Latest news with #Linda-GailBekker
Mint
7 days ago
- Health
- Mint
When an HIV Scientific Breakthrough Isn't Enough
(Bloomberg Opinion) -- A landmark breakthrough in HIV prevention — a scientific feat decades in the making — received final approval from the Food and Drug Administration last month. Gilead Sciences' lenacapavir is so effective that global health leaders had started to cautiously talk about the end of an epidemic that continues to kill more than 600,000 people each year. We should be celebrating its arrival. Instead, aid groups and the countries most affected by HIV are reeling from the Trump administration's relentless attacks on the global health infrastructure. Instead of perfecting plans for a rollout of the medication, they are scrambling to ensure people with HIV have the drugs they need to survive. Last year, I wrote about the stunning — or as one HIV expert described it, 'spine-chilling'— results from a large study of lenacapavir. None of the women and adolescents who were given the twice-yearly injection in the trial became infected with HIV. In a second study involving men who have sex with men, and transgender individuals who have sex with men, the treatment was 96% effective. Even better, Gilead is working on a newer version that could potentially offer protection for a year or more. That's about as close to an HIV vaccine we're likely to get — at least for many years. It's also the world's best shot of achieving the goal of ending HIV by 2030. For low- and middle-income countries that continue to face frustratingly stubborn infection rates, a twice-yearly drug could be a game-changer. Although existing treatments of daily pills do an excellent job at preventing infection, getting people to use them consistently has been difficult. There is the stigma attached to the pills. Ensuring patients return for frequent testing and refills is also challenging — as is simply remembering to take them daily. Consider the typical day of a mom with a newborn and it's easy to understand how six months of protection could make a real difference in lowering HIV cases in women and infants. Some experts have even suggested lenacapavir is our best chance of wiping out new infections in children. That was before the Trump administration abruptly shut down USAID, the lead agency behind Pepfar. The global initiative to combat HIV/AIDS is credited with saving an estimated 26 million lives since its inception in 2003. Although the administration granted a limited waiver to allow some HIV services to continue, funding is significantly restrained. As health workers grapple with fewer resources, their focus has shifted to people living with HIV. 'When the chips are down, you safeguard treatment because those people will die if they don't get their antiretroviral,' says Linda-Gail Bekker, director of the Desmund Tutu HIV Centre at the University of Cape Town. And yet, she said, 'prevention we know is an absolute cornerstone to bringing this epidemic under control.' Because the situation is so dynamic, it's been difficult to capture what's happening on the ground. The best current model suggests the administration's actions could result in at least 70,000 additional new infections, and another 5,000 deaths in the next five years. UCLA infectious disease epidemiologist Dvora Joseph Davey says that in 2024, the eight public health clinics in Cape Town — where she is based — saw three infants who were HIV-positive at birth. In the first five months of this year, they've already seen three babies born with the infection. She knows there will be more. One pregnant woman with HIV recently came into the clinic and, at 37 weeks, her viral load was dauntingly high. She'd skipped picking up her last three-month supply of pills. The nurse she'd been seeing was let go as part of the funding cuts, and no one was available to do a blood draw at her last visit, Davey says. If the people who, in theory, should still be benefiting from global aid are falling through the cracks, what hope do we have for prevention? Prevention efforts have already been severely disrupted in some countries. Supply is responsible for some of the upheaval, but the more complicated problem is getting the drugs to the people who need them most. 'We need low-cost product and also a low-cost delivery mode,' says Carmen Pérez Casas, senior strategy lead at Unitaid, a global health initiative hosted by the World Health Organization. The situation for the latter 'has changed radically,' she says. HIV prevention is not as simple as just handing out a prescription. It's first identifying those most at risk of infection, getting them tested to confirm they are negative, and offering counseling about their options. It's ensuring they return for more testing and the next dose of their medication. That requires a vast support network ranging from doctors and nurses to counselors, pharmacists, lab technicians, data scientists and more. Pepfar supported all of that infrastructure. In South Africa, for example, cuts have resulted in lost jobs for some 8,000 health workers focused on HIV. Aid groups are doing their best to ensure the breakthrough's promise is not entirely lost. Their first hurdle is bridging the gap to the arrival of low-cost generic lenacapavir, which isn't expected until sometime in 2027. (Gilead is allowing a handful of drug companies to make and sell generic forms of lenacapavir in the countries most heavily impacted by HIV.) Global health agencies are anxiously awaiting the company's price tag for those countries to understand how far their funding can be stretched. Then they need