What years of HIV vaccine research can teach us about the search for a COVID-19 vaccine

HIV Vaccine Awareness Day is 18 May, and with the ongoing COVID-19 pandemic, the importance of vaccine research to both diseases cannot be overstated. As with HIV, the best way to defeat the coronavirus pandemic is through a vaccine – and we can draw from 40 years of solid HIV vaccine research to help get us there.

A global response

SARS-CoV-2, the virus that causes COVID-19, has taken the world by surprise, just as HIV did in the 1980’s. However, unlike HIV, the world has come together and shown that a coordinated, global response to a pandemic is possible in record time. Many aspects of this response, including the search for a vaccine, have built upon technologies and lessons learned from recent epidemics, including HIV.

There are now over 120 COVID-19 vaccine candidates in the development pipeline, 90% of which are at the preclinical stage. Lessons learned from the SARS and MERS epidemics have informed the design of many of the COVID-19 vaccine candidates. The trials are also heavily influenced by knowledge gained from HIV vaccine research; this research has told us that several factors – how often new strains emerge, the force of the infection and the types of immune responses – are key to the design of a successful vaccine.

Unprecedented speed

The speed at which the SARS-CoV-2 virus was isolated (a few days) and the viral genome was decoded (a few weeks) is unprecedented and truly remarkable. In comparison, it took more than two years to isolate the virus that caused AIDS. This time around, we benefitted from the knowledge built over decades of the global HIV response: several teams involved in HIV vaccine research have been able to promptly decode the viral genome, identifying key components to use in the design of a COVID-19 vaccine. The spirit of collaboration that has built up around work to find a vaccine, too, is unprecedented.

Approaches to vaccine development include tried and tested strategies, such as the use of weakened virus strains (which was not applicable for HIV) and vaccine components benefitting from years of development (the use of protein-based research in the search for a COVID-19 vaccine echoes the approach used during the development of the AIDSVAX experimental HIV vaccine).

Other common platforms include DNA and MVA that have been extensively used for HIV vaccine R&D and are now being repurposed for COVID-19. Years of clinical research by both industry and academic leaders with these products provide the safety data required to speed up their use for research in humans.

New approaches based on different technologies, such as mRNA-based vaccines that have been in preclinical stages for HIV, are also being trialled for COVID-19. They could ease the burdensome production of protein-based vaccines by using the host cell’s own replication machinery to act as a “self-produced” vaccine. Some of these new technologies allowed for the rapid development of candidate vaccines at a fraction of the cost and time of more traditional processes – within weeks of receiving the sequence from China. If these are successful, they could be repurposed for the development of an HIV vaccine.

Remarkable collaboration

In the crowded race to develop a vaccine, several biopharma firms previously involved in HIV are now heavily investing in a COVID-19 vaccine. New alliances are facilitating the sharing of key reagents. A flurry of companies are investing in research. Even if they do not all succeed, their efforts will contribute to improving design, platforms and approaches. Several coalitions have formed, calling on the talent and knowledge of scientists, clinicians and experts who previously worked on an HIV vaccine and bringing together public and private funding (for example, CEPI). There is much to learn that could eventually benefit the search for an HIV vaccine.

Beyond product development and management, HIV prevention R&D led to the creation of several clinical trial networks. These infrastructures could be rapidly mobilized to assess COVID-19 vaccine candidates and, later, be a place of choice to conduct integrated research following well-established principles of engagement with vulnerable communities.

The HIV response has greatly contributed to the conduct of ethical research and led the development of the Good Participatory Practice (GPP) Guidelines. The accelerated and aggressive approach to COVID-19 vaccine development, from 'challenge' studies to the potential contribution of low- and middle-income countries, requires careful attention and consideration given to the design and conduct of trials, and must heed the lessons from years of biomedical HIV prevention trials.

Only the beginning

A safe and efficacious COVID-19 vaccine will be only the beginning. Issues of manufacturing at scale, distribution and access will open a new area of discussion, but here too, 40 years of responding to HIV can help us address stigma and access, and also anticipate inequalities and create an enabling environment to support behaviour change.

The COVID-19 response has shown unprecedented mobilization against a global threat across many fields. The contribution of HIV vaccine research cannot be understated. And beyond the financial investment and promise of further funding, we can look to the many people who are dedicating their time and sharing their experiences for inspiration to support the quest for a COVID-19 vaccine.