S1: Hey there , San Diego. It's Andrew Bracken in for Jade Hindman. Today , what do cuts in federal funding mean for the future of HIV and Aids programs around the world ? Plus , how progress being made on a vaccine for HIV could be lost. This is KPBS Midday Edition. Connecting our communities through conversation. For the past year , the Trump administration has cut off funding to programs that provide direct aid to communities affected by HIV and Aids. That includes the dismantling of the US agency for International Development , or USAID for short , which provides a lot of that funding. John Cohen is a senior correspondent with Science magazine. He's been covering the global HIV and Aids crisis for decades while he's based in San Diego. He spends at least a quarter of the year going around the world on reporting trips and diving deeper into these issues. In May , he traveled to two countries in southern Africa to look at how these communities have been impacted by cuts so far. And John joins me now. John , welcome to Midday Edition.
S2: Thanks so much for having me.
S1: So on this recent reporting trip , you traveled to Eswatini and Lesotho.
S2: And what that means is they have more adults living with the virus than anywhere else. They also have had two of the most remarkable responses to their epidemics , and that has been with help from the U.S. government , largely through the President's Emergency Plan for Aids relief , known as PEPFAR.
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S2: Let's roll the clock back to 2003. At that period of time , it cost about $15,000 a year to treat somebody with the best HIV medicines for a year. So most of the world that's affected by HIV didn't have the money to pay for that. Those drugs became available in the United States around 1996. So we were watching people die from Aids all over the world when there was good medicine that allowed people to live normal lifespans. And , as we later learned , also hit the virus so hard that they didn't spread it to other people when they took these medicines. So it broke the back of epidemics. Pandemics. And then we learned that these same drugs , if people took them who were not infected , could protect them. It's called pre-exposure prophylaxis or Prep. So incomes the US government. And there also was the creation of something called the Global Fund to Fight Aids , Tuberculosis and Malaria. These two entities start around the same time. It leads to generic manufacturers to rush in to make these drugs. The price plummets to about $120 a person per year , and the US government is able to help countries purchase the drugs , but more importantly , set up programs to distribute them , test people , monitor people and make sure that the epidemics are declining.
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S2: They've had their people trained by these programs , and those people are training others themselves now. And they had hoped to phase out the PEPFAR funding by about 20 , 30 , about five years from now in Eswatini and Lesotho , both countries are purchasing the bulk of their HIV medicines , so they're not reliant upon the US government to buy the drugs any longer. It's everything else , what's called the wraparound services. And when I was in the countries , that's what I saw falling apart. The drugs are there. The issue is they have no impact if people don't take them.
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S2: And I went to a clinic where there were pregnant women lined up along the wall sitting on benches , and I talked to them. How long are you going to be here today before you see someone ? And they said , well , at least four hours , maybe eight. The clinic had to fire a bunch of nurses. They didn't have the money. They were supported by PEPFAR. And a lot of these clinics also rely upon people who are living with HIV. They're called expert clients , and they do HIV testing and counseling for people. So they help them if they are positive on the test , adjust to living with the virus , and if they're negative , they help them maybe start prep. They encourage them to do this. This clinic had lost that support as well. So these women who were pregnant were not receiving HIV tests. And when you break that down , stopping the transmission from a woman living with HIV who is pregnant to her baby is the greatest prevention Campaign in the HIV world of all time. It works remarkably well. And the impact is the kids are born without the virus and they don't get it from breastfeeding. And before this , about 30% of these women were transmitting the virus to babies , creating whole new generations of infected people. We broke the back of that with this phenomenal prevention advance. That's not happening.
S1: So how are , you know , health care providers in these countries you visited navigating these new challenges ? Now that it seems like , you know , there are more of these challenges for resources.
S2: You know , it's one thing when you don't know what to do. These are people who are really well trained. So they're frustrated. They're working longer hours. They feel betrayed. In many cases. They came to trust the US government and the allies in the program supporting them , and they just can't believe it. They're just kind of dumbfounded as though they've been cheated on or something. And it's not as though they feel like we owe them. That's not it. We had made commitments. They were judged by their performance and they were hitting milestones. So they're dumbfounded and they're frightened.
S1: So , you know , these programs turned around the effect of the crisis in these countries that you report on here. Someone you spoke with was Newhart , who heads the UN Aids program in Eswatini. Here's a little of what he had to say to you.
S3: This country was one time doomed to be completely wiped out , you know , by HIV. But today , this is a country that is actually celebrating excellent results to demonstrate to the whole world that , you know , if you really invest appropriately and you have the right programs , you can actually turn the HIV epidemic from a crisis to an opportunity.
S1: Some kind of illustrating your point there. And I think he mentioned to you , he was even concerned whether that would be his last interview.