to get the drug to patients. Experts tell me they've scaled back their expectations given the upheaval with Pepfar. The Trump administration's termination of National Institutes of Health grants to foreign countries has created additional hurdles. It's been particularly devastating in South Africa, where the NIH supported a significant chunk of research related to HIV. That means less money to conduct so-called implementation studies for lenacapavir, which are crucial for understanding how to improve the drug's use in the real world. One simple thing the Trump administration could do is free up funding for prevention. Pepfar continues to operate under a waiver that only allows PrEP money to be spent for those who are pregnant or breastfeeding. Groundbreaking science alone won't end HIV. It must be paired with affordability and access. The Trump administration's callous cuts to global health efforts put all of those things at risk — including the promising future where HIV is brought to heel. More From Bloomberg Opinion: This column reflects the personal views of the author and does not necessarily reflect the opinion of the editorial board or Bloomberg LP and its owners. Lisa Jarvis is a Bloomberg Opinion columnist covering biotech, health care and the pharmaceutical industry. Previously, she was executive editor of Chemical & Engineering News. More stories like this are available on
Daily Maverick
15-05-2025
- Health
- Daily Maverick
New strategies required to protect mothers and infants who are still getting HIV
Over the past two decades, South Africa made massive progress in reducing transmission of HIV from mothers to their babies. Even so, about 7,000 babies still contract the virus every year. Experts put this down to having the right puzzle pieces for prevention but failing to integrate them optimally. About 7,000 infants in South Africa still contract HIV from their mothers every year — a stark reminder that, while significant progress has been made in preventing mother-to-child transmission (MTCT), that progress has somewhat plateaued. Twenty years ago, there were 10 times as many — about 70,000 — new infections per year in babies. Today, the MTCT rate has dropped from a peak of over 30% at the turn of the century to about 2.7%. The story is mainly one of antiretroviral medicines helping suppress the virus in the bodies of mothers living with HIV, thus protecting tens of thousands of babies over the years. But the story is also one of progress that has slowed in recent years — while South Africa's MTCT rate lingers well above 2%, it is at or below 1% in several developed countries. About a decade ago, South Africa was making great progress towards reducing new HIV infections among children and keeping their mothers alive, but that has been followed by some complacency, says Professor Linda-Gail Bekker, CEO of the Desmond Tutu Health Foundation and Director of the Desmond Tutu HIV Centre. As pointed out by Professor Adrian Puren, Executive Director of the National Institute for Communicable Diseases and the the head of its Centre for HIV and Sexually Transmitted Infections, 'although the vertical transmission (another term for MTCT) rate is low, because of the high burden of maternal HIV, the absolute number of vertical transmissions remains high'. As pointed out by Dr Glenda Gray, a Distinguished Professor at the University of the Witwatersrand: 'We have very high rates of HIV in pregnant women in South Africa. About a third of all women in our country who are pregnant are HIV infected, and it's even higher in some parts of KwaZulu-Natal and particularly in young women.' An evolving problem The progress of the past two decades is largely due to increased access to antiretroviral therapy and how well the medicines suppress the virus in a person's body. If a mother living with HIV is stable on treatment, the chances are very close to zero that the virus will be transmitted to her baby. In the public sector, pregnant women are routinely tested for HIV and offered antiretroviral therapy if positive. A complication, however, emerges when a woman contracts HIV late in pregnancy or in the months after birth and the virus is then transmitted to her baby via breastfeeding before she is diagnosed and can start the treatment that will suppress the virus. The latest estimates from Thembisa, the leading mathematical model of HIV in South Africa, suggest that this dynamic is indeed driving much of the MTCT in the country. Of the approximately 7,200 babies who contracted HIV in South Africa from mid-2023 to mid-2024, only 2,500 became positive before or at birth. The rest of the transmissions occurred during breastfeeding in the months after birth. While a portion of these mothers were on antiretroviral therapy, the majority had not been diagnosed with HIV yet. HIV-exposed infants are at particularly high risk if the mother was recently infected. As Bekker explains, this is because a person who has just acquired HIV has a very high amount of the virus in their body, since their immune system hasn't had time to fight it yet, making it easier to pass the virus on. 'So, you get very high viral loads, and this is therefore a very dangerous time for vertical transmission,' she says. Dvora Joseph Davey, an associate professor of epidemiology at the University of California, Los Angeles, and the University of Cape Town, concurs. 