In his commentary, Dr. Fauci also explores whether ending the pandemic without a vaccine is “economically feasible.” His deduction? No, for a number of reasons. For one, the resources required to keep those on anti-HIV drugs for the rest of their lives, are increasing. The 17.2 million infected individuals who are not receiving treatment, will also need to be put on medication. He also adds, “The cost of providing PrEP and other preventive services to the millions of people who are at risk for HIV infection is substantial.” In fact, UNAIDS estimated that to provide effective treatment and prevention response from 2016 to 2030 in low- and middle-income countries would be incredibly costly—adding up to at least $350 billion. Dr. Fauci cites another study that found that “donor-government funding” dedicated to HIV has actually decreased by 7% in 2016, “the lowest funding level since 2010.”
“That then allows me to come to a conclusion that we will actually need an HIV vaccine to achieve—and I want to underscore a very important word—a durable
end to the HIV pandemic. So, I’m not saying that we’re not going to make major strides in getting the trajectory down, but will it stay down given all of the constraints that we see without a vaccine?” Dr Fauci asked in his presentation at IAS 2017.
A large HIV vaccine trial that had been conducted in Thailand found that the vaccine was capable of decreasing risk of infection by 31%, “a figure inadequate to justify the licensure of the vaccine.” This finding is not entirely unsurprising. In fact, Dr. Fauci predicts that a future HIV vaccine will not be as effective as the other vaccines currently available for other infectious diseases, such as smallpox and yellow fever, vaccines that are estimated to be almost 100% effective. Why? Because it is extremely difficult for the human immune system to “mount a protective response against HIV,” he stated. Nonetheless, a vaccine that decreases risk by at least 50% is needed, he writes.
Dr. Fauci stresses that the vaccine alone does not hold the answer to ending the pandemic. The development of a moderately-effective vaccine “together with the optimal implementation of existing treatment and prevention modalities” are capable of ending the ongoing pandemic.
“It is critical to continue to accelerate a robust research effort in that direction while aggressively scaling-up the implementation of current treatment and prevention tools,” Dr. Fauci concluded. “To do anything less would lead to failure, which for HIV is not an option.”
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