Contributor: While Many Americans Refuse COVID-19 Vaccination, People Affected by HIV Have Been Waiting for 40 Years

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SAP Partners | <b>Rutgers School of Public Health</b>

The social, structural, and economic drivers of HIV are not so different from COVID-19. Still, those who have witnessed the ravages of HIV have been in a 40-year holding pattern when it comes to a vaccine, according to experts from the Rutgers School of Public Health.

Vaccines have a long and complicated history in the United States. Despite overwhelming evidence that vaccinations for diseases ranging from smallpox to polio to influenza have helped save lives, vaccine hesitation remains evident in some segments of the US population, particularly in relation to COVID-19 vaccines. Although vaccine hesitancy is rooted in legitimate concerns, vaccine rejection is predicated on false information and is deadly.

One group of individuals who overwhelmingly support COVID-19 vaccination are those who have experienced and witnessed the ravages of HIV. We are the ones who have long awaited a vaccine to curtail the HIV/AIDS epidemic and would welcome it with open arms. For us, this rejection of COVID-19 vaccination is anathema, as we have witnessed more than 700,000 Americans die due to AIDS complications since 19811 and nearly 750,000 deaths to COVID-19 in the United States in the last 2 years.

Lest we believe that the HIV epidemic is over, in 2019 approximately 40,000 individuals were infected and more than 15,000,2 mostly marginalized poor Black people, succumbed to the ravages of the disease.3

The social, structural, and economic drivers of HIV are not so different from COVID-19, placing those with fewer means, less access to health care resources, and less power at higher risk.4 We remind our medical doctor colleagues that viruses are certainly biological entities but the conditions they perpetuate are socially produced diseases. Thus, medications or vaccines alone are never enough if we are to curtail epidemics.

This year, we commemorate 40 years after the initial diagnoses of HIV in the United States, and despite calls for bringing an end to AIDS by 2025, there is still much work to be done toward eradicating this disease, in part due to delays created by the infiltration of SARS-CoV-2, the virus that caused COVID-19. Case in point: While we had developed such a plan for New Jersey in 2019, our efforts became immobilized until recently, as we collectively combatted this newest pandemic.

Efforts to control viruses, particularly variola major and variola minor, the pathogens that cause smallpox, can be traced back to the Ottoman Empire in the 1600s through a now-obsolete technique known as variolation. In this method, a small amount of aged material from a small blister of someone who has had smallpox for some time (aged disease) was introduced into a person yet to be infected. This procedure resulted in a small reaction, likely much more severe than any faced with any of the COVID-19 vaccines, but eventually conferred immunity. Such physical reactions to bolster one’s immunity is a small price to pay to protect one’s health and the health of their families and communities. Over the centuries, variolation has led to the development of vaccines for numerous pathogens, including cholera and typhoid.

Vaccine development evolved at a rapid pace in the 20th century, highlighted by success against the poliovirus. Since the 1940s, polio had been disabling some 35,000 American children a year, and like COVID-19, prior to the widespread use of vaccines, parents were fearful to let their children play or socially interact with others lest they be infected. Sound familiar? Thanks to the vaccines developed by Jonas Salk, MD, using an inactive virus technology, and Albert Sabin, MD, using an attenuated virus technology, there here have been no cases of polio since 1979 in the United States.5 Sadly, the rejection of the COVID-19 vaccines will likely prevent us from full eradication of this disease—at least over the next few years—amid the ongoing battle with variants like Delta and Omicron, which are elevated with their Greek letter names because of their power to spread disease and incubate in the bodies of the unvaccinated. In less affluent nations, the lack of vaccine causes these mutations; in America, it is deadly misinformation that fuels both vaccine rejection and disease.

Today, according to the Kaiser Family Foundation,6 less than one-third of parents indicate a willingness to vaccinate their children for COVID-19 while another third indicate they would never have their children vaccinated. In contrast, parents did not show the same resistance against vaccinating their children for polio. Consider the fact that there have been 8498 COVID cases per 100,000 children in the population (17% of all cases)7 and that long COVID has been detected in children, which may lead to multisystem inflammatory syndrome.8 Long COVID9 likely affects millions around the globe and is characterized by lingering symptoms that interrupt people’s lives, much like HIV does. As is the case with others who are living with diseases, such as HIV, multiple sclerosis, or any other chronic condition, COVID long-haulers see an uncertain future in terms of their health and the ability to access care for their conditions. Why would any parent subject a child to such a life?

World AIDS Day 2021 is being commemorated 4 decades after detection of the first AIDS cases in the United States. Forty years after the initial diagnoses of HIV in the United States and numerous failed trails, there is still no safe and effective vaccine to combat HIV. Although advances in the treatment of HIV and the use of antiretrovirals, both as treatment and prevention, have heralded a breakthrough in the management of the virus,10 the disease continues to spread, primarily through sexual behavior, and primarily in sexual minority Black men.3 To date, while we can prevent people from acquiring HIV via the use of antiretrovirals, it is through reliance on pharmaceutical medications, regular interaction with health care providers, and the costs associated with this care—compared with what could be a single- or multidose vaccination.

A vaccine against HIV would champion a new era whereby new infections could eventually be eradicated, much like we have accomplished with polio. The groundbreaking work that has led to the development of mRNA vaccines used to combat COVID-19 is currently being tested as means of vaccinating against HIV.11 Perhaps, there is a glimmer of hope.

But the success of HIV vaccination or any other vaccination program is dependent on the actions and behaviors of people who seek to protect their health and the health of others. This requires compassion, empathy, altruism, a trust in science, and belief in truth—characteristics some may lack and that lack of which could risk the health of others.