'We know that in South Africa, over a third of HIV in infants is due to getting HIV from their mothers who were HIV-negative at their first antenatal visit, and they acquired HIV at some point during pregnancy or lactation,' she says. She explains that MTCT is in part due to inequity in healthcare. Mother-to-child transmissions often occur in certain pockets, such as in rural areas, because of limited access to prevention methods, late diagnosis, not starting treatment on time, and coming into antenatal care late. 'This points to missed opportunities in sustaining maternal antiretroviral therapy adherence and viral suppression throughout the breastfeeding window — an area where we urgently need more targeted and consistent support,' says Olwethu Mlanzeli, who leads Communications and Advocacy for the youth HIV-focused initiative Africa Reach. What to do? South Africa's 2023 guidelines for preventing vertical transmission (of several infectious diseases) does cover several of the issues experts raised in interviews with Spotlight. Among others, the guidelines recommend that pregnant women or new mothers who are newly diagnosed with HIV should be started on a dolutegravir-based antiretroviral regimen, since dolutegravir is particularly effective at rapidly suppressing the virus. The guidelines prescribe testing babies for HIV at birth, 10 weeks, and at six and 18 months. But in South Africa, good guidelines are not always followed by universal implementation. In line with this, several experts firstly suggest simply strengthening existing HIV treatment and prevention services, particularly those aimed at women before, during and in the months after pregnancy. It is suggested that women should continually be offered HIV testing during all stages of pregnancy and after birth. Joseph Davey says this needs to be integrated better, so that the same nurse offers contraceptives, HIV testing and HIV prevention medicines, proactively. Her research has shown that, at least on a small scale, training clinics to integrate the services can work well. Puren notes that the integration of MTCT care could also be done by joining HIV testing with infant immunisation programmes. 'There doesn't need to be a major overhaul,' adds Joseph Davey. 'These are simple steps related to data collection and targets around HIV testing that can be implemented within existing standards of care.' Experts also suggest that it is crucial to put women and babies on HIV treatment and HIV-prevention treatment as widely as possible during the postnatal phase. Joseph Davey cautions that these interventions are not the same across the country. The Western Cape, for instance, has explicit guidelines around HIV prevention medicines and pregnancy that have been updated every few years, while this does not seem to be the case for other provinces. Joseph Davey says that expanding this could be helpful. But even with good guidelines, there are barriers to adherence. Bekker notes that a daily HIV prevention regimen may be difficult to take for a pregnant woman experiencing morning sickness, or while she is a new parent. 'So here comes the perfect opportunity for long-acting injectable pre-exposure prophylaxis, such as cabotegravir or hopefully, in the future, lenacapavir,' she says. Not widely available Cabotegravir injections provide two months of protection against HIV infection per shot and lenacapavir six months per shot. Neither is yet widely available in South Africa. Cabotegravir is registered here, and lenacapavir's registration is expected in the next six months or so. There are other potential advances, according to Gray, that could make a significant difference. 'Antiretrovirals can mop up and control a lot, but to eradicate breast milk transmission we need other monoclonal antibodies or an HIV vaccine. And so, if we really are committed to eradicating paediatric HIV, then we need more tools besides antiretroviral therapies in the toolbox.' For now, these alternatives to antiretrovirals remain experimental and none have been proven to work or been approved for use by regulatory authorities. Lastly, Mlanzeli notes that patient awareness is a key part of the challenge, especially during the postnatal period. 'There's a need for greater investment and visibility around prevention of MTCT programmes, particularly in the postnatal period,' she says. 'While many governments allocate substantial resources to HIV programmes overall, these resources don't always translate into strengthened support for mothers and infants.' Brodie Daniels, Specialist Scientist at the HIV and other Infectious Diseases Research Unit at the South African Medical Research Council, agrees. 'What we need to focus on now is educating women on the increased risks during pregnancy and breastfeeding if they are HIV-uninfected during their antenatal visits,' she says. 'Women need to be encouraged to test more often during these periods, so that if they do seroconvert, both they and their infant can be placed on prophylaxis.' Impact of aid cuts In recent months, large and abrupt cuts to HIV funding from the United States government have severely disrupted HIV services in South Africa and neighbouring countries. While some limited funds are still flowing, it is a small fraction of what there was previously and there is little hope that funding will be restored. Several researchers Spotlight spoke to are very worried that the cuts will negatively impact MTCT rates. The cutting of some services, specifically those aimed at marginal groups, will probably lead to many not being able to access HIV counselling, prevention and testing services in a timely manner. Thus, the number of women contracting HIV while pregnant or breastfeeding and not being virally controlled may increase. But the silver lining is that change is within reach, if the resources are available and implementation is done right. As Bekker puts it: 'We know exactly what we need to do, and it's not like we don't have the tools. We need to just do it!' DM
