The NIH Just Canceled Funding for HIV Vaccine Research – Is That Wrong?

Dr Joe Marine is back with a persuasive argument that the reordering of scientific funding priorities are not that scary.

I was fortunate to go to medical school in the San Francisco Bay area from 1988-1994. I spent two of those years in a molecular immunology lab studying mechanisms of T-cell receptor expression.

When I started my 3^rd year clerkships in 1992, the HIV epidemic was devastating the gay men’s community in San Francisco. Other than Bactrim for PCP prophylaxis, there was little effective treatment. AZT was widely acknowledged to be a dud that was having no real impact on the disease course. I believe that every patient on our service during my 3^rd year medicine clerkship at Moffitt-Long was a young man suffering from complications of advanced HIV disease: cryptococcal meningitis, toxoplasmosis, Kaposi’s sarcoma of the lung, PCP pneumonia, premature dementia/encephalopathy. I will never forget these formative experiences caring for these unfortunate patients. They taught me a great deal about being a doctor and the tragic nature of disease.

I remember during this time that the medical scientific community placed a great deal of hope in development of a vaccine for HIV. Even then, it struck me as a dubious effort. There was little precedent for a vaccine against an infectious agent which did not trigger effective natural immunity. We still had little understanding of how HIV caused immunodeficiency. A few scientists even questioned whether HIV was the sole causative agent, even though the epidemiologic association was very strong.

Fast forward to 2025. We still have no effective vaccine for HIV despite extensive efforts and many billions of dollars of public and private funds spent. However, enormous progress has been made in treatment, particularly in the development of drugs that can achieve near-complete viral suppression and near-normal life expectancy, in addition to stopping transmission. Long-acting formulations may soon allow dosing as little as twice yearly. The advanced complications that I saw routinely as a medical student are today rare in the US. Most medical students today will never see them.

Yet, in FY2024, HIV research continued to be one of the largest line items in the NIH budget – nearly $3.3B, which is more than the NIH spends on all of cardiovascular disease research. In 2024, the CDC reported that over 700,000 Americans died from CV disease. In contrast, in 2023, fewer than 4,500 people died from HIV-related causes. It seems reasonable to question the disproportionate funding that HIV research continues to receive.

It is with this background that I read the news today that the NIH is cutting funding for HIV vaccine programs.

It is understandable that those who have invested their careers in HIV vaccine development do not want to see their funding reduced or eliminated. In a perfect world, there would be unlimited funds for every possible avenue of biomedical research. But in the real world, funding priorities have to be established based on scientific promise and public health need. We have heard for many years that victory in this effort is “just around the corner.” Yet, objectively, the 40+ year effort to develop an HIV vaccine has had little concrete success, despite many billions of USD spent. At what point should the effort be deemed futile? And if an effective vaccine is possible, why would pharma or private foundations like the BMGF not fund it? Public research funds may be better redirected toward other priorities. This is likely what RFK, Jr meant when he said that we are going to be giving infectious diseases “a break” for the next few years.

Does every infectious disease even need a vaccine? This seems to be dogma in the infectious disease world, but we should question it (along with every other medical dogma). In a post-covid world, how many people would even want a novel HIV vaccine? I doubt that the US public would accept a universal HIV vaccination campaign. The modes of transmission are well-understood and widely known. The fact that transmission in the US still occurs despite medications that completely suppress viral load indicates that some people are not being reached with treatment and prophylaxis. It is likely that many of those people will also be difficult to reach with an HIV vaccination effort. So even if by some miracle a highly effective HIV vaccine were discovered, it might not have much impact on the pandemic.

Looking at the larger picture, we are likely to see a significant reordering of medical and scientific funding priorities in the next few months.

Rather than holding their noses, complaining about a few careless citation errors, and ignoring the MAHA Report, medical and scientific professional organizations should be working to make their case to the public and HHS and NIH. The outcome of this reordering is going to have a substantial impact on the future of US biomedical research.

As a cardiologist who has seen my father and both uncles succumb to the effects of premature CV disease, I am biased, but I will be hoping to see a substantial increase in funding for research into CV disease mechanisms, prevention, and treatment. It is still the leading cause of death in the USA. **

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** It was during the covid pandemic too . . .