People living with HIV (PLWH) know what it like to try to live every day with a deadly virus. Much like the parents of children crippled by polio and those of us who have witnessed too many of our 20-something-year-old friends die of AIDS, PLWH know firsthand the deadly effects of viruses. Therefore, so many of us who have experienced the death of a loved one to HIV or COVID-19 scratch our heads at the rejection of the COVID-19 vaccine.

Our research center12 has been working with PLWH for over 2 decades and has continued to do so throughout the COVID-19 pandemic. Our efforts have shed light on the access and delivery to care that has been shaped by the COVID-19 pandemic and the resilience of PLWH. More recently, we have sought to understand how PLWH have experienced COVID-19 vaccination. Not surprising, we found that PLWH overwhelmingly gladly partook in the COVID-19 vaccination program.

In one study, we found that 64% of PLWH had already received 1 vaccine dose by May 2021, the very onset of the vaccination program, while 66% of those yet to be vaccinated indicated they would receive the vaccine. Of those who were in states in which they were eligible, 75% had received at least 1 dose. The majority of those not vaccinated at the time of the survey were in states where they were not eligible. Tellingly, about 86% of vaccinated individuals indicated they had done so to protect their own health, 76% acknowledged they were vaccinated to protect the health of others, and 69% did so to bring an end to the pandemic. These statistics highlight a segment of the population all too aware of the ravages that viruses can create personally, but also of their own responsibility in advancing the public’s health. This is what empathy looks like.

Recently, conservative talk show host Dennis Prager made some comments we found disrespectful, that claimed the “discrimination” faced by those who refuse to get the COVID-19 vaccine was akin to the actual discrimination faced by the early victims of the HIV epidemic in the 1980s and 1990s.13 Loosely, he said it would have been inconceivable for gay men and intravenous drug users to be treated like pariahs in the way that people who are not vaccinated with COVID-19 are. This misrepresentation of history not only contributes to the spread of misinformation around HIV/AIDS and COVID-19, but also likens a group of people making an active choice to not be vaccinated with a viable, safe, and effective vaccine for COVID-19 to those who did and still do not have a choice when it comes to protecting themselves against HIV/AIDS. This community—our community—would have willingly accepted an HIV vaccination in lieu of a life living with HIV and the ongoing stigma perpetuated against PLWH.

Had a vaccine for HIV been developed and rolled out as rapidly as that for COVID-19, hundreds of thousands of lives would have been saved. Many of us would have gladly signed on for that vaccine. Instead, 40 years later, we are eagerly waiting for this critical medical intervention to stop the spread of HIV and transform it from an endemic disease to an eradicated disease like polio.

For the 700,000-plus who have died of AIDS complications and the 1.2 million who are infected with HIV and who must live a life of constant treatment, such a vaccination is too late. It is them who we honor on this World AIDS Day in 2021.

References

1. The HIV/AIDS epidemic in the United States: the basics. Kaiser Family Foundation. June 7, 2021. Accessed November 8, 2021. https://www.kff.org/hivaids/fact-sheet/the-hivaids-epidemic-in-the-united-states-the-basics/

2. Basic statistics. CDC. Accessed November 9, 2021. https://www.cdc.gov/hiv/basics/statistics.html

3. HIV and African American people. CDC. Accessed November 8, 2021. https://www.cdc.gov/hiv/group/racialethnic/africanamericans/index.html

4. Halkitis PN. Managing the COVID-19 pandemic: biopsychosocial lessons gleaned from the AIDS epidemic. J Public Health Manag Pract. 2021;27(suppl 1):S39-S42. doi:10.1097/PHH.0000000000001267

5. Polio elimination in the United States. CDC. Accessed November 7, 2021. https://www.cdc.gov/polio/what-is-polio/polio-us.html

6. Hamel L, Kirzinger A, Lopes L, Kearney A, Sparks G, Brodie M. KFF COVID-19 vaccine monitor: January 2021. Kaiser Family Foundation.January 22, 2021. Accessed November 8, 2021. https://www.kff.org/coronavirus-covid-19/report/kff-covid-19-vaccine-monitor-january-2021/

7. Children and COVID-19: state-level data report. American Academy of Pediatrics. Accessed November 8, 2021. https://www.aap.org/en/pages/2019-novel-coronavirus-covid-19-infections/children-and-covid-19-state-level-data-report/

8. JoJack B. Long COVID in children: how long might it last? Medical News Today. September 21, 2021. https://www.medicalnewstoday.com/articles/long-covid-in-children-how-long-might-it-last

9. Taquet M, Dercon Q, Luciano S, Geddes JR, Husain M, Harrison PJ. Incidence, co-occurrence, and evolution of long-COVID features: a 6-month retrospective cohort study of 273,618 survivors of COVID-19. PLoS Med. Published online September 28, 2021. doi:10.1371/journal.pmed.1003773

10. Halkitis PN. Biomedical advances in the treatment of HIV and the evolution of U=U: New Jersey HIV Links. Spring 2018. https://fxbcenter.org/downloads/AIDSLINE/HIVLinks-Spring2018.pdf

11. A phase 1 study to evaluate the safety and immunogenicity of eOD-GT8 60mer mRNA vaccine (mRNA-1644) and Core-g28v2 60mer mRNA vaccine (mRNA-1644v2-Core). ClinicalTrials.gov. Updated September 30, 2021. Accessed November 8, 2021. https://clinicaltrials.gov/ct2/show/NCT05001373

12. Center for Health, Identity, Behavior & Prevention Studies. Rutgers School of Public Health. Accessed November 8, 2021. https://sph.rutgers.edu/centers/chibps/index.html

13. Guerrero D. Far right host Dennis Prager: unvaccinated are more ostracized than AIDS patients. The Advocate. November 9, 2021. Accessed November 9, 2021. https://www.advocate.com/news/2021/11/09/far-right-host-unvaccinated-are-more-ostracized-aids-patients