VACCINE FUNDING PROJECT INTERNAL DOCUMENT: SOUTH AFRICAN MARKET ANALYSIS
South Africa’s HIV epidemic is the worst case scenario. And it presents to most challenging environment for the development of a universal antiretroviral vaccine.
HIV in South Africa Contents
Current Data Global Perspective The nation has the dubious distinction of ranking first in most categories of HIV infection data. According to recent data, South Africa’s overall infection rate is estimated to be as high as 18% on average with many regions of the country reporting infection rates approaching 40%. If these infection rates were applied to Western Europe and North America, over 122 million North Americans and 332 million Europeans would be infected. National Impact Every sector of the country reels from the effects of this disease. It threatens to devour its economy, decimate its labor force and collapse its healthcare system – regarded as the best in SubSaharan Africa. Several states within the country are experiencing even higher rates of infection. The highest infection rates approach 1 in 4 citizens. The lowest infection rate is still an extraordinary number: 1 in 12. A simple statistic demonstrates how deeply the epidemic has affected the very fabric of South African society. The average life span of a South African has dropped from 61 years in 1985 to 50 years in 2010. An eleven year drop despite 25 years of medical advances. This decline now ranks a South African’s life span on par with Ugandans1. 1
SOURCE: Nation Master
Current Data Demographic Analysis Infrastructure Competitive Analysis
VACCINE FUNDING PROJECT INTERNAL DOCUMENT: SOUTH AFRICAN MARKET ANALYSIS
Figure 1: HIV Infection Rates by South African State, 20072
Total HIV infected
5,372,000
Adults (2064) Male youth (1524) Female youth (1524) Children (014) New infections (per annum) Uninfected births (over calendar year) HIV+ births (over calendar year) Infected through breastfeeding
4,880,000 181,000 831,000 294,000 527,000
2
SOURCE: AIDS Foundation South Africa
1,057,000 38,000 26,000
Of particular note, there is a pronounced disparity between male and female populations. This may be partially (if not wholly) due to societal and traditional practices of underreporting by firstline medical staff. As mentioned by AIDS Foundation South Africa, doctors often do not cite AIDS as a cause of death to avoid its prevalent stigma, thus “protecting” the family’s reputation.
VACCINE FUNDING PROJECT INTERNAL DOCUMENT: SOUTH AFRICAN MARKET ANALYSIS
Demographic Analysis A Desperate Need to Target New Treatments The total number of South Africans infected with HIV is staggering. A tightly focused effort, especially one using a universal vaccine could prove to be the most effective way to alter the dire future of the country’s HIV+ population. While a vaccine can not assist those already infected, statistics broken into age segments reveals a unique opportunity for the application of a universal vaccine. South African HIV Prevelance By Age and Gender 35.00
30.00
FEMALE MALE
25.00
20.00
15.00
10.00
5.00
0.00 2-14
15-19
20-24
25-30
30-34
35-39
40-44
45-49
50-54
55-59
Clearly, females within the 2034 year old demographic represent the majority of those at risk. This also is the demographic that directly impacts perinatal and antenatal infection rates.
60+
VACCINE FUNDING PROJECT INTERNAL DOCUMENT: SOUTH AFRICAN MARKET ANALYSIS
Vaccination of this particular age group has the potential to impact future infection rates for generations. The potential for a universal HIV vaccine multiplies this effect by a magnitude, since it preempts any mutation of the virus infecting those vaccinated today.
