A look into the new Moderna vaccine against AIDS, and why the biology and social stigma surrounding H.I.V have contributed to 30 years of unsuccessful vaccines.
In the midst of a global pandemic, a global conversation is being had about vaccinations. The urgency of the COVID-19 pandemic led to a boost of funding into the production of new and effective vaccine technologies in the blink of an eye. Unfortunately, victims of other pandemics and epidemics have not been so lucky.
2021 marks 40 years since the first reported cases of AIDS-related deaths and diseases were reported in California, with the surge of rare diseases in gay men giving the disease its frequent, headlining title of ‘the Gay Cancer'. Since then, between 27.2 million and 47.8 million people have died from AIDS-related illness, with a further 38 million currently living with H.I.V.
Companies have tried relentlessly for 30 years to produce a vaccine that is effective against H.I.V, however, its genetic fluidity makes it somewhat like breaking a biological enigma code. Lately, Johnson and Johnson saw an embarrassing failure in their advanced H.I.V vaccine’s trials – where 5,407 South African men and women from 2017-2021 saw no difference in the rate of infection between those who had a placebo and those that didn’t. This comes as a far-too-frequent disappointment for pharmaceutical companies.
Moderna, however, is trying to break this cycle of H.I.V vaccine failure using the same mRNA technology they used in their successful COVID-19 vaccine: a technology that the virus (hopefully) can’t dodge as easily.
The International AIDS Vaccine Initiative (IAVI) and Scripps Research found the basis of Moderna’s propulsion into the trial phase of this vaccine. A report by the two organisations concluded that, for the first time in humans, a group of immune cells called germline B cells can be activated to produce broadly neutralising antibodies (bnAbs) against HIV.
Antibodies are funnel-shaped proteins that attach themselves to the proteins on the surfaces of pathogens (called antigens), like HIV. Antibodies, therefore, cause the virus to be digested or deactivated, meaning it can no longer cause disease. HIV normally would avoid this fate by changing their antigens constantly and therefore allowing them to continue unnoticed in our immune systems.
bnAbs, however, are far less susceptible to this as they target a protein known as the gp120. Gp120 allows viruses to attach to their target cells, where they cause disease. Gp120, therefore, doesn’t mutate as often as other proteins or else the H.I.V particle won’t be able to infect the cell. The study conducted by Scripps and IAVI focuses on an engineered protein called eOD-GT8 6omer, which is very similar to the shape of the gp120 protein. This has shown promise in humans as, when injected, it stimulates a process where the germline B cells secrete slightly different antibodies to one another against the gp120 protein. This variation means that all forms of H.I.V can be targeted.
So, how does Moderna fit into all of this?
Moderna is attempting to make this process cheaper and more efficient by using mRNA technology. Instead of producing eOD-GT8 6omers in the vaccine (a slow and laborious process), Moderna is instead using mRNA to write the instructions for our own bodies to produce this protein. This will therefore activate the immune response from germline B cells and give us immunity to H.I.V.
The trial is still in the early days, with 56 people in the USA being trialled at the end of September 2021. This is to be followed up by wider testing in Rwanda and South Africa, permitting these trials are successful.
Trials will not produce any results until 2023 and, in the time, we still have a lot of work to do to properly educate the population on the science and history of H.I.V. Recently, Channel 4’s “It’s a Sin” won best new drama, as well as having Oli Alexander (the show’s lead) nominated for best dramatic performance in the National Television Awards. For the British LGBTQIA+ community, this was a long-awaited, public exposure of the truth of the virus and how it was covered up globally with little support during the early days of its outbreak. Similarly, Netflix’s “Pose” has racked up 9 Emmy nominations since its debut in 2018, which follows the lives of the African American and Hispanic LGBTQIA+ in Harlem’s ballroom drag scene – many of which are sufferers of H.I.V and AIDS. This shows a move in the right direction for western nations in the education of young people about the large-scale cover-up and trauma that people of minority status and members of the LGBTQIA+ community suffered at the hands of this virus. Although this is a step in the right direction, the H.I.V stigma is still perpetuated by many.
Back in July, American rapper DaBaby made comments with harsh anti-LGBTQIA+ rhetoric at the Rolling Loud Music Festival in Miami. During his performance, he asked every audience member to "put your cell phone light up", apart from those who were HIV-positive or were gay men who had sex in car parks.
Although an apology has since been made, it isn’t one that many perceive as genuine. The apology happened to coincide with Boohoo dropping DaBaby as a brand representative, emphasising that, no matter how many steps forward western society takes to combat the stigma around H.I.V and AIDS, public figures can instantly remind us that it still exists. Globally, poor sexual education and comments from public figures have additionally led to the increased stigmatisation of H.I.V.
Many countries have begun the criminalisation of sex education under their respective Child and Family Protection Acts. Across many eastern European nations such as Poland, Russia and Hungary, sex education is illegal, and teachers caught educating students on sex education can face up to 3 years imprisonment. The Kremlin has also rejected a WHO report that highlights the dangerously high prevalence of HIV in Russia, with 72.2 new cases per 100,000 per year.
This denotes an alarming movement to cover up the truth about H.I.V and AIDS, which can only lead to a sustained prevalence of the H.I.V stigma. The stigma surrounding the virus is what led to such late development of vaccinations against H.I.V/AIDS, with the Reagan administration refusing to publicly recognise the epidemic until 3,500 Americans had died with the virus.
For now, many LGBTQIA+ members and people of minority status wait in anticipation for what’s to come of these trials in 2023. In the meantime, we need to begin to question how we can cognitively integrate H.I.V education into school curriculums globally, or else face the consequences of increased H.I.V stigmatisation The vaccine is by no means a cure for those who currently live with H.I.V, but it’s a step that needs to be made to build a future that is free from the virus.
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