South Africa has more people living with HIV than any other country, and US President Donald Trump’s aid freeze has hit patients hard – as well as researchers, who were close to a breakthrough in the development of a vaccine for the disease.
In January, United States President Donald Trump ordered a 90-day pause in all foreign development aid, pending assessment of its consistency with his "America First" foreign policy, and dismantled the United States Agency for International Development (USAID).
This foreign aid freeze has affected development programmes around the world, leaving shipments of medical supplies, including HIV drugs, stranded and disaster response teams unable to deploy. Waivers for "life-saving humanitarian assistance" too have been hampered.
South Africa is particularly severely affected, as Trump has issued an executive order to cut all funding to the country, citing disapproval of its land reform policy and its genocide case against US ally Israel.
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South Africa has the world's largest population of people living with HIV – more than 8 million – and has become a hub for research on a potential vaccine. But key clinical trials and research have already been halted.
Results on ice
South African lab technician Nozipho Mlotshwa was waiting for test results for the vaccine, when the order came from USAID to stop work.
The first round of vaccines she and her colleagues made in Johannesburg had produced an immune response in rabbits, which was promising but not conclusive. The team tweaked the formula and sent off four new versions for pre-clinical tests.
"This was very exciting, we were getting quite good results," Mlotshwa, 32, told news agency Reuters from her lab in the Antiviral Gene Therapy Research Unit at the city's University of the Witwatersrand.
Now the animal blood samples containing the results are sitting untouched in a freezer.
A trial of an earlier, separate vaccine candidate, which was about to be tested on humans in South Africa as well as Kenya and Uganda, is also on ice.
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These labs are part of a wider South African-led HIV vaccine development scheme known as BRILLIANT and funded entirely by a $45 million grant from USAID. It is now unclear if or when the project will be resumed.
'We were gaining momentum'
The project is one of many worldwide to be hit by Trump's actions since he took office last month. Others affected include efforts to protect food crops from pests and diseases, and the publication of a paper on the mpox outbreak – which has now been blocked.
"It feels like you're building something and you could really make a huge difference," Nigel Garrett, chief scientific officer at the Desmond Tutu Health Foundation, said. "And then it's wiped away."
HIV's ability to mutate quickly has confounded efforts to create a vaccine ever since it was first identified in 1983. The researchers in Johannesburg are using the mRNA technology behind some of the Covid-19 vaccines.
Several other mRNA-based HIV vaccine candidates worldwide have reached clinical trials, but BRILLIANT is unique in being African-led, aiming to develop capacity for producing vaccines in Africa.
For the past year the Johannesburg team had been working with genetic sequences from two South African patients who have HIV but whose bodies produce a rare type of antibody that neutralises the virus. They are trying to simulate that immune response.
"We were gaining momentum," said Patrick Arbuthnot, director of the research unit, adding: "An HIV vaccine is the holy grail of the field."
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'Good for the world'
Ntobeko Ntusi, CEO of the South African Medical Research Council, is spearheading the HIV vaccine search.
"Most of the landmark and groundbreaking studies have been conducted in this country. But these have been good for the whole world," he said.
Ntusi says he does not expect funding for projects like BRILLIANT to resume, given the executive order on aid to South Africa.
The council gets around a third of its funding from US federal sources, for research that is mostly on HIV and tuberculosis but covers other areas including maternal and infant mortality and antimicrobial resistance, he said.
Garrett, from the Desmond Tutu Health Foundation, says the vaccine that was ready for testing on humans was a mix of two substances developed in the US and the Netherlands, which have shown promise but never been tested together. They are now sitting in storage.
"We had a huge opportunity, good funding. It's difficult for other funders to fill that gap," he concluded.
(Reuters)
