Note: Some information on this page is courtesy of the International AIDS Vaccine Initiative .
HIV/AIDS is a disease of grave global proportions and has appalling human and socio-economic impacts. 30 million people have already succumbed to HIV/AIDS, and the epidemic continues to grow in all regions of the world. UNAIDS and the World Health Organization (WHO) estimate that about 2.7 million people were newly infected with HIV in 2010, of which 390,000 were children. An estimated 34 million people worldwide, many of them in parts of the world where access to care, treatment and support is inadequate or non-existent, are now believed to be living with HIV/AIDS.
A safe, effective, affordable and globally accessible preventive HIV vaccine offers the greatest promise for reducing global rates of HIV infection and reversing the devastating social and economic costs and development inequalities that have been exacerbated by HIV/AIDS. Historically, vaccines have proven to be one of the most cost-effective public health interventions for controlling the spread of infectious diseases. More than 30 common infectious diseases are now preventable with vaccines, including polio, measles, mumps and whooping cough. A vaccine for HIV could substantially alter the course of the AIDS epidemic; prevent untold personal suffering; and save millions of lives and billions of dollars in health care and associated costs.
A safe and effective HIV vaccine may not be available for another decade. Although significant work has been undertaken in Canada and worldwide to develop an HIV vaccine, none has yet been proven to effectively protect against infection. Although a proof of concept was demonstrated in the recent Thai trial there remain significant scientific obstacles to developing and delivering HIV vaccines that can only be overcome through long-term, focussed and globally coordinated action.
Many scientists believe that even when a safe vaccine is licenced for use globally, it may not provide complete protection against HIV infection. A "first generation" HIV vaccine may only delay progression of the disease for those who have been vaccinated, however, they could still become infected with HIV later on. Nevertheless, such a vaccine could slow the progression of HIV and provide scientific evidence to support the development of more effective vaccine candidates.
The many scientific challenges inherent in developing and delivering an HIV vaccine make it a costly endeavour. In 2009, the world invested approximately $868 million in HIV vaccine research and development to develop and test HIV vaccine candidates and to carry out the policy and advocacy work to lay the foundation for their development and introduction (HIV Vaccines and Microbicides Resource Tracking Working Group). Sustained and significant global investments will be required in the coming years to achieve the goal of safe and effective HIV vaccines and may result in expenses that are higher than costs to develop vaccines for other diseases.
HIV/AIDS is a disease that knows no boundaries - geographic, socio-economic, gender, age or otherwise. The burden of the disease is greatest in low-and-middle-income countries, particularly in sub-Saharan Africa and in the Caribbean, East Asia, Eastern Europe and Central Asia. It is also particularly entrenched amongst vulnerable groups in society, such as the homeless; indigenous peoples; people who inject drugs; the mentally ill and other disabled persons; commercial sex workers; men who have sex with men; prisoners and persons in detention; and migrant workers - people who are isolated from family and support networks; and those whose gender, sexual orientation, culture or personal circumstances make them dependent on, and vulnerable to others. In many low and middle income countries, and particularly sub-Saharan Africa, women and girls continue to be affected disproportionately by HIV: women account for approximately 60% of new HIV infections in the region.
Involving at-risk populations in clinical trials is the most efficient and effective way to assess whether a candidate vaccine will work and will be acceptable to diverse population groups. There are different strains of HIV, and it is not yet clear whether a vaccine that protects against one strain will be effective in protecting against others. This means that trials must be conducted not only in developing countries (over 90 percent of people living with HIV/AIDS are in the developing world), but also in different parts of the world amongst people of different genders, races and cultures. Engaging at-risk populations in clinical trials also ensures that related benefits, such as harm-reduction counselling and other services, reach those most in need.
The CHVI represents a significant Canadian contribution to global efforts to ensure that the ultimate benefit of HIV vaccine research and development, an HIV vaccine, is made readily available at reasonable prices and in sufficient quantities to those who are most in need but can least afford it. To that end, the needs of developing countries are at the core of the CHVI.
Community involvement is essential to the development of HIV vaccines. People from vulnerable communities not only volunteer for clinical trials, but also play a key role in designing trials that would be acceptable to their communities. The engagement of communities lends credibility for the study and fosters public and government support for vaccine research. It also helps ensure community acceptance of vaccines, once they are discovered.
The Global HIV Vaccine Enterprise is an alliance of independent organizations around the world dedicated to accelerating the development of a preventive HIV vaccine based on a shared Scientific Strategic Plan (SSP) . The SSP envisages implementation of a strategic plan for HIV vaccine research that spans vaccine discovery; product development and manufacturing; and clinical trials. It also envisages increased resources by mobilizing significant new funding to achieve the scientific plan; and greater collaboration by promoting more efficient, faster ways for researchers to share successes and failures and avoid duplication of efforts.
