It’s been two and half months since Donald Trump signed executive orders freezing US foreign aid. What was initially a 90-day pause has morphed into abrupt and widespread shutdowns of HIV, and sexual and reproductive health services around the world.  

Key USAID-funded HIV research and development programmes (R&D) have not been spared. These include promising clinical trials, most of which have South African researchers and scientists at the helm. Experts warn that halting these life-saving HIV research programmes will erode trust between communities and scientists, setting back R&D by decades.

The MATRIX project, BRILLIANT Consortium, ADVANCE, MOSAIC and CASPR are just some of the research projects that have been forced to stop since January. 

Ethical termination

“The abrupt termination of this initiative not only disrupts critical scientific progress but also undermines the principles of equity and inclusivity in global health research,” says Tian Johnson, founder of the African Alliance and BRILLIANT Consortium’s Principal Investigator for Community & Advocacy.

The BRILLIANT Consortium — short for BRinging Innovation to cLinical and Laboratory research to end HIV/AIDS In Africa through New vaccine Technology — spans eight countries across Western, Eastern, and Southern Africa. 

Led primarily by African women scientists and advocates, BRILLIANT aims to develop an HIV vaccine designed, tested, and manufactured entirely in Africa.

“That means every part of the new technology will be researched, tested, and manufactured on the African continent with support from the United States government. The vaccines will also be designed to prevent the strain of HIV that is the most common in sub-Saharan Africa,” says Johnson.

From the community arm of the trial, Johnson says that their mission at this time will be two-fold: close out the project ethically, and advocate for governments to fund important work that could end the HIV epidemic. 

The process of stopping a clinical trial or research project varies, explains Mitchell Warren, Executive Director of AVAC – the AIDS Vaccine Advocacy Coalition, but overall, it erodes trust. 

“We know from COVID-19 that science moves at the speed of trust,” says Warren. In other words, research and development work can only move forward as much as communities trust in the researchers, scientists and investigators running the projects.

“There were a couple of [small] active clinical trials [from MATRIX], and people have been called back at a moment’s notice, and told ‘we have to discontinue the trial because of the US government, and we have to take the product away’.” 

These trials were co-created with African investigators and approved by regulatory agencies in South Africa, Zimbabwe, and Kenya. Now, they are being completely dismantled, states Warren. 

Concerns around PrEP

The MOSAIC project (part of CATALYST), which provides women with oral PrEP, the vaginal ring, and injectable cabotegravir, is now in limbo. MOSAIC is a seven-year project that was scheduled to run from 2021 to 2028. The project was funded by PEPFAR through USAID. Now, in the project’s fifth year, local investigators are scrambling to determine who takes ownership of these PEPFAR-funded products, and what happens next. 

MOSAIC included participants from nine countries, where, for most, the project was the primary way to access cabotegravir and the vaginal ring.

“How do we help women navigate if the product runs out? And there were limited supplies of both rings and injectable cabotegravir, and you’ve created these bonds and trust with these participants. Do you do nothing and just send them on their way, and potentially put them at greater risk of HIV infection? Or do you get them into an oral PrEP programme that may exist in the country?” questions Warren.

“So trust matters,” he says. 

Building back 

Speaking hypothetically, Warren explains that should these projects be able to restart, the relationships between the investigators and the communities would be strained. 

“Many [participants] know they may benefit themselves, but often people engage in clinical research because they trust the investigator. They want to help answer a question, because they want something for themselves, for their families, for their children, for the next generation. It’s taken decades to build that trust.”

But Johnson believes that the search for an HIV vaccine will pick up again.  

“Despite this setback, our commitment to finding a vaccine for HIV remains unwavering. We will come out of this stronger than ever. Our love, passion, and commitment to this work — our integrity and our desire to ensure we leave no one behind — are greater than their hatred for us.” – Health-e News 

*Health-e News requested comment from MATRIX and MOSAIC but did not receive a response by the time of publication. Should additional comments be provided, we will update the story accordingly.