be developed, and what sort of impact will it have on the epidemic?

Our paper for the Copenhagen Consensus suggests that even under conservative assumptions, a vaccine to prevent HIV infection would be both cost-effective and a major game-changer in the AIDS epidemic. These findings make a strong case for the continuation and scale up of AIDS vaccine research and development. A vaccine, even if only moderately effective, has the potential to change the face of the epidemic, save lives, and generate enormous monetary benefits for society as a whole.

On September 26th, the findings from each of the assessment papers were presented to the Copenhagen Consensus Expert Panel, consisting of three Nobel Laureates in economics and two other eminent development economists. The panel ranked increased funding to AIDS vaccine R&D at the top of their list of priorities. They felt that after vaccine R&D, it would also be highly cost-effective to spend additional dollars in areas such as expanded male circumcision and broader treatment efforts.

The value of a vaccine is dependent upon several factors. Since there remain many uncertainties surrounding the timing of vaccine launch and its likely efficacy, we interviewed a cross section of leading vaccine research scientists. There was general agreement that the world would have a first-generation moderately (50%) effective AIDS vaccine by 2030. This expectation has been bolstered by recent breakthroughs in vaccine development, such as the 30% effective Thai RV144 vaccine of 2009 and the discovery of broadly neutralizing antibodies.

To estimate the gains from a vaccine, we also needed to imagine what the epidemic will look like twenty to thirty years from now. Using epidemiological projections from the aids2031 project, we considered several future scenarios, some more optimistic and some more pessimistic regarding how well AIDS will be controlled with measures other than a vaccine.

We found that unless AIDS is stopped by the discovery of a cure – a drug that eliminates the HIV virus from the body -- 25 years of widespread vaccination of Africa’s adult population, starting as late as 2030, would lead to benefits – lives saved, treatment costs avoided, and so on – amounting to an incredible benefit of $470 billion to $3.5 trillion US dollars. Over this same period, between 7 and 16 million people would avoid becoming infected. Free from illness, these individuals would live longer, healthier, and more productive lives. They would avoid the financial burden of antiretroviral therapy, which costs an average of $500 per person annually. Children who would have otherwise lost one or two parents to AIDS would still have caretakers, and their communities would not have to absorb the cost of orphan care. The value of these benefits would outweigh the costs of AIDS vaccine develop and delivery by a very large multiple, with such “benefit:cost ratios” ranging from a minimum of 2 to 1 to a maximum of 67 to 1.

(Below: Table 5, taken from the original report, shows the cumulative number of vaccines administered and infections averted for two different scenarios, differing in HIV prevalence, AIDS deaths, and the number of people on ART. These numbers are dependent upon the vaccine characteristics and state of the epidemic.)

What would be the value of spending an extra $100 million a year in AIDS vaccine R&D? We found that if well targeted, such an expanded investment could speed up the time to the discovery and launch of an AIDS vaccine of several months to more than a year over the coming two decades. The added benefit, resulting from reduced HIV infections, would again be worth tens of billions of dollars, easily justifying the increased level of R&D spending.