In July 2010, at the XVIII International AIDS Conference in Vienna, Austria, the Government of Canada and the Bill & Melinda Gates Foundation announced their renewed commitment of up to $139 million to implement the Canadian HIV Vaccine Initiative. The Government of Canada and the Bill & Melinda Gates Foundation are supporting the establishment of a new CHVI Research and Development Alliance, which is the cornerstone of the renewed CHVI, and will enable Canada be a leading contributor to global efforts in developing a safe effective, affordable and globally accessible HIV vaccine. The Alliance will facilitate the advancement of the science that will lead us towards the ultimate goal of an HIV vaccine.
The CHVI will be an inclusive, global collaboration involving developed and developing countries, researchers, non-governmental organizations, the private sector and governments.
The Government of Canada and the Bill & Melinda Gates Foundation renewed their commitment of $139 million to implement the Canadian HIV Vaccine Initiative. Funding will be available until 2017.
Since the CHVI was established, $51 million has been committed to support domestic and international research; improve collaboration among researchers in Canada and around the world; and enhance capacity for vaccine trials, policy development, national regulatory authorities and community engagement.
In addition, $55 million has been earmarked for advancing basic science, translating research into clinical trials, and addressing enabling conditions related to HIV vaccines; $30 million for prevention of mother-to-child transmission of HIV; and $3 million for supporting a coordinated approach under the renewed Canadian HIV Vaccine Initiative.
Globally, the number of new HIV infections continues to outpace the number of people on treatment: for every two people starting treatment, a further five become infected with the virus. Even if the incidence of HIV infections continues to decline at current rates, there will still be more than 22 million new infections by 2015 (UNAIDS, 2009). Scaling up existing and effective prevention efforts in the short to medium term to reach vulnerable populations, particularly women and children, is essential to reversing the epidemic.
Coverage for services to prevent mother-to-child HIV transmission rose from 10% in 2004 to 45% globally in 2008 (World Health Organization, United Nations Children's Fund, UNAIDS, 2009), and the drop in new HIV infections among children in 2008 suggests that these efforts are saving lives. Yet an estimated 430,000 children were born with HIV in 2008 (UNAIDS, 2009). Recognizing the opportunity to slow the spread of HIV by strengthening an existing, effective, prevention intervention while the development of an HIV vaccine is being pursued, the Government of Canada is also investing in the prevention of mother-to-child transmission of HIV in low and middle income countries, as part of a comprehensive approach to HIV prevention. Innovative and effective implementation strategies and programmatic solutions to improve the efficacy and effectiveness of available interventions and overcome existing barriers and bottlenecks will be used to enhance PMTCT service delivery.
The Government of Canada's investment in the CHVI Research and Development Alliance complements our efforts to address the spread of HIV and AIDS in Canada and globally.
The CHVI Research and Development Alliance is a network, in Canada, that brings together leading researchers from the public and private sectors, as well as the international community, to develop innovative solutions to the challenges facing HIV vaccine development.
The Alliance will serve as the focal point for Canadian research, product development and technical expertise related to HIV vaccines. The Alliance will work with partners in low- and middle-income countries, particularly in Africa, to leverage local expertise and knowledge, build on cooperative research and policy initiatives, and expand needed local capacity.
An Alliance Advisory Board will provide governance and oversight to the CHVI Alliance. The role of the Advisory Board is to provide recommendations on projects to be funded to CHVI Ministers and the Bill & Melinda Gates Foundation and to oversee the implementation of the Alliance.
The CHVI is designed to build on key strengths and investments made by the Government of Canada and to mobilize partnerships and expertise in Canada and in low-and-middle-income countries. The CHVI increases total Government of Canada investment in HIV/AIDS and it further enhances HIV vaccine activity in Canada and low-and-middle-income countries through a partnership with the Bill & Melinda Gates Foundation.
The CHVI is closely aligned with the goals of the Federal Initiative to Address HIV/AIDS in Canada that include preventing the acquisition and transmission of new HIV infections in Canada and contributing to global efforts to reduce the spread of HIV and thereby mitigate the impact of the disease. It complements HIV/AIDS activities undertaken and supported by the Public Health Agency of Canada, the Canadian Institutes of Health Research, Health Canada and Correctional Service Canada under the Federal Initiative, including HIV vaccine-related research and the development of the Canadian HIV Vaccines Plan.
The CHVI also complements the Canadian International Development Agency's support to the Global Fund to Fight AIDS, Tuberclosis and Malaria, The Joint United Nations Programme on HIV/AIDS (UNAIDS), the World Health Organization (WHO), and a range of projects and initiatives that advance a comprehensive, long-term approach to effective, evidence-based HIV prevention, while strengthening health systems to ensure equitable access to essential care, treatment and support for all those who need it, and protecting and supporting children infected and affected by HIV/AIDS.