Nairobi, May 17-18 2016. In commemoration of the 2016 World AIDS Vaccine Day, representative civil society groups from the Eastern and Southern Africa (ESA) region convened to re-invigorate and accelerate Civil Society Action on investments and innovation in AIDS Vaccine Research and Development among other New Prevention Technologies (NPTs).

The timing of this meeting, hosted by WACI Health, KANCO, MANASO, EANNASO in partnership with IAVI, coincided with the process for the High Level Meeting on HIV&AIDS- a process that would lead to the endorsement of a political declaration reiterating commitment by UN member states to bring about an end to the AIDS epidemic.

Africa civil society had agreed to a common civil society regional position on the HLM, which included this specific language on preventive vaccines:Boldly pursue new scientific solutions and expand investment in research and development for improved diagnostics, easier and more tolerable treatment regimens, preventive and therapeutic vaccines, and other prevention technologies as well as a functional cure.

Is Prevention being left behind?

This particular language and demand, which set the tone for the 2 day’s meeting, had been inspired by concerns over slowed but not reversed tide of new HIV infections. As noted by Ms. Jacquline Makokha, UNAIDS Regional Support Team for Eastern and Southern Africa, in her remarks callingupon CSOs to join UNAIDS in its efforts to revitalize HIV prevention. She added that in overall, provision of large scale, effective HIV prevention interventions were yet to be optimized, hence the slow reduction of new infections. She further noted that with funding for prevention dwindling, fewer than one in five people at risk of HIV infection today has access to prevention programs.She elaborated on theUNAIDS quota for prevention campaign, which calls for 25% of all funding for HIV/AIDS programs to prevention efforts.

Still too many new infections

While prevention approaches including condoms, VMMC, antiretroviral treatment as prevention (TasP) and PrEP have brought about substantial reductions in new HIV infections, with a record of 14% decline in ESA region between 2010-2015, there are still too many people becoming infected worldwide to bring the epidemic to a halt. According to UNAIDS 2016 data, 2.1 million people became newly infected with HIV in 2015, globally. Eastern and Southern Africa is home to 960,000 of those, accounting for 46% of the global total of new HIV infections.

Need for new tools

The need for new tools to bolster existing strategies for prevention and ultimately end the pandemic is undeniably of paramount importance.  Glenda Gray, President of the South African Medical Research Council, and colleagues,in their paper on ending AIDS, argue that the widespread elimination of HIV will require the development of new, more potent prevention tools. The paper goes further to point out that true containment of the epidemic requires the development and widespread implementation of a scientific advancement that has eluded us to date—a highly effective vaccine. A safe, effective, licensed, affordable and accessible vaccine would help to sustain the impact of expanded access to existing treatment and prevention options.

Dr Borna Nyamboke of KAVI Institute of Clinical Research, in her remarks further stressed that efforts to ensure broader access to HIV testing and treatment as well as existing and emerging HIV prevention options must go hand-in-hand with efforts for additional ways to prevent HIV, including a vaccine.‘Indeed, there are now more tools than ever to help control the HIV epidemic, but an HIV vaccine remains a critical component of the long-term strategy for ultimately ending the epidemic.’

Long timeframe for availability; planning for access

While vaccine development is a slow, iterative process, now 35 years into the HIV epidemic, researchers believe that an HIV vaccine is closer than ever,given the probable start of new vaccine efficacy trials in 2016/2017. Results from theseefficacy trials would likely not be available until 2021. In addition, positive results are just the beginning of making a vaccine available to those who need it. Moving from trial results to licensure, wide-scale manufacturing and rollout plans can add several years to the process. Therefore, planning for access after positive results should take place in parallel with the research.

Advocates, donors, policymakers, regulators and funders all have a role to play in planning now to ensure that positive results from a trial are translated as quickly as possible to a safe, effective, licensed and widely accessible HIV vaccine.

HIV Prevention R&D Investment

Research on HIV&AIDS is identified as important in HIV and AIDS response world over with hopes for advanced treatment, vaccine, and a cure being purely hinged on HIV&AIDS Research. However, overall funding has remained at nearly the same level for approximately a decade. In 2015, preliminary reported funding for HIV prevention R&D decreased from US$ 1.25 billion in 2014 to US$1.18 billion. Changing funding dynamics and priorities in donor countries have shaped these trends and will continue to do so in years to come.  Currently, neither national budgets nor regional commitments to health demonstrate adequate investment in new HIV prevention R&D.

DrNdukuKilonzo, the Director of the Kenya National AIDS Control Council, speaking to the 36 CSO leaders from 13 countries in the ESA region, in her opening remarks made reference to NACC’s leadership towards increased investments for HIV research agenda in Kenya- an initiative that could be replicated in other African countries. NACC’s policy brief on domestic financing of the HIV and AIDS research agenda provides guidance on the policy directions required to ensure a greater return on investment. Most notably NACC willwork to ensure commitments of allocation of 2% of GDP to the National Research Fund (NRF) and 10% of total HIV spending to HIV research are materialized

Civil society role and commitment

Thirty six CSO leaders from 13 countries in the ESA region gathering in commemoration of WAVD 2016 at this meeting, reiterated their commitment to addressing HIV&AIDS, and a world without AIDS. To achieve that vision, civil society must not lose sight of two things:

• Making maximum use of the prevention and treatment strategies available right now.
• Investing in research and development of critically needed new prevention options.

The group further called Civil Society in Africa to strengthen and sustain momentum to support innovation and accelerate research & development toward new prevention options (like vaccines and microbicides), better treatment therapies, and a cure. The meeting underscored the need for Civil Society and communities to continue to discuss and share experiences on how CSOs are transitioning to respond to HIV R & D needs in the quest for an end to AIDS.

CS committed to step up advocacy and issued a call to action, boldly calling upon African governments to accelerate HIV R&D investments through:

1. Budgetary allocation of at least 15% of national budgets to health so as to increase funding to accelerate R&D for newer and improved health technologies including HIV new prevention technologies.
2. Budgetary allocation of at least 2%of ministries of health budget to research
3. 10% of HIV allocations be earmarked for research
4. 25% of HIV allocations be earmarked for prevention efforts

Rosemary Mburu is the Executive Director of WACI Health, which hosts the Africa Civil Society Platform on Health (CiSPHA) and GFAN Africa hub. WACI Health is an ACTION partner, a global health advocacy partnership.