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Remarks by Stephen Lewis, UN Special Envoy for HIV/AIDS in Africa, delivered at the opening ceremony of the AIDS Vaccine 2005 International Conference Montreal, Canada 6 September 2005
Stephen Lewis AIDS Vaccine 2005 International Conference Montreal, Canada
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This is a meeting of researchers and scientists. I am an advocate. It's pretty obvious that you can't turn me into a scientist, but I want to turn you into advocates. To that end, I shall show my unbounded respect by refusing to employ scientific jargon, nor dare I even attempt it when sitting on a panel with two such illustrious and knowledgeable colleagues.
Last month, in Maputo, Mozambique, I attended the annual World Health Organization regional meeting of all the African Ministers of Health. Late in the afternoon of the second day of the Conference, an hour-and-a-half was set aside for a discussion of HIV/AIDS and prevention. A significant number of African delegations participated, raising all the conventional responses involving behaviour change, and a few responses somewhat unorthodox in content, from male circumcision to bio-chemical sexual suppressants!
What was not mentioned, by any official delegate, throughout the entire session, was a vaccine. It was as though the preventive technologies had totally fallen off the radar - microbicides and vaccines both. If it hadn't been for the presence of the former Prime Minister of Mozambique, Pascal Mocumbi, attending as an 'observer', the word ?‘vaccine?’ would not have passed anyone's lips. And do remember, Dr. Mocumbi has a particular interest: he's now the High Representative of the Clinical Trials Partnership in The Hague.
What was even more interesting than the omission of preventive technologies at the Maputo conclave ?– ('peculiar' might be a better word) - was that the session was based on an actual report, issued by WHO, of a conference on prevention attended by a large number of African and international experts, held in Brazzaville over three days in June. The report contained every aspect of prevention with which we are all familiar, but the word ?‘vaccine?’ did not appear from beginning to end. Again, it was as if the preventive technologies were somehow outside the fault-lines of AIDS.
How can this be? Africa is the epicentre of the pandemic. Something, somewhere is profoundly out of whack. The world needs an AIDS vaccine more urgently than it needs any single medical discovery, and Africa needs it more than any other part of the world. But for some inexplicable reason, the consuming enthusiasm, the obsessive drive, the sheer, unrelenting passion for a vaccine is simply not riveting the world at large as should be and must be the case.
I would argue that the same kind of extraordinary commitment, in country after country, to achieve '3 by 5', and then to progress to universal treatment, is exactly what has to happen in the pursuit of a vaccine. And that's why I opened with the emphasis on advocacy, advocacy that can be embraced by everyone at this gathering - advocacy that will move us closer to breaking the back of the pandemic.
Within that broad rubric, let me make three points.
First, we clearly need a great deal more money in the quest for a vaccine. As you know, it's estimated that we spent $690 million in 2004, and should be spending a minimum of $1.2 billion every year hereafter, virtually doubling current annual expenditures. Even though there have been new monies committed by the Gates Foundation, and significant additional funds recently announced by Dr. Fauci, we're still several hundred millions of dollars short on an annual basis.
I want to say, categorically, that this state of affairs is unconscionable. There was nothing more than a rhetorical nod in the direction of a vaccine at the G8 meeting in Gleneagles: it's almost beyond belief that the political aristocrats so solemnly gathered couldn't bring themselves to promise an absolute funding guarantee, in perpetuity, until a vaccine is discovered.
After all, the entire Summit was driven by an agenda for Africa. The promise was made of a doubling of foreign aid, to $50 billion a year for the continent by 2010. The G8 political leaders all understand that AIDS is decimating parts of Africa; they all know that none of the Millennium Development Goals will be reached in the high-prevalence countries because of the virus; they all acknowledge that whatever the combination of treatment, prevention and care, Africa's future remains perpetually compromised until AIDS is vanquished. But they couldn't bring themselves to guarantee that those in search of the new preventive technologies of microbicides and vaccines - the most formidable potential weapons we have against the pandemic - would be given the keys to the vault of scientific discovery.
I hate to say it, but the explanation might lie in the gap between promise and fulfilment. What has emerged, post-Gleneagles, is the unsettling news that part of the monies promised for official development assistance are already earmarked for debt relief, Iraqi as well as African. That profoundly diminishes the money available for foreign aid, certainly from Japan, and quite probably from others. And that, in turn, can help to explain why the Global Fund, whose replenishment conference ended just a few hours ago in London, has apparently fallen some 3.3 billion dollars short for the period 2006 - 2007. The allocation for the Global Fund was meant to come out of ODA, but the ODA is already found wanting before the signatures on the G8 agreement are even dry.
Think about that for a moment. All common sense would suggest that the Global Fund to Fight AIDS, Tuberculosis and Malaria is exactly the source from which should come some of the future funding for vaccine development, particularly involving trials in African countries. If that source is arid, vaccines are the losers again.
The argument I'm building towards is this: Your pursuit is in jeopardy. Your collective voices must be heard on the funding dimensions of a vaccine. It can't be left solely to activists. You're the influential professionals. You should give no quarter; the world depends on it.
Which brings me to the second item: allied with the question of resources is the question of broadening the base of scientific enquiry in the search for a vaccine. It seems to be widely accepted that the private pharmaceutical and biotech companies must be brought on board. Their participation hitherto, with one or two notable exceptions, has been, quite simply, paltry.
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