Written evidence submitted by the International
AIDS Vaccine Initiative (IAVI)
30 September 2009
ABOUT THIS
DOCUMENT
This document provides written evidence from
the International AIDS Vaccine Initiative in response to the IDC
call for submissions issued on 17 July 2009 and in relation to
an inquiry into DFID's Annual Report and Resource Accounts for
2009 as well as the recently published White Paper.
BACKGROUND TO
IAVI
1. IAVI is a global not-for-profit, public-private
partnership (PPP) working to accelerate the development of a vaccine
to prevent HIV infection and AIDS. Founded in 1996, IAVI researches
and develops vaccine candidates, conducts policy analyses and
serves as an advocate for the field. IAVI supports a comprehensive
response to HIV/AIDS that balances the expansion and strengthening
of existing HIV prevention and treatment programs with targeted
investments in new AIDS prevention technologies. It also works
to ensure a future vaccine will be accessible to all who need
it.
2. IAVI is committed to promoting AIDS vaccine
research and education worldwide, engaging communities in the
trial process, and improving clinical infrastructure in areas
hardest hit by the global epidemic. With five offices worldwide
(New York, Amsterdam, New Delhi, Nairobi, and Johannesburg), IAVI
collaborates with the public and private sectors in both western
and low- and middle income countries.[20]
3. IAVI welcomes the opportunity to submit
evidence for this IDC enquiry focused on DIFD's Annual Report
and Resource Accounts for 2009; as well as the recently published
White Paper, Eliminating World Poverty: Building Our Common
Future.
KEY POINTS
4. Given IAVI's core business, this submission
will focus on DFIDs role in supporting new prevention technologies
for HIV/AIDS; specifically an AIDS vaccine. We are aware that
a range of other organisations and consortia will be making separate
submissions which cover the depth and breadth of DFID's work as
set out in the White Paper and Annual Report.
5. Broadly, however, IAVI wishes to commend
DFID for its strong leadership in the international development
arena; demonstrable in its unwavering commitment to staying on-track
to allocate 0.7% GDP as Official Development Assistance (ODA)
by 2013, despite the current global financial crisis; and the
sustained momentum and dedication in galvanising donor and recipient
governments alike around the achievement of the Millennium Development
Goals. DFID support in 2009 has resulted in tremendous successes,
including: the provision of anti-retroviral drugs (ARV) for HIV
treatment to 100,000 people; the distribution of over half a billion
condoms; and the training of 60,000 health care professionals.
6. Despite real gains on some MDG targets,
such as under-five mortality, progress in meeting targets on HIV/AIDS
in many countries remains off-track. Despite tremendous advances
in HIV prevention efforts and in the treatment of HIV disease,
an estimated 7,500 people are newly infected with HIV every day.
Of further concern are the future generations of newly HIV-infected
individuals who will require access to ARV's. Demand forecasting
for access to ARV's estimate that 55 million people will require
these life saving medicines by 2030 (today less than 4 million
people have access to ARVs).[21]
The need for new prevention technologies is stark.
7. IAVI in partnership with the Futures
Institute developed an AIDS vaccine impact model, assessing various
HIV/AIDS prevention and treatment strategies. The modelling revealed
that an AIDS vaccine could substantially alter the course of the
HIV/AIDS pandemic and reduce the number of new infections; even
if vaccine efficacy and population coverage levels were relatively
low and other programs for treatment and prevention had been scaled
up. The results from the modelling showed that a potential AIDS
vaccine would not have to be 100% effective nor have to reach
100% population coverage to have effect. For example, a vaccine
with only 50% efficacy and being administered to only 30% of the
population could potentially reduce HIV incidence in the developing
world by one-quarter over 15 years.[22]
8. A range of vaccine efficacy and coverage
scenarios were modelled to assess the potential impact of a new
AIDS vaccine on the pandemic (low, medium, high and very high)
with a variety of other factors combined, including: selective
population targeting; incomplete achievement of universal access
targets; and whether or not the vaccine would protect against
HIV infection and reduce probability of onward transmission. Even
the most modest vaccine efficacy (30%) and coverage levels (20%)
could avert 2.1 million new infections worldwide. The most optimistic
scenario could avert 12 million new infections (efficacy of 90%
and 40% population coverage). Vaccination as a prevention strategy
is also cost effective, significantly off-setting direct treatment
and care costs, as well as the wider economic and social costs
of HIV disease. The need for a vaccine as part of an integrated
prevention and treatment strategy therefore is compelling.
