As we see so often, it could be that the cure is worse than the disease. Modern medicine is so burdened by government meddling, that it creates perverse incentives. People are kept in hospital to spend money instead of being fully recovered at home.
The most interesting point of the article for me is that this vaccine appears to be a series of shots which act as a curriculum for the immune system. Each one slightly different and targeting a different stage of B-cell development. I've never thought of vaccine series working like that, so it was a new and impressive idea.
This is the way a lot of modern cancer vaccines are being developed. The idea is to create custom vaccines in the future targeting the patients specific cancer. So they are therapeutic vaccines. Obviously some cancers cannot be reach by a vaccine or are so aggressive that they overwhelm the patient before they can help.
I'm not aware of cancer vaccines that use this sort of b-cell priming, though I've heard lots about mRNA vaccines, as well as neo-epitope based cancer therapeutic vaccines. Are you analogizing the neoepitope approaches to the B cell progression here? That is somewhat similar, but the chain of new vaccines does seem quite different and novel to me.
From what I understand, random interactions can prime the immune system in the wrong way, leading it down the wrong path. This is why some people can get lucky with immunity and be super resistant to flu, because they happened to luck into a response that targets a common factor in most flu strains. Other people have bad luck and target some area that mutates frequently, and they proceed to get walloped by every flu strain, every year.
This is why it's hard to make a 'super vaccine' for flu, becuase it takes many rounds of shots to retrain some people's immune systems once they've latched on to the wrong recipe for antibodies.
All vaccines are training data for the immune system, which is a learning machine whose operation is a little bit like a genetic algorithm. It generates and sieves variation using a vocabulary of pre-encoded building blocks to fit the targets it's presented with.
It's an incredible system, and a product of probably a billion years of evolution since the first multicellular organisms had to protect themselves from infection.
While HIV vaccine research is an exciting field, it's worth pointing out that halting HIV transmission is, practically speaking, a solved problem with oral and injectable reverse transcriptase inhibitors. The ongoing loss of life and health due to HIV could be stopped if we cared enough to invest resources in wide-scale PrEP availability and public health education. Waiting for an HIV vaccine is the domain equivalent of hoping fusion power will solve our energy needs. Other solutions exist already; we just have to use them.
You could say the same about teen pregnancy being a practically solved problem, except there is still the problem of teen pregnancy. Or even something more mundane as driving consistently safely all the time to solve the problem of accidents.
If everyone was disciplined all the time in regard to everything, many problems in the world would simply not exist. But we live in reality where for whatever reason, people don't know to do something, or they do know and they're just not disciplined, or they make a mistake due to extenuating circumstances. And I would expect that the vast majority of people would oppose any idea of somehow punitively "dealing with" people who get some things wrong.
So I would say that it's very evidently not a practically solved problem, because if it were we wouldn't be looking to solve it still.
Within this reality, a vaccine is a great additional tool at solving the problem of preventing the spread of HIV.
Which is in fact panic that teens are not having enough children, because that's where we have seen big drops...
This whole "panic" seemed weird from the start, but once it becomes clear that it's from the lack of teen pregnancies it takes on an even creepier Epstein-like oddness.
I agree, but I don't think #3 is possible. For a variety of reasons, both biological and societal, the older people get the less likely they are to have kids, and fewer of them.
Taking teen pregnancy as an example: we have the tools to avoid it. We have condoms, we have birth control, we have the morning after pill, we have abortion. We have all the tools -- are more tools really going to help? The fact that teen pregnancy is still an issue is not because we lack the tools to solve it.
HIV prevention is similar. We already have the tools. We have condoms. We have PrEP. Sure, a vaccine would be nice, but if someone is unwilling to go on PrEP, why would they suddenly be willing to get a vaccine?
Another tool isn't going to hurt, obviously. But it also isn't the #1 highest leverage place to be spending our time if the goal is to reduce HIV transmission. (It is, however, a great use of time to develop a vaccine if you're profit-motivated. HIV prevention is a massive business. 1 year of PrEP in the US costs $20-30k, although luckily ACA mandates $0 copay. I could imagine a $50k HIV vaccine being a blockbuster drug especially if ACA also mandates $0 copay - tons of money to be made! Ugh)
Edit: To be clear, I'm excited there's a promising vaccine. However, I am not getting my hopes up that a vaccine will magically cure all of the social/political issues getting in the way of a vaccine actually being widely distributed and administered.
> but if someone is unwilling to go on PrEP, why would they suddenly be willing to get a vaccine?
Because PrEP at even its best and most modern version requires an update every six months for life. If you're well-off and in SF or NYC or London that might be easy, but there's so many externalities such as:
- People who misjudge the risk they're at, so don't go on the meds in the first place
- People who live in regions where getting to a doctor even every six months is a challenge
- The six-month injection is extraordinarily expensive and a life-time treatment, for a disease you don't even have yet.
If instead it becomes a once-in-a-lifetime series of shot, like many other vaccines are already, we can start considering a path to extinguishing the disease, not just teaching people to live with it.
Then there's the financial savings of a series of three shots once vs a lifetime of them.
All the tools we have against teen pregnancy need teens making right decisions, or taking corrective actions.
If there were a pill that'd block pregnancy for X years, given at the age of Y, then parents could enforce it and teen pregnancy would be solved (also it'd be very cruel but I'm just trying to make a point so bear with me).
Going back to our topic: People could also forget PrEP, be drunk and forget to wear a condom and so on. If this vaccine (or vaccine series) creates a somewhat permanent protection, it'd make a huge difference.
The US state of Colorado provided young women free IUDs (which are reversible and can last up to eight years) with private funds, and it was wildly successful. I argue teen pregnancy is solved assuming systems remain in place for women to have robust access to contraceptives and reproductive healthcare (which is a systems problem that is never solved completely, but reliant on defending the subject system constantly in perpetuity). The current US administration is rolling back teen pregnancy prevention programs to increase fertility rates in these age cohorts, so there is clearly work ahead to maintain the progress we've made.