S2: I think it was his last interview. He subsequently had his office shut down because UNAids , a division of the United Nations , was receiving funding through PEPFAR. And that stopped. So here's a metric that's really easy to understand and underscores the success. With the help of PEPFAR and the Global Fund. The UNAids had set a goal that 95% of people in a country should know by the year 2030 , if they are living with HIV , they should have tests and know it. 95% of that group should start treatment , and 95% of the people who start treatment should fully suppress the virus to the point that they're not going to transmit it to anyone else. Both Lesotho and Eswatini have already hit that 95 , 95 , 95 goal. Most of the world hasn't. These two small countries , 1 million to 2 million people with the highest HIV prevalence in the world , with resource limitations that are profound. Have both accomplished this. The danger now is they're going to slide backward.
S1: So , you know , as we mentioned at the start , you've been covering HIV and Aids for for a long time , for decades. And it's been so long. You know , I think a lot of people may not remember the devastation that came from the Aids crisis. Can you talk about , you know , what it looked like then when you started reporting on this and how you're thinking about the past ? Now , as these new , you know , programs are in jeopardy.
S2: So I started really making HIV Aids my beat in 1990. So 35 years ago , at that point , if you were diagnosed with HIV , it's usually because you were sick. You showed up pretty ill. The treatments that were available would maybe buy you a couple of years of life. But there were a lot of young people dying really terrible deaths. And as I started traveling outside of the United States to places that were hit even harder , I would walk into hospitals and see dozens , if not hundreds of people in beds dying. And it was a war zone. It was tragic beyond belief. I would get depressed when I'd come home from these trips because I couldn't really process things while I was working. And it would wallop me when I got home what I had seen. And the way that you die from Aids is it cripples your immune system , and you start becoming vulnerable to all of these bugs that don't do anything to healthy people. And you lose your eyesight. You lose your ability to feel the ground. You lose your ability to eat. It's just a horrific way to to die. And this was happening to young people all over the world and destroying families and destroying communities. And to see the miraculous advance in 1995 96 , of these cocktails of drugs that let these people come out of their deathbeds and go back to work , go back to their families , create new families to live normal lifespans , was one of the most powerful examples in my life that I will ever see of what biomedical research can do.
S1: And , you know , kind of jumping off that point. How have more recent advancements in science changed the outlook for HIV and Aids ? I mean , there's been more recent drug breakthroughs that have just recently been approved by the FDA.
S2: Yet there's a new form of Prep that is an injection made by Gilead of a drug called Lena that lasts for six months. So a shot will protect people from becoming infected for six months. It's not a vaccine , but it's the next best thing. It's. It's a it's a huge advance and it's a new tool. This is kind of like birth control. You know , you want birth control. You want options. Some people want a pill , some people want condoms , some people want abstinence. Whatever you want to do , you have options. That's where we're at right now. The options have become more and more accessible to people. And there's also this enormous , underappreciated spillover of what HIV research has done for other diseases. And front and center is Covid , the Covid vaccine. But still , we've seen new drugs come out during Covid that are based on research out of HIV. So it's had this spillover effect for biomedicine and for training researchers for many , many different infectious diseases that I don't think people really grasp in. San Diego is a hub of all this. Yeah.
S1: Yeah. Let's talk more about that. You know , we've been talking more globally in the impact.
S2: It has UCSD , Scripps Research , Loyola Cancer Immunology. It has biotech companies and it has major pharmaceutical companies. They've all contributed to tremendous amount. The leading Aids vaccine , HIV vaccine programs now in the world. One of them is based at Scripps , and it was just told that it's going to lose its fund , not not be eligible for more funding from the NIH because the NIH , for reasons that confound this research community , is cutting back funding at a time when they've made great progress. And it's it's a tough nut to crack. Don't get me wrong , an HIV vaccine isn't around the corner , and there would be an HIV vaccine today if this were an easy virus to stop with an immune system. It's not it's not Covid , which was a chip shot comparably. But you have to see this through the big picture. And what San Diego has done is played a critical role in helping to create new treatments and preventions that have been used around the world.
S1: And coming up , we'll be talking more about , you know , the HIV vaccine research coming out of Scripps , as you mentioned there.
S2: And it isn't simply an act of charity. We have , through our Foreign Assistance and PEPFAR , a bipartisan supported program , saved an estimated 26 million lives. And as the UNAids country director in Eswatini was pointing out , we've kept countries alive. And because of that , there's soft diplomacy where we've created goodwill toward us everywhere. And I think people who are against foreign assistance need to understand it's a tiny portion of the budget. It prevents the collapse of countries that otherwise might require us to come in with our military or other needs of support. And these viruses , as virologists , loves to love to point out they don't know borders. They don't care. And if a resistant mutant crops up in Eswatini and Lesotho , it's going to be here soon enough. So the more that we work on this together , and we behave as though we are connected to each other , the better off all of us are. And and I think that's something that wherever you sit on the political spectrum , you have to appreciate there are things that connect us. And viruses do and so do our responses to them. Yeah.
