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The human immunodeficiency virus (HIV) and SARS-CoV-2 are almost nothing alike, but the response to the COVID-19 pandemic has a lot to learn from four decades of AIDS efforts. Not only in research and development (R&D), but also in communication, human behavior, equity and implementation of programs to prevent, detect and treat infection on a global scale. Above all, with a view to avoiding upcoming waves of great impact and preparing the deployment of vaccines.
On World AIDS Day, EL PAÍS talks with global leaders in the fight against HIV about the lessons of this field for covid-19; why countries, even high-income ones, are failing to contain the new coronavirus; and how the response to the pandemic can strengthen strategies against HIV / AIDS and other infectious diseases, both existing ones and those that will emerge in the future.
Investigate Tomorrow’s Epidemics Today
Decades of research on issues that have nothing to do with a coronavirus have taken decades for prototype covid-19 vaccines to be developed in just a few months. So says William Hasseltine, founder of Harvard University’s HIV and Cancer Research Units, who led the effort to sequence the HIV genome in the 1980s.
“HIV research has been absolutely vital to COVID-19: it has bequeathed many of the scientists who now lead R&D on the new virus along with the infrastructure to conduct research and clinical trials. In turn, the first effective drugs against AIDS were drugs that had been rejected for cancer, “says Hasseltine who, coincidentally, was one of the first people to save his life thanks to another innovation, penicillin, in 1945.
It took decades of research on issues that have nothing to do with a coronavirus for prototypes of vaccines against covid-19 to be developed in just a few months
“Without the failure of the vaccines against HIV, we would not have the success of the vaccines against SARS-CoV-2,” says José Alcamí, who heads the AIDS Immunopathology Unit at the Carlos III Health Institute in Madrid. Prototypes such as Moderna and Astra-Zeneca are based on new vaccine models that have been tested in diseases such as Zika, Ebola, yellow fever and, above all, HIV.
The Executive Director of the International AIDS Society (IAS), Birgit Poniatowski, highlights the unprecedented levels of collaboration sparked by covid-19 and how IAS is promoting dialogue between diverse scientific communities. “However, we must not forget about HIV in these difficult times; we are concerned that many researchers have switched to covid-19 and no longer have time to continue their work on HIV, “he says. “I also wish that the same enthusiasm [en torno a la covid-19] be extended to other infectious diseases, including tuberculosis, malaria and HIV, for which there is still no vaccine “.
The Deputy Director of the Desmond Tutu HIV Center Linda-Gail Bekker speaks from South Africa, one of the territories most affected by HIV and tuberculosis in the world and the sub-Saharan African country with the most cases of coronavirus patients. “The involvement of the private sector in the development of vaccines and drugs for COVID-19 is unprecedented; we haven’t even seen it in HIV or tuberculosis, ”says Bekker.
Vaccines yes, treatments too
Funding for covid-19 research has focused on vaccine development, leaving drug development on the back burner. This, despite the fact that the fight against HIV has already highlighted the false dichotomy between prevention and treatment and the fact that there are no panaceas, but combinations of tools, according to the director of the International Center for Clinical Research at the University of Washington Connie Celum. “HIV has taught us that treatment is also prevention, in the sense that it reduces the viral load to the point of avoiding transmission,” he says, pointing out that it could also occur with covid-19.
Covid-19 drugs could play an important role even in a world with vaccines. Above all, taking into account that its deployment will not be done overnight. Drugs could prevent mild cases from becoming severe; reduce hospitalization time and stop contagion, although according to Celum it would take an injection of funds to develop specific products for the coronavirus instead of reusing existing ones.
Experts agree that covid-19 is here to stay and that the aspiration is to manage it like the flu virus. But this requires supporting scientific research on a sustained basis or facing the consequences.
Hasseltine gives an example: in the past decade, drugs against SARS and MERS were being developed that could also have worked against SARS-CoV-2, but when the alarm was passed, the funds were withdrawn and the initiative was left up in the air. . “The lesson is that you should never let your guard down when it comes to funding antiviral research,” says the scientist and also founder of a dozen biotech companies.
Standards are important, but they are not enough to contain infectious diseases like HIV and COVID-19. They can only be controlled if citizens trust their countries’ public health strategies and decide to collaborate to protect themselves and others. One of the primary tasks of the authorities, and also of scientists, is to generate this trust.
Asked how governments are doing, Sharon Lewin, Director of the Peter Doherty Institute for Infections and Immunity in Melbourne, Australia, says: “It is as if each country is being examined at the same time and in a different room; the results are being very uneven ”. Two important elements for improving governments’ scores are effective communication and mechanisms that facilitate compliance with public health policies, from financial aid to translating information for immigrants.
“It is essential that scientists are listened to and that science is communicated to the public clearly and without ambiguity; and when you don’t know something, you have to say it, ”says Bekker of the Desmond Tutu HIV Institute. For Celum of the University of Washington, scientists also have a role to play. When the alarm about HIV went off in the 1980s, for example, there was no Internet. “As scientists, we must help the public differentiate between preliminary results and strong evidence, between reliable studies and other small or poorly designed ones.”
Pandemics are strong where there is inequality
Winnie Byanyima, ONUSIDA
Hasseltine agrees, but also stresses individual responsibility for the common good. “The science has been stellar for both HIV and COVID-19, but it is not enough. Political leadership and social solidarity are needed to control these pandemics, ”he says. “Individual freedom is important, but it has limits: when in the middle of a pandemic we say that we have the right not to wear a mask and go to the pub every night, we are exceeding these limits ”. In a globalized world, this means that the virus is not only transmitted between neighbors, but between countries, many of them with fragile health systems already before the arrival of covid-19.
Defend human rights
Incoherent and uncoordinated subnational policies. Draconian restrictions. Sounded infractions. Politicization of the response. Tensions over access to the vaccine. Contradictions. Denial of reality. According to experts, covid-19 has brought this and more to the surface. And, like HIV, it has highlighted issues of social vulnerability and inequity in access to health services. “Pandemics are strong where there is inequality,” says UNAIDS Executive Director Winnie Byanyima, who advocates the prevalence of health over economic benefits through initiatives such as The People’s Vaccine Alliance. Speaking from Nairobi, she calls for a global, multisectoral and female-led response. A response that puts the most vulnerable people at the center, drawing on the experience of HIV.
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