If you're sure you don't want kids, or more kids, a bisalp, or bilateral salpingectomy (permanent birth control, removal of both fallopian tubes), is covered by Medicaid or ACA compliant private insurance in the US at 100% with no patient cost sharing as part of the Affordable Care Act federal statute. Doesn't apply to teens imho, but provides protection for 21-45 cohort for those seeking it.
HIV PrEP in the short term is solved with a twice a year injectable (lenacapavir) until improved options become available (rapid deployment and robust availability of a vaccine given to as many at risk people as possible, as soon as possible). It can be provided for as little as $40/person.
(with all of that context shared, all vaccines and medical protocols that improve quality of life, as well as defend and empower the human, are welcome and needed, as quickly as reasonable)
That's like asking "if someone is unwilling to practice abstinence, why would they be willing to wear a condom, or to flip a magic 'not fertile right at this moment' lightswitch?"
A vaccine is something you do once and PrEP is something you have to continue to do over time and get overcharged out the ass for the entire time and worry about if it will remain available in the future.
All your arguments are sound, and I'm still missing your point. Pharma is interested in doing pharma, indeed. But who's interested in your solution, assuming you have one? A significant part of the current electorate (internationally, even) seems to abhor sex ed, condoms, abortions and all that. So tell me again please how you suggest we address teen pregnancy - in THIS world.
Right, but we know that HIV/AIDS essentially is a solved problem in rich countries, that the mentioned interventions are readily available in rich countries, and the only reason HIV transmission is high in poor countries is because, well, they're poor. We (humanity as a whole) have plenty of money, we could fund these things, we simply choose not to.
I would caution against making an allusion to self control. It would be very cruel to act as if people who get a disease through no fault of their own could have avoided it, and most people who contract HIV could not. You may not have intended to make that allusion, but you did.
> So I would say that it's very evidently not a practically solved problem, because if it were we wouldn't be looking to solve it still.
This is obviously not what is meant by "practically solved problem". Everybody knows it is not actually solved.
It's a solved problem if you are someone that knows you'll be exposed to HIV in the very near future and you have the money and wherewithal to purchase PrEP before that event (and you can plan the event 7 days out).
The power of a vaccine is you can give it to adults and kids before they are sexually active and protect them, potentially, for the rest of their lives.
I'd also be curious to know if the combination of ART + the vaccine might cure someone of HIV. Which is also a pretty big deal.
Also, PrEP pills can have side effects long term. And distributing huge amounts of daily pills to remote areas of the globe is much harder than the patients getting a shot on their yearly medical visit.
> I'd also be curious to know if the combination of ART + the vaccine might cure someone of HIV. Which is also a pretty big deal.
"Cure" in the sense they could become indefinitely under detectable levels. It's worth noting that to really cure a person of HIV you'd need to remove all mutated cells.
This is completely inaccurate. There is PrEP that requires dosing two times a year. You can also get PEP if you engage in a risky activity without PrEP.
Yes, it exists, but how available is it really? If I recall correctly, the injections are also not very pleasant.
"Gilead sells LEN at very high prices (over $28,000 per person per year in the US), severely restricts its supply to certain countries, and refuses to sell it directly to Doctors Without Borders/Médecins Sans Frontières"
I was explicitly referring to PEP. I'm not sure why you would make assumptions about where I have or haven't been when you have absolutely no information.
PEP remains largely free in SSA post-USAID/PEPFAR cuts.
Ad-hoc use of PrEP just requires that you take a double dose 1 hour prior to potential exposure, and follow up with another double dose 24 hours later, at least with the versions commonly prescribed to sexually active groups in my area.
I agree that a vaccine is another game-changer, but it’s extremely important that we don’t spread misinformation about the efficacy and convenience of PrEP. In developed societies, it has already all but eliminated new transmissions among groups that were previously most at risk.
Cost and compliance are still 2 major factors that have not been solved.
We also have education and stigma. While within the LGBT community it is far more common to be open about status and taking prep and doxy (far from perfect though), it still feels like outside of that the conversations are not happening as much as they should.
Throw in doctors that are not being proactive about the conversation.
Right now it seems like having prep and doxy is largely considered only if you are engaged in "risky" behavior (not saying that in a judgmental way to be clear), instead of just being sexually active and protecting yourself. Money and investment alone won't fix that, that is a societal shift around how we talk about sex.
That is also before we get into the cost issues in many other countries just for those that do need it.
PReP has some side effects. While they are rare, they are things you need to be aware of. If you are not doing risky sex it isn't for you.
Most people want to believe they are in a monogamous relationship and thus not having risky sex - even though they are the one cheating. Either PReP needs to be more common, are people need to stop their risky sex activities (that they are not even admitting to).
> If you are not doing risky sex it isn't for you.
That blanket statement I very much disagree with. Sure there are side effects but that is part of why you also get tested every 3 months for liver issues (not that it is the only side effect, but still).
Instead of it being a blanket statement it should be a conversation with your doctor about the pros and cons.
You can still get HIV even if not engaging in risky behavior. Same with people getting pregnant when they did not intend too.
I am thinking college kids that are still figuring out their sexuality and exploring new things. You're going to make mistakes so having a conversation about prep with your doctor is a really good idea.
You are extremely unlikely to get HIV from anything other than risky sex. That's what "risk" means: it's another word for "probability," just a probability of negative outcomes. These probabilities are known: https://www.aidsmap.com/about-hiv/estimated-hiv-risk-exposur...
Some of that table is already mitigated: we test blood for HIV, so transmission by blood transfusion is unlikely. Transmission by pregnancy is less likely simply because few women have HIV: 80% of new cases in the US are male, 20% female.
The real question is whether "having a conversation about prep with your doctor" is going to lead to someone caring enough to pursue a prophylactic course of medication when that same person doesn't care enough about his own health or others' to avoid risky sexual encounters. Is someone irresponsible enough to pursue causal, unprotected sex with random partners also likely to be responsible enough to visit a doctor proactively and comply with a prep regimen? Sure, it's a "really good idea," but a simpler and better idea is not to have random sex in the first place. A "really good idea" depends on a level of self-control that some people obviously lack.
