Dr Anthony Fauci Speaks to the Likelihood of Vaccines for HIV and COVID-19

In an interview to mark the 25th anniversary of The American Journal of Managed Care®, Anthony S. Fauci, MD, director of the National Institute of Allergy and Infectious Diseases, noted how there’s never a guarantee with vaccinology but that he and other officials feel fairly confident that we'll get a vaccine for coronavirus disease 2019 (COVID-19), possibly by the end of the year and the beginning of 2021. The same cannot be said for HIV, he added, although he has cautious optimism that we'll get vaccines for both, because the immune system’s response has thus far not been adequate enough to clear the virus.

Transcript

What are the similarities and differences between HIV and COVID-19 when it comes to prevention, vaccines, and cures?

Well, the common denominator is that they both started off as a new virus that the human species has never had any experience with. It [COVID-19] jumped, as many of these new emerging infections do, from an animal reservoir to a human.

The differences are profound. The differences are (1) that [it] is highly efficiently transmitted from person to person by the respiratory route, which makes it very difficult to prevent yourself from getting infected—except by doing draconian things that we've done with COVID. Namely, essentially shut down your country, lock it down, have such physical separation that you don't transmit because you're not physically close enough to transmit a respiratory infection. That is a very, very profound and draconian way of blocking infection.

HIV, although its impact is enormous, with over 80 million infections and over 37 million deaths—and still over a million people getting infected each year—that is so different, because it's insidious. It started off slow. It started off, we saw the tip of the iceberg not realizing that many people more were infected than were actually we were seeing getting sick. It's transmitted by very, very specific modalities and behaviors: sexual, both gay sex and heterosexual sex; mother to child, which can be prevented by treating the mother; blood-in-blood transfusions; and plasma transfusions, which you can stop, essentially, by screening the blood and the blood products. So it remains a disease and an infection that's transmitted by certain very specific behaviors, unlike COVID. The mortality, untreated, of HIV approaches 100%. Very few exceptions. Less than a fraction of a percent of people are elite controllers.

The rate at which you get infected varies. It's a chronic infection mediated by a virus. So if you can get infected today, you could go 10 years before you actually get symptoms enough to make you feel sick. That's very different from COVID. You get sick. It's explosive. You get infected. You either get better within a period of a couple of weeks or you progress to disease and die.

So they have so many things that are different about them, but yet some things that are common denominators of them.

In a recent article in The Journal of the International AIDS Society, you and your coauthors wrote that finding “safe, effective, and durable vaccines for both HIV and COVID-19 are NIAID’s top priorities.” What are the current challenges?

Well, I think the challenge for getting a vaccine against SARS-CoV-2 [severe acute respiratory syndrome coronavirus 2, the virus that causes COVID-19] is more of a time element. We feel fairly confident that given the fact that the body makes a pretty good immune response against natural infection that you can get a vaccine to induce a similar response that could protect. You never guarantee that. There's never a guarantee with vaccinology. But we feel fairly confident that we'll get a vaccine. We'd like to get one, and the projections are that's at least aspirationally possible by the end of the year and the beginning of 2021. Whereas with HIV, we've been working on a vaccine for 30-plus years. And it is very difficult to get a vaccine because it's very difficult to induce the body to do something that even natural infection doesn't successfully allow it to do, [which] is to develop an adequate immune response to clear the virus. So the challenges are very, very different.

I'm more confident that we'll get a vaccine for SARS-coronavirus-2 than I am that we'll get one against HIV. Although I have cautious optimism that we'll get it for both. But I think it's going to be much easier to get it against the coronavirus.