S1: Yeah. And I think , you know , as we were talking before we started chatting here , I think a lot of us think about viruses , vaccines , all that's gone around much differently over the last half decade than we did maybe before. But this is something , again , you've been covering for several decades.
S2: One is working in Guinea and one in Nepal. So we're focusing on children and teenagers because it's about the future. That's what this really is about. When young people are sick with diseases that can be prevented , it is one of the most tragic things any of us have witnessed , and something I've learned after traveling to many countries to do my job. Everyone everywhere wants to be healthy. There's no one who wants to be sick or wants their family to be sick. Wants people they love to be. Nobody wants people to be sick. We all want health everywhere. There are lots of things. We all don't want that some people think we should all want justice or education. People argue against these things in places. No one argues against health. And I think the point that I really want to underscore is we have to invest in the future and take care of the children today. And I hope that everyone across the political spectrum red , blue , whatever , sees that America has been a shining example of how to make a better future for the world.
S1: I've been speaking with Jon Cohen , senior correspondent with Science magazine. We'll link to his full piece at KPBS midday. Jon , thanks so much for being here.
S2: My pleasure. Thanks for having me.
S1: When midday Edition returns how funding cuts risk the future of HIV vaccine research , including here in San Diego.
S4: What it means is probably a huge setback in HIV vaccine work , probably setting us back a decade or longer.
S1: That's ahead on mid edition. You're listening to KPBS Midday Edition. I'm Andrew Bracken in for Jane Heidemann. We're covering how the Trump administration's spending cuts could impact the future of HIV and Aids research. One critical aspect of that research looks into the development of a vaccine. Researchers were on the cusp of a major scientific breakthrough , but now are worried spending cuts could put their work. And vaccine research as a whole in jeopardy. I'm joined by Dennis Burton. He co-leads the consortium for HIV and Aids Vaccine Research at Scripps , where he's also a professor. Professor Burton , welcome to Midday Edition.
S4: Thank you.
S1: So before we dive in , can you set the scene a bit for us ? Where were you in your research when you found out funding may be at risk ? Yeah.
S4: So HIV is , you know , one of the the greatest problems in biomedicine. So it's , um , it's caused us many , many headaches. But in the last sort of 10 to 15 years , we and others have focused on designing vaccines that induce the sorts of antibodies that can , um , fight against HIV , so-called broadly neutralizing antibodies. And we've just started to have some real successes in , um , in animal models and in the clinic as well. We're starting to see that we're getting the sorts of antibody responses that we want in small human trials. So we've been very excited lately that we're , um , we're making accelerating progress , and we were looking forward to moving towards a vaccine in the next funding cycle from the NIH.
S1: You mentioned these headaches that , you know , working on HIV created in the complexities therein.
S4: So it's not really even one , one , um , virus. It's really hundreds of thousands of , of related strains. So the vaccines got to protect folks not against just one virus , as might be the case , um , for some viruses , but against all these different strains. So the antibodies that you that the vaccine induces have got to be able to , um , attach and take care of all these very , very different strains. And that's means that you need very special antibodies and very special technologies to induce them. But we've kind of worked those out now to a large degree. So that's why we think we're we're really getting somewhere.
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S4: So a lot of new technologies , new approaches , new ways of doing things have arisen. And , you know , as one example , the , um , mRNA technology that has been so useful against in the Covid vaccine , but is now also finding applications in cancer in , um , in , uh , advanced melanoma and so on. This , uh , this technology originally started with , with researchers working in HIV. And there are there are other examples of that.
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S4: So , uh , the , um , program folks sent us an email and said , uh , can you go on a , um , a zoom call , uh , tomorrow ? So we went on the , um , the zoom call and they said , uh , look , unfortunately , the , um , the , the planned , um , next phase of this program is , has , is is not going to happen where the upper management of NIH has decided to not continue with these these efforts.
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S4: We're hoping we can find continue at some sort of level with alternate funding. But but that's very much up in the air. What it means is probably a huge setback in HIV vaccine work , probably setting us back decade or longer. What it also means is the dispersal of these teams. I mean , we have over the last two cycles of this program , we have assembled a team of of scientists with very different Expertise. And that's contributed a lot to , uh , success is the fact that we bring together virologists and immunologists , structural biologists , computational biologists. We bring all these people together. And , um , you know , it takes time to build teams like that. And , um , that's just going to be blown away. Now , once you remove the funding source , then the teams get dispersed. And it's very hard to rebuild a team of this magnitude of this different expertise.