9. DFID is cognisant of the current challenges
in preventing and treating HIV/AIDS and the need for a range of
new tools to prevent the spread of HIV. In 2008, DFID announced
a new £220 million fund for research and development on the
discovery and development of new prevention technologies for a
range of diseases, including HIV/AIDS, as part of their new Research
Strategy.[23]
DFID has adopted a portfolio approach supporting a range of organisations,
such as public private product development partnerships, to spur
innovation at all stages of the R&D continuum. DFID's support
and financial commitment in the R&D sector is designed to
provide predictable, long-term funding to actors engaged in the
discovery and development of new public health tools.
10. In this interconnected world, no one
individual, government, institution or private sector company
holds the answer to eradicating HIV from the globe. The discovery,
development and distribution of an AIDS vaccine require the greatest
minds and resources from both the public and private sectors.
Product development partnerships are strongly positioned to mobilise
these diverse parties, bringing together talent and expertise,
wherever they reside, to bear on the health issues that affect
the developing world. The IAVI partnership model links leading
vaccine design laboratories in academic, biotechnology, and big
pharma settings with vaccine development expertise in industry
and clinical investigators in the developing world. The combination
of a private sector approach focused on effective and flexible
management and decision-making on portfolio choices, with the
mission of a public sector entity and the stringent oversight
requirements of a non-profit, provide a hybrid solution to address
the specific needs of a fast changing environment. This industry-NGO
hybrid culture has enabled IAVI to achieve key milestones since
its founding, for instance successfully translating novel technologies
into seven candidate vaccines tested in eleven countries, a rate
of development unprecedented outside of industry. The IAVI model
therefore adds considerable value to the investment made by DFID
on behalf of the British taxpayers.
11. DFID is to be commended for its bold
support of R&D efforts to develop new tools for diseases which
disproportionately affect poor countries and for the emphasis
and priority it places on prevention efforts more broadly. DFID
is the largest bilateral government donor in research and development,
investing in efforts now which will safe-guard future generations.
The United Kingdom's leadership on supporting research for, amongst
other tools, better HIV prevention, as demonstrated by the DFID
launch of a five year research strategy culminating in the announcement
of strong and long term financial support to Product Development
Partnerships, including IAVI, has been pivotal to a sustained
effort in AIDS vaccine research. DFID's strong political and financial
support as IAVI's first public sector donor, dating back to 1998,
close to IAVI's inception, has been critical to help IAVI accelerate
the design and development of AIDS vaccines, as well as to obtaining
critical long term support from other public sector donors. This
sustained and flexible support has been key to the establishment
of a collaborative scientific programme involving researchers
throughout the world through clinical trials in Africa, India,
Europe, and the US.
12. With recent good news from the AIDS
vaccine field there is considerable reassurance that DFID's research
strategy, reinforced in the White Paper, is sound, moral and ethically
right. Recently two new broadly neutralizing antibodies on the
HIV virus were discovered, the first to be discovered in more
than a decade, that will allow researchers to try to exploit the
newfound vulnerability on the virus to craft new approaches to
designing an AIDS vaccine, specifically for the countries that
need it most. The announcement of the Thai trial, a phase III
trial of a prime-boost vaccine combination, moreover is the first
proof that an AIDS vaccine candidate confers protective benefits
in humans.[24]
RECOMMENDATIONS
13. The comprehensive response mounted against
HIV and AIDS and supported by DFID, needs to be sustained, and
in many areas increased, to ensure continued scientific progress
for all types of interventions and innovations, particularly in
AIDS vaccines. As IAVI continues to focus on, and address the
challenges posed by AIDS vaccine research and development, sustained
and flexible resources are crucial to scale up research efforts.
The AIDS vaccine field is entering a renaissance period where
substantial investments in preclinical and clinical vaccine development
efforts are likely to create major breakthroughs in challenges
impeding AIDS vaccine development. It is imperative that these
investments are safeguarded and continued to bring us closer to
our mission of developing an AIDS vaccine for the world. Investment
in research and development processes for vaccine discovery moreover
require long term predictable and flexible financing. There is
an urgent need to reinforce institutional grant funding with innovative
financing mechanisms which overcome problems of lack of predictability
and provide longer term revenue flows.
20 For more information on IAVI's work visit http://www.iavi.org Back
21
All Party Parliamentary Group on AIDS (2009) The Treatment
Timebomb Report of the enquiry of the APPG on AIDS into long-term
access to HIV medicines in the developing world. Back
22
Between 2015-39: IAVI (2009) Estimating the Impact of an AIDS
Vaccine in Developing Countries Policy Brief 20 August 2009. Back
23
DFID (2008) Research Strategy 2008-13 Crown Copyright, 2008. Back
24
For more information on the Thai trial visit http://www.hivresearch.org/ Back
|