> Is someone irresponsible enough to pursue causal, unprotected sex with random partners also likely to be responsible enough to visit a doctor proactively and comply with a prep regimen?
Yeah, me. What a wild statement to make. It’s a big world out there, my friend.
> You are extremely unlikely to get HIV from anything other than risky sex.
Yes because it is such a fantastic idea to just ignore that there is still a risk regardless of what we call "risky" sex just because it doesn't fit in your puritanical views of sex.
If someone can get HIV the first time they have sex than your entire argument is moot.
Just have the conversation with your doctor and protect yourself and stop trying to push your views on others.
This is such a simple thing to say, talk to your doctor. Thats it. If doing so stops one person who is not engaging in anything that we would deem being risky from getting HIV, that is a win. There is nothing in your world that would stop someone who is having sex with someone that maybe they have been going on several dates, from getting HIV from that person if a mistake happens.
And yet, you seem to think that we are saying that you should be going to an orgy every other day.
Oh and let's not ignore that there are monogamous couples that one may have HIV and they need to also protect themselves.
I guess it depends on what we call risky, I mean if someone is actively trying to get pregnant are we considering that "risky"?
Someone could be taking the necessary precautions and a mistake happens, a condom breaks, whatever. Someone could have sex with one person in their life and they got it from that person. I would not consider that "risky" in any real sense of the word.
Any sex carries some amount of risk, and the key is being risk aware and not assuming that just because you are not engaging in what is generally deemed "risky" that you are safe. Instead you should be having that conversation with your doctor and determining what your risk tolerance is.
That is where I disagree, how many people are positive that never considered themselves engaging in risky behavior.
To me it is very dangerous, and leads to the situation we are in now, to just say only even consider prep if you are engaging in risky behavior.
It doesn’t take a lot for the risks to far outweigh any potential side effects. As far as I’m aware, every healthcare system in the developed world either recommends or enforces checkups after starting PrEP.
The LGBT community should also think about abandoning some risky practices which allow infections, and promote antibiotic resistance in the case of doxycicline "prep".
But I guess that sex without condoms is worth it, right?
> But I guess that sex without condoms is worth it, right?
Not speaking about LGBT related matters; Sex without condom is just like everything else - it depends on the person. For some people there is little to no difference. For others, wearing the condom removes all sensation, reducing the act to physical exercise. So is sex without condoms worth it? For some people, yes, it is.
PrEP is freely available in the UK and there is almost no requirement in practice of engaging in risky sex. I don't know anyone turned down for not having risky enough sex
Which countries are you talking about out of curiosity?
It is endemic in the simian population. It will keep crossing over into humans again and again. It has done it before several times. People who live near forests would have to be on Prep everyday of their lives. The reason they eat bushmeat is the because they are poor and will be too poor to afford daily medication. A once-and-done vaccine would at least stop new crossovers. Only then could we really get a handle on ending this disease world-wide.
There are some dubious metaphors in use here. Public health is not about math problems to be “solved.” “A solution exists” is just a milestone. “We just have to use them” - yes, but leave out “just,” there is more to do and it’s hard.
The answer to “are more tools really going to help” is always going to be “it depends.” Promising interventions sometimes fail entirely. If they statistically improve outcomes, that’s a win. Only occasionally is a disease entirely eradicated.
PrEP is difficult on the body over time and though it can be used if you are high risk you are meant to avoid certain medications while using it and have to do follow ups with your doctor to check organ functions.
The analogy to malaria is pretty on point. Pre-Exposure Prophylaxis (PrEP) is, you nailed it, prophylactic. It's not as good as a vaccine would be, and it's not as cheap as a one-and-done shot, but we've gotten to the point where you can get one shot every six months (lenacapavir) and, it's 99%+ effective at preventing infection. And, much like with malaria, the prophylaxis works— there is currently no HIV vaccine that reliably prevents infection.
From a convenience factor, sure, but both effectively turn a death sentence into a solved problem. I believe GP was pointing out that we should prioritize funding for the existing solution until the more convenient one is available.
"The ongoing loss of life and health due to HIV could be stopped if we cared enough to invest resources in wide-scale PrEP availability and public health education."
It wouldn't be stopped, only slowed. You would still have transmission from accidental or unknown exposure. You would also have a small portion of the population that didn't care, regardless of the education.
As we all hopefully learnt from COVID-19, slowing sufficiently is the same as stopping. It’s a numbers game. Slowing transmission below some threshold will eventually mean that there are no new transmissions.
For rich people (meaning the ~3 billion people that have some sort of access to medical infrastructure), it is a solved problem, but there are quite many people without any access to it. Even for those "solved problem" people, taking a pill every day to be protected is inconvenient. They might not take it every day, etc.
Also, even if it were a solved problem, the methodologies developed here can probably help with other viruses too in the future. This has already happened with the antivirals originally developed for HIV.
> Perhaps the money being used to fund a superfluous vaccine should be used to fund access to PrEP in the Third World
An astounding statement. Is it not possible that a vaccine giving decades of protection would give better health outcomes than doing PrEP every 6 months?
I was 16 when Magic Johnson announced he had AIDS. That was the first time it felt real to me. I remember a couple of friends crying because we all thought he would be dead in 1-2 years. And here he is and seems to be living a normal life.
Those on prep would welcome a vaccine, it would be a significant improvement. I agree that this is no reason to take the foot off the gas with prep availability, we need more ASAP.
Who's waiting? The problem is the populations we need to distribute it to can least afford it.
The reason we want a vaccine is because there's a huge logistics difference between a twice yearly injection and the real magic of something more like an MMR shot where one dose is usually effective for life.
It's a problem that was "solved" long before that by just wearing a condom and protecting yourself against other diseases too, and even pregnancy. Condoms are cheap, widely available and decades of condom-related education has been given out to many different generation of kids and adults worldwide.
Somehow we still need day after pills, abortions, antibiotics and other STD meds, and vaccines, now (hopefully) for HIV too.
So, clearly condoms are not the complete answer. Any solution that does not acknowledge the reality of how people actually behave is going to be imperfect.