S1: And , you know , ten years is a long time. You know , as you mentioned , it's kind of taking back a decade or more. Is there hope that , you know , at least some of the vaccine research can be picked up from other countries or other research centers throughout the world ? Could kind of pick up some of what you may be losing here in the United States.
S4: It's possible. It's possible. You know , the United States has always been the world leader by some margin in HIV vaccine research. And so that's , you know , a big question. It's possible that China , you know , that is investing a lot these days in biomedicine that they may pick up on this , at least to some degree. But that remains to be seen.
S1:
S4: I mean , most of our research is actually based in the United States , but what we have done is , um , clinical trials. We've done also in , uh , South Africa , which is the epicenter or sub-Saharan Africa is the epicenter of the Aids pandemic. And so , um , that's been very important for the clinical trials. And it looks like that will all be , um , will all be lost now.
S1: So there are , you know , currently many treatments for HIV treatment for that disease has come a long way.
S4: And the latest development , the long acting antiretroviral drug. Then the capper there is a huge advance. But you know these drugs still cost money and they and people have to take them. So they still have some strong limitations. And I think most folks , even those who have been , you know , test who shown the drugs are effective , they are still of the view that if we want to eradicate HIV , if we want to really control this virus and eventually get rid of it , then we're going to need a vaccine. And I think that's true of , you know , many diseases that , that , that the best way to control them is complete and utter prevention. And that's what vaccines do. And they're cheap , relatively cheap. And , you know , if it's a really good vaccine is is one shot and you're done and you're hopefully protected for life. And that's that's what we want to do. We want to give folks freedom from HIV for life.
S1: Now zooming out a bit more on just vaccines more generally. Earlier this month , U.S. Secretary of Health and Human Services RFK Jr. You know , gutted the CDC's independent vaccine advisory panel , removing all 17 of its members and bringing in new appointees , some with more anti-vaccine views.
S4: I mean , I think vaccines are , you know , the two medical interventions that have done the most are for human health are clean water and vaccines. And they have been so successful in a way , they're victims of their own success. I mean , can I ask you a question ? Uh , how many people do you think died of , um , of smallpox in the 20th century ? Oh , and don't be don't don't be shy , because many colleagues get that wrong.
S1: Smallpox in the 20th century. Yeah. Um , 200,000.
S4: Uh , the answer is about 300 million. The answer is about 300 million. So it's a very , very large number of people. And after 1978 , no one on earth has died of smallpox. Wow. No one. Uh , because it was eradicated. And and and most people believe that , uh , that eradication was , due to , um , vaccination , vaccination programs that , uh , got rid of the virus entirely. So we just don't have to worry about it anymore. You know that that's how powerful vaccines can be.
S1:
S4: I mean , because of the uncertainties as well. You know , the uncertainties of what's happening are having a lot of effects. You know , we can't , uh , you know , nobody knows if they're going to have a job tomorrow. You know , it's difficult to to recruit people. Now , we we get some of the best minds coming from , um , different foreign countries. They are not going to come if they , uh , if the conditions look to be as difficult and uncertain as they can. So I think we're in a stage of of trying to work out how , you know , we want to keep moving forward. We want to , you know , do our science and do our work and make vaccines. But right now , we're in a sort of in a kind of limbo because there's so much uncertainty about what's what's happening. So it it's a very bad situation in biomedical science generally in this country , which , which has been the world leader for so long.
S1: Earlier you mentioned how these spending cuts could set HIV vaccine research quite a bit like ten years , I think you mentioned. Yeah , but are you at all hopeful that the field could can recover and build on the progress that's already been made ? And if not , what will it take to get that back on track ? Yes.
S4: I mean , you know , the progress is still there. The technologies that we've developed are still there , but reduced funding or no funding means that , you know , things are going to go much more slowly. And , um , you know , we've still got a lot to learn. We've still got to test different , different approaches , different candidates and so on. And so we're not going to be able to do that. So the progress is going to be inevitably much slower. And as I said , the dispersal of the teams is also going to , um , detrimentally affect the speed at which we can we can move forward. I mean , we're not going to give up. Nobody's going to give up. But , you know , it's just going to be much slower and much harder. And yeah.
S1: I've been speaking with Dennis Burton , professor of immunology and microbiology and co-lead of the consortium for HIV and Aids Vaccine research at Scripps. Professor Burton , thank you.
S4: Thank you. My pleasure.
S1: That's our show for today. I'm Andrew Bracken. KPBS Midday Edition airs on KPBS FM weekdays at noon , again at 8 p.m.. You can find past episodes at KPBS morgue or wherever you listen. Thanks again for listening. Have a great day.