VACCINE FUNDING PROJECT INTERNAL DOCUMENT: SOUTH AFRICAN MARKET ANALYSIS
Current Prevention and Treatment is Failing South Africa's report to United Nations General Assembly Special Session on HIV and AIDS (UNGASS)3 for the period January 2006 to December 2007 states: The estimated number of people needing treatment (children and adults at WHO Stage 4) in South Africa: 764,000 by the middle of 2006 889,000 needing treatment in 2007 The estimated number of children (<15years) needing treatment was 52,000 in 2006 and 65,000 in 2007, of which 23,369 received treatment in 2006 and 32,060 in 20074. The Actuarial Society of South Africa’s comprehensive 2003 study (ASSA2003) is based on a rigid and disciplined analysis of all sectors of the infection. Its projections, based on this study are a keystone of HIV prevention planning. On the assumption that by June 2008, 495,000 people will be receiving antiretroviral treatment, the model estimates that 520,000 people in need of treatment will not be receiving it (numbers rounded to nearest 10,000)5. ASSA2003 estimates that the number of people in South Africa in 2007 with HIV is approximately 5.5 million. Evidenced by a survey by the South African Department of Health, HIV prevalence among pregnant women attending public clinics is nearly 30% (29.1%).
3
SOURCE: United Nations General Assembly Special Session on HIV and AIDS
4
SOURCE: Treatment Action Campaign (TAC) A complete data set and spreadsheet is available for individual analysis.
5
The infection rate of this demographic was 0.7% in 1990, a rate considered intolerable in many nations today.
VACCINE FUNDING PROJECT INTERNAL DOCUMENT: SOUTH AFRICAN MARKET ANALYSIS
The South African Government first embarked upon an Operational Plan6 to provide to people with HIV through the public health sector in November 2003 through the 3,6637 public clinics in the nation.
school budgets which are funded publicly, and therefore the data is not stable8.
The Operational Plan committed the government to providing ARV treatment to the 1,650,000 people believed to need it by March 2008. In 2008, the government pledged to implement a national strategic plan (NSP) that included the target of providing 80% of all people in need of antiretroviral (ARV) drugs with treatment by 2011. The most recent data available shows that South Africa’s healthcare infrastructure is comparable to well developed nations: • • • •
684 hospitals 143,519 hospital beds (4.8 per 1,000 people). Nurse to doctor ratio: 4.5 0.6 physicians per 1,000 people.
Of note: As of 1999 total health care expenditure was estimated at 7.2% of GDP. In 1994, the government sought to reverse the discrimination against blacks by building 780 community clinics by the year 2000. However, the money to fund these clinics comes from the medical
6
SOURCE: AIDS Foundation South Africa SOURCE: TAC
7
8
SOURCE: Nations Encyclopedia
VACCINE FUNDING PROJECT INTERNAL DOCUMENT: SOUTH AFRICAN MARKET ANALYSIS
Infrastructure
VACCINE FUNDING PROJECT INTERNAL DOCUMENT: SOUTH AFRICAN MARKET ANALYSIS
Currently, the only HIV vaccination program in South Africa is the South African AIDS Vaccination Initiative (SAAVI). In a July Statement, SAAVI reported: Development of these vaccines is the culmination of eight years of research and development which has involved scientists across South Africa and globally. The vaccine designs are based on HIV subtype C, the dominant strain circulating in southern Africa. They are the first HIV test vaccines developed in Africa to make it into human clinical trials. These tests do not pursue Cure Lab’s universal vaccine methodology. Of the nine current global strains of HIV, this trial focuses solely on the currently predominant strain which is surely to mutate as it is treated with new anti retrovirals. TWO OPPORTUNITIES EXIST By aligning ourselves with existing and native organizations mentioned in this report (such as TAC, AIDS Foundation South Africa, SAAVI) and the South African Department of Health, Cure Lab would have a welldocumented, disciplined and respected entrée to South Africa’s current political and social environment. Data already acquired would assist Cure Lab and garner a benefit otherwise unavailable. There are no current universal vaccination trials in this country. Although the international community has focused aid on the region, it has ignored the prospect of a
universal vaccine. By leveraging domestic need and international interest, Cure Lab could easily capture a substantial amount of support once clinical trials begin.
VACCINE FUNDING PROJECT INTERNAL DOCUMENT: SOUTH AFRICAN MARKET ANALYSIS
Competitive Analysis