With just two months until the World Vaccine Congress in Washington we are delighted that some of our wonderful speakers are keen to take part in exclusive interviews for the community. These interviews will be shared in preparation for the event as well as afterwards, and shine a light on the work that our speakers are doing and their sessions at the Congress.
In this zoom conversation we met Dr Mark Feinberg, President and CEO of IAVI: the International AIDS Vaccine Initiative. We discussed some of the key areas that he will be covering at the Congress in April, digging a little deeper into some of the key global health issues of today. If you would like to see the full transcript of the interview you can access it at the bottom of this page. We hope you enjoy it!
Tell us about your role at IAVI
For many in our community, Dr Feinberg will be a well-known and recognisable figure for both his academic and leadership roles. Still, we asked him for a little bit of an outline and he kindly obliged. He explained that IAVI is “now in its 26th year”. Founded with the “specific intent of accelerating HIV vaccine development”, it has more recently expanded to address “additional diseases” using the “capabilities and technologies” that were developed along the way.
IAVI has a particular focus on “global health threats that disproportionately impact people living in low-income countries”.
“It has a specific goal of really trying to make sure that the best, most powerful scientific innovations can be, you know, applied to addressing the needs of people who would otherwise be left behind”.
Furthermore, IAVI aims to keep the products it works on “available in an affordable and accessible manner to the people who need them”.
Why is accessibility so important to global health?
Accessibility is a word we hear a lot in the vaccine world, and it is a concept that is central to IAVI’s mission. We asked Dr Feinberg why it is so important to global health and what barriers prevent us from achieving it. He suggests that COVID-19 emphasised the importance of accessibility.
“If you don’t plan for equitable global access, there’s going to be really these tragic inequities”
“The health of every individual around the world is equally important”
That’s IAVI’s “commitment” and is shared by lots of people throughout the community. However, “access doesn’t happen by accident”. Dr Feinberg suggests that when developing a product, you must include “affordability and scalability” in the “profile or preferred product characteristics”. Without “appropriateness for diverse circumstances”, at the centre of your process, “you will not achieve those goals”.
What about sustainability?
Sustainability is another key aspect to IAVI’s work. Therefore, we asked Dr Feinberg about how this relates to accessibility. For him, they are “really connected”. He refers to IAVI’s work in Africa and India, where “many of the diseases” IAVI targets are “important problems”. In these places the organisation is working to facilitate “scientific research and product development capabilities”. He contrasts this with a “colonial view to global health” that was previously held by many, suggesting that IAVI has been working to address “for a long time”.
“If you want a product to be developed in a manner that’s appropriate for a population, you need to understand the needs and preferences of that population, and you also need to have a trusting and trusted relationship with those individuals.”
This kind of relationship is developed through “effective community engagement and understanding”. However, the best way to ensure that products are appropriate for a population, is to have “capable investigators who come from the countries where you are thinking that the products need to be used”.
Once more, COVID-19 exemplified this. Dr Feinberg identifies “many of the really important discoveries” of the pandemic as emerging from “studies done by African investigators in Africa”. He suggests that their “capabilities in the infrastructure” were “really catalysed by the response to the AIDS pandemic”.
“So in many ways we’re seeing the value of how investments in one area can have benefits in the future in other areas.”
COVID-19 and other diseases
One of Dr Feinberg’s sessions at the Congress will consider the issue of diseases that were “forgotten” during the pandemic. As he rightly points out, these diseases were never truly “forgotten” by people who experience them, nor their researchers, but perhaps neglected by the media in the shadow of COVID-19. However, he agrees that the “public health response to those other pressing global health problems has been compromised” by the pandemic.
From “distraction of resources” to “supply chain issues” it isn’t surprising that rates of various infections have increased. For HIV, TB, or malaria, the “public health response was compromised”.
“You know the nature of infectious diseases is when a problem is going in a bad direction, it has continued momentum to continue to go in the bad direction for a while, and so it’s not just that, simply restarting the earlier intensity of the control efforts is necessary. You need to think about augmenting that to really not only make progress, but get back on track”.
However, it’s not just COVID-19 that is to blame. TB was the leading cause of death to an infectious disease before COVID-19, yet there was “tremendous underinvestment” into public health control measures.
“Why that’s the case is to be honest with you, a mystery to me. I think it’s probably an issue where you know human nature is such that if you have a problem and it’s there for a long time, and it’s hard to deal with, you tend to try to ignore it and put it in the back of your mind.”
HIV vaccine trials
Another of Dr Feinberg’s sessions at the Congress will explore HIV progress from a vaccine perspective. We asked why, given progress in other areas of HIV management, vaccination is still a priority, and how much progress we can expect. Although we know of recent updates from Janssen there have been more positive updates in other areas that are neglected by the “headlines”. Despite the steps forward in pre-exposure prophylaxis and therapeutics, to end the problem we’re “going to need a vaccine”.
“The problem is that HIV is the most vexing pathogen that vaccinologists have ever really tried to take on”.
However, Dr Feinberg suggests that a lot of the “creativity” that the vaccine community now demonstrates is derived from the history of HIV vaccine research. We have “work to go” but the research is “viable” and Dr Feinberg remains “optimistic”.
Our penultimate question is concerned with the two big challenges every vaccine developer faces at the moment. Not only is the health threat something to contend with, but once that is achieved we have to convince the public that it’s safe to accept. With disinformation and vaccine hesitancy becoming worse over recent years, this is a growing issue for the community.
Dr Feinberg recognises that COVID-19 vaccines were “a remarkable scientific accomplishment” but also an “accomplishment of collaboration across the scientific community and between private sector and public sector partners”. However, these efforts have been tragically undermined.
“What’s really tragic is the level of disinformation and the consequences of that disinformation have been really profound”.
Although “not an expert” in how to solve the problem of misinformation, Dr Feinberg suggests that scientists need to “consider what role they can play in making sure the public has a better understanding” of the “tremendous efforts” that go into vaccine production.
Why the World Vaccine Congress?
Our final question, as always, invites our speakers to share their reasons for joining us at the Congress. For Dr Feinberg, although COVID-19 had “many terrible consequences”, it also presented the “traditional vaccine development ecosystem” with a “shake up”.
“I think lessons from COVID are going to really help us do more and better in vaccine development broadly. And I think it will be very interesting to hear people’s ideas about how we can make that happen.”
We are so grateful to Dr Feinberg for his time and insightful responses to our questions. If you’d like to hear more from Dr Feinberg do join us at the Congress in Washington this April. For a full transcript see below!