Mail & Guardian
30-04-2025
- Health
- Mail & Guardian
The US's NIH funds R6.65 billion of research in South Africa
If all of its National Institutes of Health funding falls away, the country could lose 70% of its medical research capacity R6.65 billion — or $350 million. That's how much South Africa receives in annual funding from the US government's National Institutes of Health (NIH) when the totals of direct grants, subgrants and funding from network studies are added up, numbers from the South African Medical Research Council and Bhekisisa 's calculations show. For direct grants, SA researchers are the main grant holders for a project and are responsible for its budget. In the case of subgrants, SA projects get research money from projects where the principal investigator is elsewhere (probably at a US institution) and network studies mean SA researchers who are part of a unit that runs clinical trials get awarded money for a study through that network. The bulk of the NIH's budget However, many of the projects with US scientists as the primary grant holders have extensive collaboration with researchers elsewhere. This means that a large part of the NIH funding awarded to US institutions is paid as subgrants to colleagues in other parts of the world — including South Africa — to set up studies for data collection and analysis, which bolsters research efforts in those countries. If South Africa loses all of its NIH funding, the country could — conservatively — lose 70% of its medical research capacity, our sums reveal. An Losing 70% of our research capacity would be a massive blow for South Africa — yet it would make less than a 1% difference to the NIH budget in the US (assuming that it would be similar to that over the past couple of years). Close to three-quarters of the grants South African principal researchers were awarded by the NIH in 2023/24 were for projects linked to HIV or tuberculosis (TB). Moreover, Adding the potential losses to research grants could have grave consequences for South African scientists produced the Getting a total of how much money for biomedical science comes to South Africa through NIH funding is not easy, though. But we trawled through the numbers to put an estimate together, based on what we think are reasonable assumptions and given what experts have shared with us. Here's our thinking. Number games The Over the past eight years, the total amount paid to such research leads based in South Africa was, on average, around $45 million (about R850 million) a year. 'Getting to that point is hard work,' says Linda-Gail Bekker, head of the 'A grant is never just 'given' — each application is reviewed by a panel of experts and only if they find the proposed project has merit and so will be worth investing in, will they award the money.' Grant holders also have to pass a clean audit every year, done to US rules, to prove that they're spending the funds responsibly, she adds. As explained in our intro, scientists can also be funded through being subgrantees on projects where the principal investigator is (probably) at a US institution (and went through the same strict application process) or by being part of a network study. Bekker explains that getting funding through a network study means a researcher who is part of a unit that runs clinical trials gets awarded money for a study. Ntobeko Ntusi, CEO of the Bhekisisa that 'before January 20, there was a second portal of the NIH that hit that level of granular detail [amounts linked to subgrants], which has [since] been disabled'. However, Ntusi explains that roughly $100 million of NIH funding (about R1.9 billion, at the current exchange rate) is awarded to South African researchers through subgrants every year and about $50 million (about R950 million) through direct awards to principal investigators. A further $200 million (R3.8 billion) or so sits in funding from network studies, which brings the total to around $350 million (R6.65 billion). A case of David and Goliath For our analysis, and to be able to make qualified comparisons, we focused only on amounts local researchers may have had through direct grants and being subgrantees, specifically in the 2023-24 financial year. We know that the amount of funding made available through subgrants is about double that from direct awards. If we take the roughly $47 million (R870 million) from direct awards plus an estimated amount twice that for the funding flowing to researchers through subgrants, those two avenues of NIH support give just over R2.6 billion. From these numbers alone, we estimate that if NIH funding to South African scientists were stopped, the country could lose — conservatively — 70% of its medical research capacity. This would be a massive blow for South Africa — yet it would make less than a 1% difference to the NIH budget in the US (assuming that it would be similar to that over the past couple of years). To get to this slice, we worked on about $46 billion (R851 billion) being available as the NIH's research budget. (According to the agency's website, Together, this makes up 0.7% of the total NIH research budget, meaning about $45.7 billion would have been available to scientists in the US. Converting these amounts to rand, at an exchange rate of R18.50 to the dollar, shows that a total of about R2.6 billion in NIH funding would have been available to South African research groups, combined from direct grants and subawards. The