The conversation about the importance of vaccines has never been more debated than in the response to the COVID-19 pandemic. How many different COVID-19 vaccines are out there and how are they different? Why is it so hard to get an appointment? When will I need a booster? Will I really need to carry my vaccine card with me wherever I go? Will there still be a third wave in spite of these medical advances?
These questions come at an interesting time in the field of HIV – as phase 1 clinical trials for a potential HIV vaccine are showing promising early results. This new potential vaccine works by creating antibodies that boost the immune system against the HIV virus and its mutations. It has been effective in 97% of those who have received it but further studies are needed before it can be rolled out. The next phase of testing will involve incorporating the mRNA technology used in Moderna’s COVID vaccine into this exciting new HIV prevention tool.
Scientists have been trying to develop an HIV vaccine for nearly 40 years, but interest in and resources for vaccine development have never been so prevalent as they are in the wake of COVID-19. Billions of government dollars have gone into the rapid development and roll out of these vaccines. Just imagine if the same had been done in the first years of the AIDS epidemic.
It should come as no surprise that an epidemic which disproportionately affected gay and bisexual men, trans people, sex workers, and people who use drugs never received that level of urgency, political will and targeted investment from major donors and pharmaceutical companies. For many years, politicians and government leaders refused to even acknowledge the outbreak happening on their soil. But the response to COVID-19 has shown us what could have been possible if the whole world had quickly rallied behind finding a vaccine. Unfortunately, we do not live in a just and equitable world.
In spite of these obstacles, we have made great progress in HIV prevention from pre-exposure prophylaxis (aka PrEP) to helping people with HIV achieve and maintain an undetectable viral load (aka U=U). This has undoubtedly changed the way that we think about HIV, but there is still so much more that could be done. Injectable forms of PrEP could prevent HIV transmission if taken every two months – but what if we can bring longer-term solutions to market sooner? And even if a vaccine becomes available, what amount of funding and resources and community mobilization would it take to get it to the communities who need it most?
Vaccines are a promising step forward, but they are also not the saving grace of a global pandemic. In spite of the near-trillions in relief money for COVID-19, there are still vast inequalities in how these vaccines have been distributed. There are huge gaps in how people have been able to access these vaccines due to their race, geography, and socioeconomic backgrounds. We must embrace science and fight for advancements to help our community, but we must also manage our expectations about what this would mean for those who are most marginalized.
The unequal COVID-19 vaccine distribution also shows the limits of a potential HIV vaccine. Even though COVID-19 vaccines are now available, most of the world is still unable to gain access. People are continuing to die from COVID-19 related causes at an alarming rate. While tourism and travel are important to many economies, traveling to places without vaccine access remains an ethical dilemma. We must learn from these lessons with the COVID vaccine so we can get ahead of these challenges for the roll out and scale up of future a potential HIV vaccine.
Our global queer community knows how to survive and adapt during a pandemic, first from HIV and now from COVID-19. A vaccine for HIV could put us back on track to global targets to lower HIV acquisition rates. However, an HIV vaccine would not alleviate the systems that marginalize our communities. It would not solve for homophobia, transphobia, sexism, classism and ableism. It would not help someone looking for housing, a job or legal protection from criminalization. It would not put an end to stigma and discrimination based on mental health, substance use, sex work, migration status, race, sexuality or gender identity.
The biggest enemy of our communities is not the virus itself, but the structural barriers that stop us from achieving a more just an equitable world. We have seen the limitations of focusing the HIV response solely on meds. There is no “magic bullet” of a cure to end AIDS.
We must prepare ourselves to address the potential challenges of rolling out an HIV vaccine, just as we have seen with vaccines for covid. We must advocate for increased funding for research and speed up the process to develop these life saving interventions. And we must always let our communities lead the way.