ANALYSIS: ESNART SIKAZINDU
TODAY, we honour HIV Vaccine Awareness Day, as we do every May 18.
As an HIV prevention advocate, I want to celebrate and thank the Zambian government for hosting the Imbokodo study, one of only two ongoing HIV vaccine efficacy trials on the globe. As a nation, we should also thank the altruistic women who give their bodies, time and hope as trial participants so that this vaccine study might finally lead us on a path to ending HIV transmission.
I want to urge Government to continue in the same spirit, collaboratively researching HIV vaccines, because they are still a necessity. While we have proven, effective HIV prevention tools now, like condoms, PrEP, voluntary medical male circumcision and treatment as prevention, these are not enough to bring the nation to epidemic control. In 2018, 48,000 people newly acquired HIV in Zambia, among a total of 1.7 million new infections globally the same year.
Vaccines have been one of the world’s greatest weapons in controlling diseases and protecting individuals from illness and death. These medical miracles have the ability to eradicate viruses like polio, measles, mumps, chickenpox and the deadly smallpox virus, which once were common and killed many people.
There are several reasons a vaccine would mean a durable and sustainable end of the HIV epidemic. Firstly, it is a one-off intervention, meaning a vaccine traditionally only requires one or a few jabs over a lifetime. Other prevention interventions require correct and consistent behaviour over time, such as a daily PrEP pill regimen or condom use at the time of sex. Secondly, a vaccine could be cost-effective or even cost-saving because it would not accrue costs over time but would continue to avert many new HIV infections and subsequently save lifetime ARV treatment costs.
Currently, there are two large efficacy trials, testing mosaic-based vaccine regimens designed to protect against a wide variety of HIV sub-types. As mentioned above, Imbokodo (meaning “rock” in Zulu), is a study that started in November 2017 across approximately 26 sites in five countries in sub-Saharan Africa: South Africa, Zimbabwe, Mozambique, Malawi and Zambia. In Zambia the study is currently taking place at CIDRZ Matero First Level Hospital, ZEHRP Lusaka, and ZEHRP Ndola. The results for Imbokodo are expected in 2022. A promising result would likely benefit Zambia for participating.
In February, there was an early stop to a vaccine study in South Africa. Unfortunately, the vaccine trial, known as Uhambo, didn’t show any advantage in those participants receiving the vaccine in comparison to the study volunteers who did not receive the vaccine. However, lessons learnt in this study could make future HIV vaccines research efforts smarter and stronger.
Imbokodo’s brother study, Mosaico, is testing a similar vaccine in Europe and the Americas with gay men and transgender participants. (HIV vaccines are studied in populations with the highest HIV burdens.)
Clearly, HIV vaccine research is not an easy or fast road. It requires political will, scientific know-how and engaged communities such as adolescent girls and young women, people who inject drugs and young men who have sex with men. Today is a day to acknowledge their collaborative work. Join me in increasing vaccine awareness among CSOs and community representatives. An efficacy vaccine will change the narrative of HIV in Zambia and globally.
The author is a 2020 AVAC Fellow fighting for the delivery of proven HIV prevention methods and the ethical development of new ones.