Everything had been leading to the meeting early last year in Zanzibar, where 100 researchers, clinicians and other experts on HIV from across Africa and beyond were meeting to discuss big plans – the development of an innovative vaccine on the continent that could prevent the disease, which continues to infect and kill people disproportionately in sub-Saharan Africa.
And they had big money to do it, reports NPR. This group, the BRILLIANT Consortium, had landed a $45m grant from the US Agency for International Development (USAID) in 2023.
“I mean, it’s unprecedented," said Nono Mkhize, a senior medical scientist with the National Institute for Communicable Diseases (NICD) in Johannesburg, “having a consortium made up of African scientists working toward an African problem in our labs here in Africa.”
Year one of the five-year grant had been almost entirely virtual. Now, they were all here together in Zanzibar and ready to turn their expertise into action. All of the presentations and discussions and arguments had coalesced around a solid plan to thwart the virus. The scientific advisory board endorsed the imminent launch of the vaccine trials.
“I remember the excitement was through the roof,” says Mkhize. “We were at the beginning of something big.”
But just as the meeting was about to wrap up, the mood darkened.
A new executive order signed by Donald Trump on the day of his inauguration, 20 January 2025, had frozen all foreign aid pending a review. Soon, DOGE would begin its decimation of USAID – cutting programmes, interrupting funding streams, letting people go, and generally sowing uncertainty within an agency that, for more than six decades, had provided global humanitarian aid and development assistance.
The disruptions were starting to ricochet around the world, including at that Zanzibar gathering.
Shortly afterward, the official stop work orders were issued.
“That was crushing, because we were about to enrol our first participants within the trial,” said Penny Moore, a virologist at the University of the Witwatersrand.
“In many ways, we’ve kind of had our legs cut off even as we’re beginning to run the sprint,” says Linda-Gail Bekker, who directs the Desmond Tutu Health Foundation at the University of Cape Town, one of the collaborating partners under the USAID grant.
Instead, the team steeled their resolve. They knew the science was sound and the need was urgent. They insisted on finding a way forward.
No sugar-coating the problem
This was all happening, said Moore, at a critical time in the fight against HIV. She doesn’t believe that treatments alone, including the recent introduction of lenacapavir, the twice-yearly injectable, will be enough.
“We need to get to the point where we are finally ahead of the virus, and the only way we can do that is through a vaccine,” she said.
Moore has been studying HIV for more than 20 years, slowly piecing together a detailed portrait of the virus. Research on HIV by her and others has also taught scientists about how the human immune system functions more generally, which has facilitated advances against other ailments including Covid-19, RSV and cancer.
A good portion of Moore’s work has been supported by the US. In addition to the equipment, her research has relied on a group of 117 South African women who have contributed their blood regularly to her lab for 20 years.
The 20 years of samples are stored in a room arrayed with half a dozen large freezers. This is, essentially, Moore’s career on ice.
Findings from the research include answering questions that helped lead to the vaccine that Moore and her team were about to start testing under the USAID grant, like – why is HIV so skilled at evading our bodies' defences?
“It’s like an M&M, in that it’s completely covered by sugars,” Moore explains. “And sugars are essentially invisible to the immune system. So it’s very difficult for the immune system to see the virus at all.”
While other viruses, including the one that causes Covid-19, deploy these sugary shields to a lesser extent, Moore says HIV is the most accomplished when it comes to hiding within and from the human body.
In addition, HIV is remarkably variable. The virus mutates frequently, making “every mistake it can every single day”, she said. But not all mistakes are bad.
“Very quickly, every mistake that survives turns into a swarm of viruses within one person, and they’re all different from one another.”
This allows the virus to evolve in different directions in different places, including within Africa. “The virus they have in Kenya is not the same as the virus we have in Botswana,” she said. “And it’s not the same as the virus they have in Senegal.”
This diversity was a big reason why Moore was so excited to be working with colleagues from different African countries under the USAID grant. It would have allowed the testing of vaccine candidates on a range of flavours of the virus in different populations on the continent.
As for the vaccine itself, its origins began with a key insight that came out of Moore’s lab, in part. A few years after becoming infected with HIV, a small fraction of the people donating blood developed something called broadly neutralising antibodies.
“These are the kinds of antibodies that can recognise and neutralise a virus regardless of where that virus comes from,” said Moore. “And in many cases, up to 90% of global viruses could be stopped by one antibody.”
When these rare antibodies appear naturally, they usually emerge too late to be of assistance to the person who has HIV. “The virus has already spread too much and they actually don’t have such an effect,” said Nigel Garrett, the chief scientific officer at the Desmond Tutu Health Foundation.
“So we need to bring it forward before someone gets infected – catch the virus before it enters the bloodstream,” he added, explaining the vaccine development strategy. “That is a journey. You have to prime the immune system, you have to then shepherd the immune system along and then you have to polish it to ensure the (production of) the right antibody against the circulating HIV viruses.”
But because the antibodies are so strange, it’s very difficult to coax the body to produce them in response to a vaccine.
This is what the USAID grant was intended to do – set up a series of trials that could flexibly and quickly work out the best way to encourage the immune system to create legions of these special antibodies.
Finding a way forward again
After the cancelation of the USAID grant, everyone was reeling.
No one wanted to scrap the vaccine project. “A devastating thing, a funding cut, yes, but we will always find a way to come back fighting,” says Sheetal Kassim, the senior research officer with the Desmond Tutu Health Foundation. “We are fighters.”
So the South African researchers on the team came up with an alternative plan.
They realised they’d have to scale back – make it a South Africa initiative only and reduce the scope of the trials. But they believed in the promise.
For Amelia Mfiki, the community liaison officer for the vaccine trials, the bottoming out of the USAID funding was a wake-up call.
“This is a great opportunity for South Africa to prove that we can do things in South Africa for South Africa with South African financing,” she said. “We still need support from other countries, but we shouldn’t be depending solely on them.”
Still, there were many late nights and a lot of unease. “We were frantically writing grants to everybody who would have us – literally, any funder in any country on whether they might be willing to support the programme,” says Moore.
Ultimately, the project secured funding from the South African Medical Research Council and the Gates Foundation (which provides financial support to NPR). It’s about a twentieth of the original USAID grant and none of it is from the US government.
Now, after nearly a year of delays, screening of participants for the pared-down trials has begun.
On the outskirts of Cape Town, a factory building stands tall in Philippi Village, an impoverished township where HIV is rampant.
The factory has been converted into a multi-use space. Mfiki heads to a room where 20 or so young women are waiting. “I will explain to them the criteria and who should join the trial,” she says. “This is the community from which we recruit and where we look for potential participants.”
Over the years, the participation of these women and others from their community has been critical for trialling treatments for HIV – which now includes vaccine candidates.
“They are equal partners to the researchers and to the research itself,” Mfiki says. That’s because without participants, there can be no trials, and progress against HIV will stall.
The first shots of the new trial start going into participants’ arms next week.
See more from MedicalBrief archives:
How Trump derailed crucial HIV research
Trump’s aid cuts halt crucial SA-led HIV vaccine trials
Trump formally ends SA’s HIV and TB research grants
US stands to lose from funding cuts for top-notch SA research