Shifting Scientific, Health Priorities and Global Economic Downturn Impact Investment in HIV Prevention R&D
Monday, July 20, 2009
Cape Town -- A new report on investment in HIV
prevention research in 2008 finds that HIV
vaccine research funding levels decreased for
the first time since investment trends have
been tracked. This may have been influenced by
shifts in scientific priorities, the declining
economy and competing priorities in the larger
global health agenda. Despite this decrease,
the overall trend since 2000 has been of
increasing investment for experimental
biomedical prevention strategies.
The
report, Adapting to Realities: Trends in HIV
Prevention Research Funding 2000 to 2008, was
released at the 5th International AIDS Society
Conference on HIV Pathogenesis, Treatment and
Prevention in Cape Town South Africa by the HIV
Vaccine and Microbicide Resource Tracking
Working Group. It is available online at http://hivresourcetracking.org/.
The
report identified investments of almost $1.2
billion in HIV prevention research in 2008, of
which $868 million supported vaccine R&D,
and $244 million supported microbicide R&D,
while other HIV prevention R&D received
much lower levels of funding. AIDS vaccine
research declined for the first time since
2000, falling by ten percent from 2007 levels.
At the same time, funding for both microbicides
and preexposure prophylaxis (PrEP) increased by
eight and 13 percent,
respectively.
Funding for HIV prevention
research remains a relatively small percentage
of the overall response to HIV/AIDS. A recent
report released by the Kaiser Family Foundation
and UNAIDS documented commitments from the
developed world for HIV/AIDS treatment and
prevention programs in developing countries of
$8.7 billion in 2008, up from $6.6 billion the
previous year.
"Research to develop new
HIV prevention tools and strategies is
essential to prevent new infections, and an HIV
vaccine still holds the greatest hope to ending
the epidemic," said Michel Sidibé, Executive
Director of UNAIDS "It is vitally important
that investments into research for HIV
prevention be sustained and increased for as
long as it takes to reach those
goals."
The Resource Tracking Working
Group identified a critical need in this time
of shifting budget priorities and economic
uncertainty for the HIV prevention research
field to identify funding needs and put in
place scientific plans to help guide research
decisions. These steps will ensure that there
is no duplication of efforts and that funding
can be linked efficiently to scientific
priorities.
"Support and interest in HIV
prevention research from public, private and
philanthropic funders over the last decade has
supported key R&D priorities, moved the
field forward and brought us closer to new HIV
prevention options," said Mitchell Warren,
executive director of AVAC. "We face tremendous
challenges -- both scientific and economic --
over the coming years, but we must not lose the
momentum we have gained. The field needs
sustained support from a range of funders. The
AIDS epidemic shows no signs of slowing, and
the desperate need for new HIV prevention
options will not change."
Levels of
funding in 2008 reflected key shifts in the HIV
prevention research field. The halting in late
2007 of the Step and Phambili vaccine trials,
which were testing a candidate vaccine
developed by Merck, ended one of the only
pharmaceutical company partnerships for HIV
vaccine R&D. This slowing in industry
involvement is reflected by a decline in
industry funding levels in 2008.
Pharmaceuticals and biotech companies in 2008
accounted for only four percent of HIV vaccine
research funding. Levels were even lower across
other HIV prevention research priorities.
Nevertheless, the commercial sector contributes
to the development of HIV prevention research
in a number of ways through pharmaceutical
company support. A number of companies have
provided ARV compounds for development as
potential microbicides, and as oral PrEP, along
with technical support to microbicide product
developers.
"The worldwide economic
crisis has fueled debate about the best way to
invest in global health, with some arguing that
AIDS takes up resources at the expense of
efforts to deal with other diseases and to
improve health systems in the developing world.
But given that AIDS is the number one killer in
sub-Saharan Africa, and number four in the
world, it is imperative that we reverse this
pandemic, and that can only be done through
improved methods of prevention, including a
vaccine. If we can conquer AIDS, we will be
able to invest resources in other pressing
priorities," said Seth Berkley, President and
CEO of the International AIDS Vaccine
Initiative.
It is important to note that
HIV vaccine research and development is
continuing to move forward. Just today, the
South African AIDS Vaccine Initiative announced
the start of a trial to study a vaccine
candidate developed by local South African
scientists. Results are also expected later
this year from the largest vaccine trial ever,
which successfully enrolled more than 16,000
participants. In addition, researchers around
the world are developing new vaccine approaches
and conducting basic research to inform vaccine
development.
The report notes that
increased investment in microbicide R&D may
reflect increased interest in research on
antiretroviral (ARV)-based candidates.
Investment increased in microbicides overall at
the same time that the field intensified its
focus on ARV-based approaches to microbicide
development.
"Increased funding for
microbicide R&D over the past decade has
fostered a major expansion for the field;
clinical trials of microbicide candidates have
been conducted in 27 countries around the
world; and pre-clinical research has yielded
important scientific information. Support from
public, private and philanthropic funders is
essential to increase R&D for new
microbicide candidates," said Polly Harrison,
Director of the Alliance for Microbicide
Development.
The U.S. government was
once again the primary funder for HIV
prevention research, supporting 71 percent of
HIV vaccine R&D, 63 percent of microbicide
R&D, and providing 46 percent of funding
for PrEP prevention research in 2008. A
decrease in investment from the U.S. National
Institutes of Health contributed to the overall
decline of funding for HIV vaccine R&D. The
U.S. government investment fell by $39 million,
a six percent decrease. Other governments also
decreased funding for HIV vaccine research in
2008: European government funding fell by 13
percent and total funding from other countries
(including Brazil, Canada, India, South Africa,
and Thailand) fell by 16 percent.
The
report authors caution that while it is too
early to attribute all of the funding decreases
to the financial crisis, there is concern that
a prolonged global recession could have a major
impact on public investment in all HIV/AIDS
programs. A recent report from UNAIDS and the
World Bank found that the economic crisis has
already affected levels of funding for
treatment and prevention programs in some
developing countries.
The Working Group
also reported on investment in operational
research related to proven biomedical HIV
prevention research interventions -- medical
male circumcision and ARVs for prevention of
vertical transmission of HIV from mother to
child. These efforts are being funded at much
lower levels that other HIV prevention
research, with $11 million supporting research
related to rollout of male circumcision and $21
million supporting operations research for
prevention of vertical transmission.
The HIV Vaccines and Microbicides Resource Tracking Working Group was established in 2004 to generate and disseminate high-quality, detailed and comparable data on annual investments in preventive HIV vaccine and microbicide research and development (R&D), and policy and advocacy activities. These data can be used to monitor current levels of effort; identify trends in investment, spending, and research focus; identify areas needing more resources and effort; assess the impact of public policies aimed at increasing investment in new prevention technologies (NPTs); and provide a fact base for policy advocacy on R&D investments and allocations. The Working Group is comprised of the AIDS Vaccine Advocacy Coalition (AVAC), the Alliance for Microbicide Development (AMD), the International AIDS Vaccine Initiative (IAVI) and the Joint United Nations Programme on HIV/AIDS (UNAIDS). More information is available online at http://hivresourcetracking.org/.