Nobody else said it, so I will. Halting HIV transmission is a solved problem if people are willing to give up sex with untested strangers. The same is true of syphilis, monkeypox, and every other sexually transmitted disease. It says a lot about human nature that a small number of people would rather have society spend vast sums of money researching and developing prophylactics and vaccines instead of changing their own behavior, while the vast majority have enough self-control not to catch diseases through random sex.
> The ongoing loss of life and health due to HIV could be stopped if we cared enough to invest resources in...public health education.
It's definitely a problem of caring, but not one of education: there are not honestly many people out there who don't know that random sex leads to diseases, but there are some people who just don't care enough to prevent their spread. If they did care, they would have sex only with known, tested partners. Minimizing harms through additional investment of resources just leads people to continue to fail to care, at society's expense.
Besides that, PrEP has enabled the return of non-HIV STIs in major cities like Berlin where a lot of the community has returned to raw-dogging since the AIDS-Scare has become a historical artifact.
Is that a huge problem? Doesn’t almost everything else have a prophylactic and is curable? Hep-C might be the only other one I believe and I’m unaware if it’s treatable or not.
Literally no one asks for proof of an STD test before sleeping with them. You might ask someone if they have STDs and use a condom but that’s how 99.99% of how people sleep with other strangers.
Abstinence has been shown to be an extremely, hilariously, stupidly ineffective strategy in all questions of human sexual health.
The HIV/AIDS epidemic would not have been nearly as serious as it was if people like you and the Catholic Church hadn’t advocated for it over all other measures.
Most things are a solved problem if we give up the things that make life worth living. Obesity is a solved problem if you just eat for health. Road traffic deaths are a solved problem if you never leave your house. Suicides are a solved problem if you just don't kill yourself.
It doesn't need to be 100% effective in humans, it just needs to slow transmission enough such that the rate of incidence declines in the direction of eradication.
I have to admit that given how many times we have been here, I struggle with being excited about any news about a HIV vaccine until we see results from humans. Just way too many times of hope.
That being said, I don't understand enough to parse this very buzzword heavy release. Is this fundamentally different than the every 6 month vaccine we have now and is a more traditional vaccine or is it just continuing on that trend?
The reason why this is a big deal is because they figured out a way to engineer the type of cells that are hard to create that can readily fight off the virus. In some people they create them already. Here they were able to get the body to create them.
I agree it is far off from something in humans but it's a giant leap. The way I see it is like sending Laika in space before we send humans. It's significant and promising of a future where humans might have a vaccine.
OK this sounds fantastic, but is it going to be another case of an expert dropping in on this thread and going "Ah, 100s of these come out every month. It's promising but nowhere near human trials yet."
As we see so often, it could be that the cure is worse than the disease. Modern medicine is so burdened by government meddling, that it creates perverse incentives. People are kept in hospital to spend money instead of being fully recovered at home.
The most interesting point of the article for me is that this vaccine appears to be a series of shots which act as a curriculum for the immune system. Each one slightly different and targeting a different stage of B-cell development. I've never thought of vaccine series working like that, so it was a new and impressive idea.
This is the way a lot of modern cancer vaccines are being developed. The idea is to create custom vaccines in the future targeting the patients specific cancer. So they are therapeutic vaccines. Obviously some cancers cannot be reach by a vaccine or are so aggressive that they overwhelm the patient before they can help.
I'm not aware of cancer vaccines that use this sort of b-cell priming, though I've heard lots about mRNA vaccines, as well as neo-epitope based cancer therapeutic vaccines. Are you analogizing the neoepitope approaches to the B cell progression here? That is somewhat similar, but the chain of new vaccines does seem quite different and novel to me.
Well, they kind of all work that way, it's just that most of the curriculum occurs naturally through interactions with wild pathogens
From what I understand, random interactions can prime the immune system in the wrong way, leading it down the wrong path. This is why some people can get lucky with immunity and be super resistant to flu, because they happened to luck into a response that targets a common factor in most flu strains. Other people have bad luck and target some area that mutates frequently, and they proceed to get walloped by every flu strain, every year.
This is why it's hard to make a 'super vaccine' for flu, becuase it takes many rounds of shots to retrain some people's immune systems once they've latched on to the wrong recipe for antibodies.
All vaccines are training data for the immune system, which is a learning machine whose operation is a little bit like a genetic algorithm. It generates and sieves variation using a vocabulary of pre-encoded building blocks to fit the targets it's presented with.
It's an incredible system, and a product of probably a billion years of evolution since the first multicellular organisms had to protect themselves from infection.
While HIV vaccine research is an exciting field, it's worth pointing out that halting HIV transmission is, practically speaking, a solved problem with oral and injectable reverse transcriptase inhibitors. The ongoing loss of life and health due to HIV could be stopped if we cared enough to invest resources in wide-scale PrEP availability and public health education. Waiting for an HIV vaccine is the domain equivalent of hoping fusion power will solve our energy needs. Other solutions exist already; we just have to use them.
You could say the same about teen pregnancy being a practically solved problem, except there is still the problem of teen pregnancy. Or even something more mundane as driving consistently safely all the time to solve the problem of accidents.
If everyone was disciplined all the time in regard to everything, many problems in the world would simply not exist. But we live in reality where for whatever reason, people don't know to do something, or they do know and they're just not disciplined, or they make a mistake due to extenuating circumstances. And I would expect that the vast majority of people would oppose any idea of somehow punitively "dealing with" people who get some things wrong.
So I would say that it's very evidently not a practically solved problem, because if it were we wouldn't be looking to solve it still.
Within this reality, a vaccine is a great additional tool at solving the problem of preventing the spread of HIV.
I thought the current panic was that young people (not necessarily teens) weren't having enough kids?
Which is in fact panic that teens are not having enough children, because that's where we have seen big drops...
This whole "panic" seemed weird from the start, but once it becomes clear that it's from the lack of teen pregnancies it takes on an even creepier Epstein-like oddness.
It is entirely possible to believe multiple things at once:
1. The drop is fertility is bad for society
2. The drop in teen pregnancy is good, despite it's contributions to 1
3. We should try to fix 1. without undoing 2.
I agree, but I don't think #3 is possible. For a variety of reasons, both biological and societal, the older people get the less likely they are to have kids, and fewer of them.
