In a monumental stride for global health, South African scientists have launched a pioneering first-in-human trial for an HIV vaccine, marking a significant breakthrough in the decades-long battle against the virus. This groundbreaking study, known as BRILLIANT 011, commenced in late January 2026 at the Desmond Tutu HIV Foundation (DTHF) site at Groote Schuur Hospital in Cape Town, with the enrolment of its first participant. It represents a beacon of hope, particularly for a continent disproportionately affected by HIV.
This pivotal moment, however, comes against a backdrop of severe challenges, including abrupt funding cuts from international partners. Yet, the resilience and determination of African researchers have ensured that this vital work continues, pushing the boundaries of medical science to protect future generations from HIV.
A New Dawn in HIV Prevention: The BRILLIANT 011 Trial
The BRILLIANT 011 trial is not merely another study; it is a testament to African leadership in medical research. Led by the South African Medical Research Council (SAMRC) in partnership with the DTHF and the Wits Health Consortium, this initiative is part of the broader BRILLIANT Consortium. Launched in 2024, the consortium brings together leading scientists from eight African nations, including Nigeria, Uganda, Kenya, Tanzania, Zimbabwe, Zambia, and Mozambique. A notable aspect of this collaborative effort is its leadership, predominantly comprised of African women scientists, who are at the forefront of developing solutions tailored to the specific HIV strains prevalent in Southern Africa.
The vaccine being tested in the BRILLIANT 011 trial is designed to stimulate the production of broadly neutralising antibodies (bNAbs). These are considered the ‘holy grail’ of HIV research due to their ability to recognise and neutralise a wide array of HIV strains, offering comprehensive protection against the virus. The success of such a vaccine could fundamentally alter the trajectory of the HIV epidemic, moving beyond treatment to effective prevention.
Protecting the Most Vulnerable: A Vaccine for Infants
Complementing the BRILLIANT 011 trial, another critical study is underway in Johannesburg, focusing on the most vulnerable population: newborns. Led by experts at the University of the Witwatersrand (Wits) and its Perinatal HIV Research Unit (PHRU), this phase I study aims to provide long-term protection against HIV to infants born to mothers living with the virus. South Africa, with over 7 million people living with HIV, faces one of the highest burdens globally, and despite significant advancements in preventing mother-to-child transmission, approximately 3 per cent of infants born to HIV-positive mothers still contract the virus.
This infant-focused trial involves an adjuvanted HIV vaccine known as CH505TF gp120, combined with an adjuvant called GLA-SE to enhance the immune response. Twenty-eight healthy newborns, all HIV-exposed but uninfected, were enrolled in the study. They receive three doses of the vaccine at 8, 16, and 24 weeks after birth. The primary objective of this phase I trial is to assess the vaccine’s safety and its ability to elicit an early immune response, specifically the production of broadly neutralising antibodies.
Early findings from this infant study have been highly encouraging, indicating that the vaccine is safe, with only mild, transient side effects such as soreness at the injection site. For parents, this research offers the profound hope of a ‘functional cure’—a state where children could potentially control the virus without the need for lifelong antiretroviral medication. The strategic focus on newborns leverages their unique immune systems, which may be more receptive to developing robust and lasting defences against HIV. This approach draws inspiration from past successes, where early antiretroviral therapy in infants has led to prolonged periods of viral suppression without treatment, as seen in cases where children remained virus-free for over eight years.
The Shadow of Funding Cuts: A Test of Resilience
The path to these scientific achievements has been far from smooth. In late January 2025, the global HIV research community, particularly in Africa, faced an unprecedented crisis. An executive order from the United States government abruptly paused millions of dollars in funding through USAID and PEPFAR, pending a three-month review. This sudden withdrawal of support threatened to dismantle years of progress and critical research programmes.
Patrick Arbuthnot, director of the Antiviral Gene Therapy Research Unit at Wits, vividly recalls the moment he received a curt notification: “Stop Work.” His lab, which had invested two years and thousands of dollars in American funding into sequencing the genomes of “elite controllers”—individuals like CAP 255 and CAP 256 who naturally suppress HIV—was suddenly forced to halt its crucial work.
“It’s all such a waste, it’s all such a waste,” Arbuthnot lamented, reflecting on the message that threatened to render his efforts futile. “Those were the words that kept running in my head when I saw the message. It seemed like it was all just for nothing.”
The impact of these funding cuts extended far beyond individual research projects. Across sub-Saharan Africa, where the United States had been a primary funder of HIV programmes, the consequences were immediate and severe. In countries like Zimbabwe, which relied on USAID for approximately 80 per cent of its HIV response, even essential supplies such as condoms were disrupted. In South Africa, clinics serving vulnerable populations, including sex workers and men who have sex with men, were forced to close. A sign at the Wits RHI Key Populations Programme in Johannesburg, for instance, informed patients that services were suspended indefinitely.
