PALOMA ADAMS-ALLEN: Partnering for an Aids-free Africa

The complex challenges we tackle at the US Agency for International Development are global in scope, but the effects are felt locally, in communities and neighbourhoods and homes.

I’ve been in SA this week to get a close look at how the US government’s work through USAID is advanced with local partners — those who possess the knowledge and expertise to advance progress in their communities. One of the greatest examples of locally led development is in SA, where the scientific community is on the cusp of developing a vaccine to prevent HIV. 

In 2003 UNAids and the World Health Organisation estimated that up to 45-million people were infected with HIV. And even though the first treatment that stopped HIV/Aids from multiplying had been discovered more than a decade earlier, only 50,000 people across Africa had access. That year, more than 2-million people died of HIV/Aids in Sub-Saharan Africa alone. 

In response, through the US President’s Emergency Plan for Aids Relief (Pepfar), the US began to invest in HIV prevention, testing, care and treatment services, working alongside local, community-based organisations to tackle the crisis. We’ve come a long way since then. In 2022 alone Pepfar funding through USAID supported more than 2.1-million South Africans on antiretroviral therapy. 

USAID’s partnerships with local organisations and healthcare providers are the driving force behind these results. More than 80% of USAID’s health funding in SA is implemented through SA organisations. That means our programmes to improve life expectancy and quality of life, including HIV prevention and treatment, are designed by South Africans. 

Just like so many of the threats we face cannot be confined to the borders of any one country, our investments and partnerships don’t simply benefit communities across Africa. With USAID and Pepfar support, a world-class scientific community across the African continent has played a critical role in averting and combating major global health crises, from snuffing out ebola in 2014 to the early identification of Sars-CoV-2 viral variants, to leading vast and complex Covid-19 vaccine trials that were implemented rapidly and surpassed global standards.

And in the face of widespread vaccine hesitancy and misinformation there are clear advantages to having African investigators, regulatory agencies and even manufacturers at the forefront of these efforts to enhance trust in their respective communities.   

Over the past two decades, Pepfar’s work to strengthen local health systems has built significant momentum. But to develop an effective, accessible, low-cost HIV vaccine that transforms our approach to sustainably controlling the virus we must ensure that African scientists and institutions are the ones leading the design and testing of vaccine candidates. To eliminate HIV/Aids as a public health threat by 2030, partners in aid, development practitioners and donors must work together to shift power to local actors. 

This is a moment for USAID to walk the walk on local leadership. For the first time USAID will invest up to $45m over five years directly with a local partner, SA Medical Research Council, for HIV vaccine research & development. This award — called HIV Vaccine Innovation, Science & Technology Acceleration in Africa (HIV-Vista) — will provide even more opportunities for scientists across Sub-Saharan Africa to advance HIV vaccine research & development, and leverage the lessons learnt from decades of US government investments.

Consider the impact of this work being led from right here in SA, and in collaboration with scientists in Uganda, Nigeria and across Sub-Saharan Africa. Almost two-thirds of new HIV infections occur in Sub-Saharan Africa, making it critical that the scientists and institutions leading the design and testing of vaccine candidates understand the region, its people and their preferences and behaviours.

This new project led by the SA Medical Research Council will broaden the field of partners and allow for greater leveraging of local resources, creative collaborations and innovative science, which may be the source of a real breakthrough towards a safe and effective HIV vaccine. Adding new scientific thinking and talent to the established expertise in this field not only strengthens our chances of success in the fight against HIV — it strengthens global health security for everyone. 

For more than two decades Pepfar and USAID have been pushing the limits on the HIV/Aids journey — to extraordinary results. And we simply can’t slow down. To continue to keep an HIV vaccine in our sights we must invest in and empower local partners in this work. 

During my time in SA I had the chance to visit SA Medical Research Council CEO and president Glenda Gray, who began her career in paediatrics in 1993, when HIV prevalence was surging in SA and across the region. In less than two decades Gray and her colleagues worked to cut the mother-to-child transmission rate in SA to under 2%, bringing paediatric HIV under control.

I look forward to returning to SA soon to see this next generation of investments in action and even more life saving progress from the researchers at the SA Medical Research Council.

Adams-Allen is deputy administrator for management & resources at USAID