No, it's from the cost of living being so high that people are delaying having kids.
Worldwide the main thing that correlates to having less kids is being more educated. High cost of living correlates with more kids, not less.
Taking teen pregnancy as an example: we have the tools to avoid it. We have condoms, we have birth control, we have the morning after pill, we have abortion. We have all the tools -- are more tools really going to help? The fact that teen pregnancy is still an issue is not because we lack the tools to solve it.
HIV prevention is similar. We already have the tools. We have condoms. We have PrEP. Sure, a vaccine would be nice, but if someone is unwilling to go on PrEP, why would they suddenly be willing to get a vaccine?
Another tool isn't going to hurt, obviously. But it also isn't the #1 highest leverage place to be spending our time if the goal is to reduce HIV transmission. (It is, however, a great use of time to develop a vaccine if you're profit-motivated. HIV prevention is a massive business. 1 year of PrEP in the US costs $20-30k, although luckily ACA mandates $0 copay. I could imagine a $50k HIV vaccine being a blockbuster drug especially if ACA also mandates $0 copay - tons of money to be made! Ugh)
Edit: To be clear, I'm excited there's a promising vaccine. However, I am not getting my hopes up that a vaccine will magically cure all of the social/political issues getting in the way of a vaccine actually being widely distributed and administered.
> but if someone is unwilling to go on PrEP, why would they suddenly be willing to get a vaccine?
Because PrEP at even its best and most modern version requires an update every six months for life. If you're well-off and in SF or NYC or London that might be easy, but there's so many externalities such as:
- People who misjudge the risk they're at, so don't go on the meds in the first place
- People who live in regions where getting to a doctor even every six months is a challenge
- The six-month injection is extraordinarily expensive and a life-time treatment, for a disease you don't even have yet.
If instead it becomes a once-in-a-lifetime series of shot, like many other vaccines are already, we can start considering a path to extinguishing the disease, not just teaching people to live with it.
Then there's the financial savings of a series of three shots once vs a lifetime of them.
It's still killing people like crazy (and spreading) in undeveloped nations. The new drugs are un-cheap.
Also, I believe that we just DOGEd our only vehicle for distributing these to underdeveloped nations.
We did, Musk has sentenced hundreds of thousands, if not millions, to death by dismantling USAID.
He’s a lovely individual really, just a boon to humanity all around.
All the tools we have against teen pregnancy need teens making right decisions, or taking corrective actions.
If there were a pill that'd block pregnancy for X years, given at the age of Y, then parents could enforce it and teen pregnancy would be solved (also it'd be very cruel but I'm just trying to make a point so bear with me).
Going back to our topic: People could also forget PrEP, be drunk and forget to wear a condom and so on. If this vaccine (or vaccine series) creates a somewhat permanent protection, it'd make a huge difference.
I'm not following the points in the above thread.
- people need to make the right decisions to take oral or injectable reverse transcriptase inhibitors
- people need to make the right decisions to take HIV vaccines
We are comparing two tools, not tools versus discipline.
In some ways these reverse transcriptase inhibitors are like a vaccine, in that they can be taken by people who don't have HIV, for protection.
They are inconvenient, requiring regular injections every few months or timing protocols for the oral versions.
An effective vaccine that lasts years would be much more convenient.
Without a HIV vaccine, the toolkit has a gaping lack; another tool is needed!
The US state of Colorado provided young women free IUDs (which are reversible and can last up to eight years) with private funds, and it was wildly successful. I argue teen pregnancy is solved assuming systems remain in place for women to have robust access to contraceptives and reproductive healthcare (which is a systems problem that is never solved completely, but reliant on defending the subject system constantly in perpetuity). The current US administration is rolling back teen pregnancy prevention programs to increase fertility rates in these age cohorts, so there is clearly work ahead to maintain the progress we've made.
If you're sure you don't want kids, or more kids, a bisalp, or bilateral salpingectomy (permanent birth control, removal of both fallopian tubes), is covered by Medicaid or ACA compliant private insurance in the US at 100% with no patient cost sharing as part of the Affordable Care Act federal statute. Doesn't apply to teens imho, but provides protection for 21-45 cohort for those seeking it.
HIV PrEP in the short term is solved with a twice a year injectable (lenacapavir) until improved options become available (rapid deployment and robust availability of a vaccine given to as many at risk people as possible, as soon as possible). It can be provided for as little as $40/person.
HN Search: lenacapavir - https://hn.algolia.com/?q=lenacapavir
US Government Overhauls Teen Pregnancy Program to Focus on Marriage and Starting Families - https://www.nytimes.com/2026/07/22/us/politics/teen-pregnanc... | https://archive.today/ - July 22nd, 2026
Teen birth rates hit another historical low in 2025, CDC says - https://www.npr.org/2026/04/09/nx-s1-5777587/teen-birth-rate... - April 9th, 2026
Private Money Saves Colorado IUD Program As Fight Continues For Public Funding - https://kffhealthnews.org/health-industry/private-money-save... - August 27th, 2015
(with all of that context shared, all vaccines and medical protocols that improve quality of life, as well as defend and empower the human, are welcome and needed, as quickly as reasonable)
That's like asking "if someone is unwilling to practice abstinence, why would they be willing to wear a condom, or to flip a magic 'not fertile right at this moment' lightswitch?"
A vaccine is something you do once and PrEP is something you have to continue to do over time and get overcharged out the ass for the entire time and worry about if it will remain available in the future.
All your arguments are sound, and I'm still missing your point. Pharma is interested in doing pharma, indeed. But who's interested in your solution, assuming you have one? A significant part of the current electorate (internationally, even) seems to abhor sex ed, condoms, abortions and all that. So tell me again please how you suggest we address teen pregnancy - in THIS world.
> And I would expect that the vast majority of people would oppose any idea of somehow punitively "dealing with" people who get some things wrong.
Of course, and for good reason. The ones who know for a fact they are right, might in fact be wrong or malicious.