Esther Casas, an HIV-TB adviser at Doctors Without Borders (MSF), highlighted the catastrophic nature of the cuts. “It’s not just the fact that the funding was cut that was the problem,” she stated. “It was the sudden way it was done. To do something like that, you have to prepare the people. But that did not happen, and that was catastrophic.” Experts warned that if these cuts were to become permanent, they could lead to an estimated 600,000 HIV-related deaths and 500,000 new infections in South Africa alone over the next decade.
The Resurrection of BRILLIANT: A Triumph of African Ingenuity
Despite the formidable obstacles posed by the funding freeze, the BRILLIANT Consortium demonstrated remarkable scientific resilience. The $45.6 million grant from USAID, which was initially intended to support the consortium, was abruptly withdrawn. However, through swift leadership action and the mobilisation of new investment, the programme was not only saved but also adapted. The South African Medical Research Council (SAMRC) and the Bill & Melinda Gates Foundation stepped in, providing crucial funding that allowed the BRILLIANT 011 trial to proceed, albeit with an initial focus on South Africa.
This ability to adapt and secure alternative funding underscores a growing trend of African-led solutions to health crises on the continent. The BRILLIANT Consortium, with its diverse representation of African scientists, embodies this spirit of self-reliance and innovation. Their determination to continue the search for an HIV vaccine, even in the face of significant external pressures, is a powerful statement about the commitment to public health in the region.
Beyond the Vaccine: The Promise of Lenacapavir and Elite Controllers
While the BRILLIANT 011 trial and the infant vaccine study represent significant steps forward, the broader landscape of HIV prevention and treatment continues to evolve. One of the most promising recent developments was the drug lenacapavir. This injectable pre-exposure prophylaxis (PrEP) demonstrated 100 per cent effectiveness in preventing new HIV infections among young women in trials conducted in South Africa and Uganda. Requiring only two shots per year, lenacapavir offered a far more convenient and effective alternative to daily oral PrEP regimens.
However, the very funding cuts that threatened the vaccine trials also jeopardised the widespread availability of lenacapavir. USAID had been poised to facilitate the drug’s transition to generic manufacturers, which would have made it accessible and affordable in high-burden regions. Nomathemba Chandiwana, chief scientific officer at the Desmond Tutu Health Foundation, expressed the gravity of this loss: “Now, that pipeline is completely gone.” This highlights the interconnectedness of research, funding, and access in the fight against HIV.
Meanwhile, the ongoing research into “elite controllers” offers another avenue for potential breakthroughs. These rare individuals, such as CAP 255 and CAP 256, possess a unique genetic makeup that allows their bodies to naturally control HIV without the need for antiretroviral drugs. Patrick Arbuthnot’s work involves sequencing their genomes to understand the mechanisms behind this natural immunity. The hope is that by deciphering these biological secrets, scientists can develop vaccines or therapies that mimic this natural resistance.
This research is particularly crucial for Africa, as African genomes currently constitute only 2 per cent of the world’s sequenced genetic data. A deeper understanding of African genetic diversity is essential for developing effective, tailored interventions for the continent’s diverse populations.
The Human Cost and the Enduring Hope
The narrative of HIV in Africa is not just one of scientific endeavour; it is deeply personal, affecting millions of families. The funding cuts, while seemingly bureaucratic, have tangible human consequences. They disrupt access to life-saving medication, jeopardise the livelihoods of healthcare workers, and undermine the trust built over years between communities and health programmes.
Yet, amidst these challenges, the spirit of hope and determination prevails. The launch of the BRILLIANT 011 trial, the continued research into infant vaccines, and the relentless pursuit of knowledge by scientists like Patrick Arbuthnot underscore a collective resolve to overcome the epidemic. As Arbuthnot eloquently put it, using a culinary metaphor to describe the progress of his research before the funding freeze: “We had the pasta in the boiling water, and we were just waiting for it to [cook]… There was still work to do to get the pasta ready. You still had to mix it with your sauce, so it wasn’t quite ready to eat yet, but we already had the pasta in the water. We were getting there.”
This imagery captures the essence of the current situation: significant progress has been made, but the final steps require sustained effort and resources. The resilience of the South African scientific community, in particular, serves as an inspiration. By securing local and private funding to replace lost international aid, they have demonstrated that the pursuit of an HIV-free future will not be deterred by external pressures.
Ultimately, the goal remains the same: to create an HIV-free generation. This is a fight for dignity, health, and the promise of a fair start for every child, regardless of their circumstances. The work being done in South Africa, from the cutting-edge vaccine trials to the fundamental research into elite controllers, is not just about medical science; it is about building a healthier, more equitable future for all.
As South Africa continues to lead this charge, it sends a powerful message to the world: the pursuit of a cure, though challenging, is an unwavering commitment. The ingredients for success are there, and the dedicated hands of African scientists are working tirelessly to bring this vital meal to fruition.
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