SAMRC's revenue from grants, including both foreign and local funders, together with the amount it gets from the government, was Bhekisisa show that this was how much they received through NIH funding in 2024, and we therefore assumed it could have been a similar figure the previous year. That brought us to a total of around R3.71 billion being available for medical research in South Africa in 2023-24, of which about 70% was from NIH backing, either to local research leads directly or through subgrants. A blow to South Africa is a blow to the world Close to three-quarters of the money South African principal researchers were awarded by the NIH in 2023/24 was for projects linked to HIV or TB. That works out to just over $34.3 million — about R635 million. Almost a fifth of that was directed to clinical trials. Last week, Adding the potential losses to research grants could have grave consequences for Take, for example, the studies on the six-monthly anti-HIV prevention drug If South Africa were to roll out the medication soon, it could stop enough new infections that Aids would practically end being a public health threat in the country by 2032, But progress like this doesn't happen overnight; it follows from years and years of prework. Although the 'An opportunity to reimagine research' 'Great science is done in collaboration with the US and, if that stops, it will create a huge [research] gap,' says Bekker. Indeed, South African scientists produced the Ntusi agrees, saying that the US investment over decades, which has helped to build high-calibre research capacity in South Africa, should not be forgotten. 'Seminal contributions from our scientists have been good, not only for the country, but also for the world. At the same time, we should continue to express solidarity with our peers in the US, who are similarly affected as we are. Many of them are losing their jobs, have had their grants terminated and are feeling overwhelmed.' Yet the US 'will remain a really important player in global health', Ntusi says, and despite the current upheaval, there's 'an opportunity [for scientists] to reimagine their research operations'. This story was produced by the . Sign up for the .
Yahoo
27-02-2025
- Health
- Yahoo
Trump Ends Thousands of USAID-Funded Programs in South Africa
(Bloomberg) -- The US has permanently stopped funding thousands of health-care programs in South Africa, with notifications sent to affected organizations. The Trump Administration Takes Aim at Transportation Research Shelters Await Billions in Federal Money for Homelessness Providers NYC's Congestion Pricing Pulls In $48.6 Million in First Month New York's Congestion Pricing Plan Faces Another Legal Showdown NYC to Shut Migrant Center in Former Hotel as Crisis Eases The move comes almost a month after Trump halted most aid to South Africa after accusing the government of confiscating privately owned land. The nation's authorities haven't appropriated any personal land since apartheid ended in 1994. 'The termination orders are coming through in droves,' Desmond Tutu Health Foundation Chief Executive Officer Linda-Gail Bekker said in an interview. The United States Agency for International Development letters, earlier published by local news service Bhekisisa, were also sent to groups funded by the President's Emergency Plan for AIDS Relief, or PEPFAR. While PEPFAR funding accounts for about 17% of South Africa's HIV/AIDS budget, 'the entire program is at risk, because so many critical projects, such as monitoring and testing, will be weakened,' Bekker and others said in a statement. A US-funded HIV vaccine trial, where South African Medical Research Council had teamed up with scientists from eight countries on the continent, has been halted because of the terminated financing. The US earlier this month issued a waiver to allow some PEPFAR activities to resume in South Africa, focusing on 'life-saving' tasks such as HIV care, testing, counseling, and medicine procurement. The waiver also covers salaries for critical health workers and staff, and was set for 90 days. Even so, the chaos from how the stop-work orders were implemented resulted in many clinics remaining closed. 'Crucial support staff will be lost as well, putting further pressure on the country's already stressed public health service,' the group known as Change said. 'The South African government has an obligation and duty to act with urgency to respond to both these drastic cuts, and the attack on South Africa's HIV and TB programming.' --With assistance from Ashleigh Furlong and Ana Monteiro. Trump's SALT Tax Promise Hinges on an Obscure Loophole Warner Bros. Movie Heads Are Burning Cash, and Their Boss Is Losing Patience Walmart Wants to Be Something for Everyone in a Divided America China Learned to Embrace What the US Forgot: The Virtues of Creative Destruction Meet Seven of America's Top Personal Finance Influencers ©2025 Bloomberg L.P.
Bloomberg
31-01-2025
- Health
- Bloomberg
Bekker: PEPFAR Was Put In Place to Save Lives in Africa
Humanitarian groups are warning that the Trump administration's halt on foreign aid risks both lives and American influence in Africa. The order is likely to affect HIV programs, malaria prevention, maternal-health support and clean-water access across the continent. Linda-Gail Bekker, Desmond Tutu Health Foundation's CEO spoke to Bloomberg's Chief Africa correspondent Jennifer Zabasajja on Horizons Middle East and Africa on the potential changes to the President's Emergency Plan for Aids Relief or PEPFAR - implemented under George W. Bush's administration. (Source: Bloomberg)