Right, but we know that HIV/AIDS essentially is a solved problem in rich countries, that the mentioned interventions are readily available in rich countries, and the only reason HIV transmission is high in poor countries is because, well, they're poor. We (humanity as a whole) have plenty of money, we could fund these things, we simply choose not to.
I would caution against making an allusion to self control. It would be very cruel to act as if people who get a disease through no fault of their own could have avoided it, and most people who contract HIV could not. You may not have intended to make that allusion, but you did.
> So I would say that it's very evidently not a practically solved problem, because if it were we wouldn't be looking to solve it still.
This is obviously not what is meant by "practically solved problem". Everybody knows it is not actually solved.
I recently read "Everything is Tuberculosis". It describes a similar issue with the rich / poor country divide.
It's quite sad and difficult to read at times.
It's a solved problem if you are someone that knows you'll be exposed to HIV in the very near future and you have the money and wherewithal to purchase PrEP before that event (and you can plan the event 7 days out).
The power of a vaccine is you can give it to adults and kids before they are sexually active and protect them, potentially, for the rest of their lives.
I'd also be curious to know if the combination of ART + the vaccine might cure someone of HIV. Which is also a pretty big deal.
Also, PrEP pills can have side effects long term. And distributing huge amounts of daily pills to remote areas of the globe is much harder than the patients getting a shot on their yearly medical visit.
> I'd also be curious to know if the combination of ART + the vaccine might cure someone of HIV. Which is also a pretty big deal.
"Cure" in the sense they could become indefinitely under detectable levels. It's worth noting that to really cure a person of HIV you'd need to remove all mutated cells.
This is completely inaccurate. There is PrEP that requires dosing two times a year. You can also get PEP if you engage in a risky activity without PrEP.
Yes, it exists, but how available is it really? If I recall correctly, the injections are also not very pleasant.
"Gilead sells LEN at very high prices (over $28,000 per person per year in the US), severely restricts its supply to certain countries, and refuses to sell it directly to Doctors Without Borders/Médecins Sans Frontières"
Source: https://www.doctorswithoutborders.org/latest/campaigns/acces...
The shots are expensive, but the pills are free in the USA. They do have adverse kidney issues over prolonged use (more for some people than others).
And clearly only the people in the USA matter.
Are you serious? I would bank money on PEP being practically free in sub-saharan Africa.
*PrEP
It... was, until Musk dismantled USAID and Congress defunded PEPFAR.
So many comments by people who have never stepped foot out the Global North making wild assumptions.
I was explicitly referring to PEP. I'm not sure why you would make assumptions about where I have or haven't been when you have absolutely no information.
PEP remains largely free in SSA post-USAID/PEPFAR cuts.
Ok... so you have to
1. Know you were exposed (many many many people don't know they're HIV+)
2. Have the means to go to a clinic within 72 hours
3. Have the social capacity to go to the clinic safely (in many parts of Sub Saharan Africa doing so would insult your partner)
PEP is an emergency drug, not a prevention at all.
My understanding is PrEP is also free, but I'm less certain about that post-cuts.
That PrEP is in some ways similar to a vaccine, and there is still a lot of value in getting a better vaccine (cheaper and/or lasting longer).
Ad-hoc use of PrEP just requires that you take a double dose 1 hour prior to potential exposure, and follow up with another double dose 24 hours later, at least with the versions commonly prescribed to sexually active groups in my area.
I agree that a vaccine is another game-changer, but it’s extremely important that we don’t spread misinformation about the efficacy and convenience of PrEP. In developed societies, it has already all but eliminated new transmissions among groups that were previously most at risk.
Does this double dose completely prevent infection?
Cost and compliance are still 2 major factors that have not been solved.
We also have education and stigma. While within the LGBT community it is far more common to be open about status and taking prep and doxy (far from perfect though), it still feels like outside of that the conversations are not happening as much as they should.
Throw in doctors that are not being proactive about the conversation.
Right now it seems like having prep and doxy is largely considered only if you are engaged in "risky" behavior (not saying that in a judgmental way to be clear), instead of just being sexually active and protecting yourself. Money and investment alone won't fix that, that is a societal shift around how we talk about sex.
That is also before we get into the cost issues in many other countries just for those that do need it.
PReP has some side effects. While they are rare, they are things you need to be aware of. If you are not doing risky sex it isn't for you.
Most people want to believe they are in a monogamous relationship and thus not having risky sex - even though they are the one cheating. Either PReP needs to be more common, are people need to stop their risky sex activities (that they are not even admitting to).
> If you are not doing risky sex it isn't for you.
That blanket statement I very much disagree with. Sure there are side effects but that is part of why you also get tested every 3 months for liver issues (not that it is the only side effect, but still).
Instead of it being a blanket statement it should be a conversation with your doctor about the pros and cons.
You can still get HIV even if not engaging in risky behavior. Same with people getting pregnant when they did not intend too.
I am thinking college kids that are still figuring out their sexuality and exploring new things. You're going to make mistakes so having a conversation about prep with your doctor is a really good idea.
You are extremely unlikely to get HIV from anything other than risky sex. That's what "risk" means: it's another word for "probability," just a probability of negative outcomes. These probabilities are known: https://www.aidsmap.com/about-hiv/estimated-hiv-risk-exposur...
Some of that table is already mitigated: we test blood for HIV, so transmission by blood transfusion is unlikely. Transmission by pregnancy is less likely simply because few women have HIV: 80% of new cases in the US are male, 20% female.
The real question is whether "having a conversation about prep with your doctor" is going to lead to someone caring enough to pursue a prophylactic course of medication when that same person doesn't care enough about his own health or others' to avoid risky sexual encounters. Is someone irresponsible enough to pursue causal, unprotected sex with random partners also likely to be responsible enough to visit a doctor proactively and comply with a prep regimen? Sure, it's a "really good idea," but a simpler and better idea is not to have random sex in the first place. A "really good idea" depends on a level of self-control that some people obviously lack.
> Is someone irresponsible enough to pursue causal, unprotected sex with random partners also likely to be responsible enough to visit a doctor proactively and comply with a prep regimen?
Yeah, me. What a wild statement to make. It’s a big world out there, my friend.
> You are extremely unlikely to get HIV from anything other than risky sex.
Yes because it is such a fantastic idea to just ignore that there is still a risk regardless of what we call "risky" sex just because it doesn't fit in your puritanical views of sex.
If someone can get HIV the first time they have sex than your entire argument is moot.
Just have the conversation with your doctor and protect yourself and stop trying to push your views on others.
This is such a simple thing to say, talk to your doctor. Thats it. If doing so stops one person who is not engaging in anything that we would deem being risky from getting HIV, that is a win. There is nothing in your world that would stop someone who is having sex with someone that maybe they have been going on several dates, from getting HIV from that person if a mistake happens.
And yet, you seem to think that we are saying that you should be going to an orgy every other day.
Oh and let's not ignore that there are monogamous couples that one may have HIV and they need to also protect themselves.
Are you arguing that all sexually active people should take prep?
I don't see how you are disagreeing. We are both saying that a lot more people are having risky sex than think they are.
I guess it depends on what we call risky, I mean if someone is actively trying to get pregnant are we considering that "risky"?
Someone could be taking the necessary precautions and a mistake happens, a condom breaks, whatever. Someone could have sex with one person in their life and they got it from that person. I would not consider that "risky" in any real sense of the word.
Any sex carries some amount of risk, and the key is being risk aware and not assuming that just because you are not engaging in what is generally deemed "risky" that you are safe. Instead you should be having that conversation with your doctor and determining what your risk tolerance is.
That is where I disagree, how many people are positive that never considered themselves engaging in risky behavior.
To me it is very dangerous, and leads to the situation we are in now, to just say only even consider prep if you are engaging in risky behavior.
All sex is risky by this measure.
Condoms break. Partners lie. Shit happens.
It doesn’t take a lot for the risks to far outweigh any potential side effects. As far as I’m aware, every healthcare system in the developed world either recommends or enforces checkups after starting PrEP.
The LGBT community should also think about abandoning some risky practices which allow infections, and promote antibiotic resistance in the case of doxycicline "prep".
But I guess that sex without condoms is worth it, right?
> But I guess that sex without condoms is worth it, right?
Not speaking about LGBT related matters; Sex without condom is just like everything else - it depends on the person. For some people there is little to no difference. For others, wearing the condom removes all sensation, reducing the act to physical exercise. So is sex without condoms worth it? For some people, yes, it is.
Compliance is the big thing.
Vaccines are the "an ounce of prevention is worth a pound of cure"
PrEP is freely available in the UK and there is almost no requirement in practice of engaging in risky sex. I don't know anyone turned down for not having risky enough sex
Which countries are you talking about out of curiosity?
My hiv exposure was from an SA, I wasn’t on Prep. This will still save lives!
It is endemic in the simian population. It will keep crossing over into humans again and again. It has done it before several times. People who live near forests would have to be on Prep everyday of their lives. The reason they eat bushmeat is the because they are poor and will be too poor to afford daily medication. A once-and-done vaccine would at least stop new crossovers. Only then could we really get a handle on ending this disease world-wide.
This is the wrong take. You are basically arguing that if we have one solution, why bother having a second one?
"Grandma needs to stop taking her statins and just exercise" type shi
There are some dubious metaphors in use here. Public health is not about math problems to be “solved.” “A solution exists” is just a milestone. “We just have to use them” - yes, but leave out “just,” there is more to do and it’s hard.
The answer to “are more tools really going to help” is always going to be “it depends.” Promising interventions sometimes fail entirely. If they statistically improve outcomes, that’s a win. Only occasionally is a disease entirely eradicated.
prep is great but i would really rather take a one-time vaccine than be expected to take an expensive pill forever that could mess up my liver
Which one do you suppose the pharmaceutical companies would prefer?
I'm sure they will gladly sell us both
PrEP is difficult on the body over time and though it can be used if you are high risk you are meant to avoid certain medications while using it and have to do follow ups with your doctor to check organ functions.
Isn’t prep more like a prophylactic, as opposed to a a vaccine?
I’m more familiar with malaria, where the preventative medicines are currently more effective than the vaccines.
The analogy to malaria is pretty on point. Pre-Exposure Prophylaxis (PrEP) is, you nailed it, prophylactic. It's not as good as a vaccine would be, and it's not as cheap as a one-and-done shot, but we've gotten to the point where you can get one shot every six months (lenacapavir) and, it's 99%+ effective at preventing infection. And, much like with malaria, the prophylaxis works— there is currently no HIV vaccine that reliably prevents infection.
There's still a huge difference between a one off injection and lifelong tablets.
From a convenience factor, sure, but both effectively turn a death sentence into a solved problem. I believe GP was pointing out that we should prioritize funding for the existing solution until the more convenient one is available.
"The ongoing loss of life and health due to HIV could be stopped if we cared enough to invest resources in wide-scale PrEP availability and public health education."
It wouldn't be stopped, only slowed. You would still have transmission from accidental or unknown exposure. You would also have a small portion of the population that didn't care, regardless of the education.
As we all hopefully learnt from COVID-19, slowing sufficiently is the same as stopping. It’s a numbers game. Slowing transmission below some threshold will eventually mean that there are no new transmissions.
For rich people (meaning the ~3 billion people that have some sort of access to medical infrastructure), it is a solved problem, but there are quite many people without any access to it. Even for those "solved problem" people, taking a pill every day to be protected is inconvenient. They might not take it every day, etc.
Also, even if it were a solved problem, the methodologies developed here can probably help with other viruses too in the future. This has already happened with the antivirals originally developed for HIV.
Again, inaccurate. You can get a PrEP shot twice a year now.
Access is a valid point. Perhaps the money being used to fund a superfluous vaccine should be used to fund access to PrEP in the Third World.
> Perhaps the money being used to fund a superfluous vaccine should be used to fund access to PrEP in the Third World
An astounding statement. Is it not possible that a vaccine giving decades of protection would give better health outcomes than doing PrEP every 6 months?
I was 16 when Magic Johnson announced he had AIDS. That was the first time it felt real to me. I remember a couple of friends crying because we all thought he would be dead in 1-2 years. And here he is and seems to be living a normal life.
He doesn't have AIDS, he's HIV-positive.
Everything is a "solved problem" if you're willing to ignore a variable (usually money or human life/toil).
Those on prep would welcome a vaccine, it would be a significant improvement. I agree that this is no reason to take the foot off the gas with prep availability, we need more ASAP.
Is it not available in pharmacies?
Who's waiting? The problem is the populations we need to distribute it to can least afford it.
The reason we want a vaccine is because there's a huge logistics difference between a twice yearly injection and the real magic of something more like an MMR shot where one dose is usually effective for life.
It's a problem that was "solved" long before that by just wearing a condom and protecting yourself against other diseases too, and even pregnancy. Condoms are cheap, widely available and decades of condom-related education has been given out to many different generation of kids and adults worldwide.
Somehow we still need day after pills, abortions, antibiotics and other STD meds, and vaccines, now (hopefully) for HIV too.
> Somehow we still need...
So, clearly condoms are not the complete answer. Any solution that does not acknowledge the reality of how people actually behave is going to be imperfect.
We live in a messy world.
Public health education means getting gay men to start wearing condoms or dental dams and apparently that's a bridge too far for them.
The total refusal for anyone at scale pretty much anywhere to use dental dams is particularly egregious:
https://www.theatlantic.com/health/archive/2019/04/dental-da...
https://slate.com/human-interest/2021/08/no-condoms-gay-sex-...
https://www.washington.edu/news/2024/02/27/qa-decline-in-con...
https://www.huffingtonpost.co.uk/entry/prep-condoms-gay-sexu...
At least a portion of the amount of people "in the closet" are closeted for fear of STDs, not particularly because of social stigma risk.
Project 2025 vehemently goes against of it. Why was I downvoted? I am right. The american government strides in lockstep with P25 and corruption.
Long history of not wanting to address the epidemic:
https://en.wikipedia.org/wiki/Ronald_Reagan_and_AIDS
Nobody else said it, so I will. Halting HIV transmission is a solved problem if people are willing to give up sex with untested strangers. The same is true of syphilis, monkeypox, and every other sexually transmitted disease. It says a lot about human nature that a small number of people would rather have society spend vast sums of money researching and developing prophylactics and vaccines instead of changing their own behavior, while the vast majority have enough self-control not to catch diseases through random sex.
> The ongoing loss of life and health due to HIV could be stopped if we cared enough to invest resources in...public health education.
It's definitely a problem of caring, but not one of education: there are not honestly many people out there who don't know that random sex leads to diseases, but there are some people who just don't care enough to prevent their spread. If they did care, they would have sex only with known, tested partners. Minimizing harms through additional investment of resources just leads people to continue to fail to care, at society's expense.
> ... a solved problem if people are willing to give up sex with untested strangers
It's wired into our DNA to do this, and while we can be socialised out of it, you'll never get anywhere close to the near 100% you'd need.
Besides that, PrEP has enabled the return of non-HIV STIs in major cities like Berlin where a lot of the community has returned to raw-dogging since the AIDS-Scare has become a historical artifact.
Is that a huge problem? Doesn’t almost everything else have a prophylactic and is curable? Hep-C might be the only other one I believe and I’m unaware if it’s treatable or not.
Antibiotic resistant syphilis and ghonerrea don't sound like a fun time
Literally no one asks for proof of an STD test before sleeping with them. You might ask someone if they have STDs and use a condom but that’s how 99.99% of how people sleep with other strangers.
Abstinence has been shown to be an extremely, hilariously, stupidly ineffective strategy in all questions of human sexual health.
The HIV/AIDS epidemic would not have been nearly as serious as it was if people like you and the Catholic Church hadn’t advocated for it over all other measures.
It doesn’t work. Change your mind.
Most things are a solved problem if we give up the things that make life worth living. Obesity is a solved problem if you just eat for health. Road traffic deaths are a solved problem if you never leave your house. Suicides are a solved problem if you just don't kill yourself.
This is the brainlet version of the correct take, which is "anal sex without condoms is objectively bad from a public health perspective".
If compliance with safe sex techniques were anywhere close to where it should be, this wouldn't be a problem.
Phase I trials happening now. Godspeed to them. It’s where most HIV vaccines die
Tested on rhesus macaques. Worked well for 44% of them.
It's a positive step, but still a fair way off for humans.
It doesn't need to be 100% effective in humans, it just needs to slow transmission enough such that the rate of incidence declines in the direction of eradication.
It will have the opposite effect, if people who get the vaccine start behaving as though they are 100% protected (which, many people will).
I have to admit that given how many times we have been here, I struggle with being excited about any news about a HIV vaccine until we see results from humans. Just way too many times of hope.
That being said, I don't understand enough to parse this very buzzword heavy release. Is this fundamentally different than the every 6 month vaccine we have now and is a more traditional vaccine or is it just continuing on that trend?
The reason why this is a big deal is because they figured out a way to engineer the type of cells that are hard to create that can readily fight off the virus. In some people they create them already. Here they were able to get the body to create them.
I agree it is far off from something in humans but it's a giant leap. The way I see it is like sending Laika in space before we send humans. It's significant and promising of a future where humans might have a vaccine.
Long-acting antiretroviral injection ≠ vaccine
Congratulations, I hope the vaccine shows the same highly positive results in humans as it did in the other primates.
Jury is out until the overall health effect is shown to be positive
This follows a widely renounced successful treatment drug too right?
I wish people doesn't let their guard down because of this
The people who would "let their guard down" did long before this news. (Or Prep, for that matter.)
OK this sounds fantastic, but is it going to be another case of an expert dropping in on this thread and going "Ah, 100s of these come out every month. It's promising but nowhere near human trials yet."
We don't need an expert even - pre-clinical is a far ways off even if successful.
This is in the "interesting advancement" stage, not "promising treatment."
Been there more times than I can count
Wait, really? Gonna have to look into this