Schulich School of Medicine & Dentistry

At Western University, a bold idea is taking shape: what if lifesaving medical breakthroughs were designed from the very beginning to reach everyone who needs them? For Eric Arts, Canada Research Chair in HIV Pathogenesis and Viral Control, the question is not only ethical, but urgent. After decades of progress in HIV treatment and vaccine development, the internationally renowned virologist has seen both the extraordinary power of biomedical discovery and the painful delays in who benefits from it. “Where you live still determines whether you benefit from medical breakthroughs,” said Arts, a microbiology and immunology professor at Schulich School of Medicine & Dentistry. “In the world of HIV, that inequity is stark.” Over the past three decades, antiretroviral therapy (ART) has transformed HIV from a fatal diagnosis into a manageable chronic condition. Yet access to the most advanced therapies has not been equal. In sub-Saharan Africa, where the burden of HIV remains highest, people have waited years – sometimes decades – for the same innovations available in wealthier countries. Many treatment programs depend on unstable international aid and government funding, and the inherent fragility threatens millions of lives. Today, roughly 40 million people worldwide live with HIV. Most require daily medication for life. There is, technically, a cure. But it is not a solution for the world. IMMUNEQUITY is a new public-private international collaboration led by Arts, medical biophysics professors Maria Drangova and David Holdsworth, engineering professors James Lacefield and Arghya Paul, law professor Bassem Awad, UBC researcher Peter Zandstra and Ugandan partners at the Joint Clinical Research Centre (JCRC) and Makerere University in Kampala, led by Dr. Cissy Kityo Mutuluuza. The team also includes researchers from Université de Montreal, University of Manitoba, and Western’s Faculty of Health Sciences, Faculty of Science and the Ivey Business School. Its mission is to reimagine how HIV cures are developed so scientific innovation, affordability, manufacturability and equitable accessibility are treated as inseparable goals. Or more simply, they’re looking for an equitable answer to the world’s HIV pandemic. “The opportunity to help design a potentially curative HIV therapy in a way that makes manufacturability, cost and global accessibility all paramount from day one is extraordinarily compelling,” said Zandstra, Canada Research Chair in Stem Cell Engineering and professor and director, UBC School of Biomedical Engineering. “If we can solve the manufacturing and distribution challenges alongside the biology, the impact could extend well beyond Canada to millions of people worldwide.”  

Reverse order. Rethink design

Right now, the only proven cure for HIV has involved hematopoietic stem cell transplantation (HSCT), an intensive procedure that effectively replaces a patient’s immune system. HSCT is complex, risky and extraordinarily expensive, with a price tag of more than $350,000 per patient for chemotherapy, hospitalization and specialized supportive care. Scaling such a procedure globally would be financially staggering. Beyond cost, HSCT requires advanced infrastructure that is unavailable in most low- and middle-income countries where the burden is greatest. For Arts and his collaborators, that reality exposes a fundamental flaw in how biomedical innovation often unfolds: cures are developed first and only later do we ask whether they can reach the majority of the world. IMMUNEQUITY aims to reverse that order. At the scientific core of the initiative is a strategy known as ‘kick and kill.’ HIV persists because it hides in dormant immune cells, forming a latent reservoir that evades both treatment and the immune system. The ‘kick’ activates these hidden infected cells, exposing them. The ‘kill’ then deploys targeted therapies to eliminate them. Rather than relying on toxic chemotherapies, Arts, Zandstra, and his collaborators will focus on ‘biologics’ or precision immunotherapies, such as antibodies and virus-like particles designed to specifically target HIV-infected cells. “These are some of the most powerful tools in modern medicine and when we take pharmaceutical profit margins out of the equation for low-income countries, we can produce them at a fraction of the cost,” said Arts. Even more crucially, biologics manufacturing is far more feasible to establish in low- and middle-income countries than transplant-based cures or chemical-based drugs. That insight reshapes the entire development strategy. Working through Western’s Frugal Biomedical Innovations program, Drangova, Holdsworth, Lacefield, Paul and other researchers from Schulich Medicine & Dentistry, Engineering and Science will rethink the design and development of tools for manufacturing biotherapeutics and for diagnosis and monitoring of HIV, so the eventual cure will also be affordable and sustainable. The cost of each element is built into the earliest stages of research design. “New biotherapeutics will not succeed if they are developed in isolation from the realities of low-resource health systems,” said Drangova. “They must be designed in parallel with scalable manufacturing, reliable cold-chain and delivery infrastructure, frugal techniques for continuous monitoring of treatment effectiveness and regulatory-grade quality systems to ensure they are safe, affordable and deployable where they are needed most.”  

Community realities set foundation

In this model, cost and deployment matters just as much as biological efficacy. The context in each region or country matters, too. The team will work alongside people living with HIV in both Canada and Uganda to ensure legal, social, ethical and cultural contexts shape the project. Awad, founder and faculty director of the Western Intellectual Property and Innovation Legal Clinic, will design IMMUNEQUITY’s intellectual property (IP) strategy and data governance framework to ensure that no legal barriers impede the development of new treatments, tools and technologies. His work will accelerate deployment and support future operations, manufacturing and commercialization in sub-Saharan Africa and beyond. IMMUNEQUITY is also integrating community engagement from the outset, echoing a key pillar of the Frugal Biomedical Innovations program and its projects. “Community voices will shape everything we do, from planning real-world implementation to developing future clinical trials,” said Arts.  

Ugandan ingenuity

IMMUNEQUITY draws on Arts’ longstanding partnership with award-winning physician, epidemiologist and medical researcher Kityo Mutuluuza and her team at JCRC, where technologies will be co-developed and tested. This decades-long research partnership was formalized in 2022 when Schulich Medicine & Dentistry signed a memorandum of understanding (MoU) with JCRC for an interdisciplinary education, training and research collaboration. The partnership also includes Makerere University College of Health Sciences and Mbarara University of Sciences and Technology. Joshua Lutaakome Joloba, who is working on a HIV-virus-like particle (HLP) therapeutic for Uganda, is currently completing his PhD under Arts’s supervision through the JCRC-Schulich graduate student exchange program.  

Economically equitable

Canadian organizations including SHC Therapeutics Inc., Centre for Commercialization of Regenerative Medicine (CCRM) and Western’s under-construction Pathogen Research Centre will contribute expertise in biomanufacturing. The collaboration will lead to knowledge flowing between Canada and Africa, strengthening capacity in both settings and the economic implications could be transformative. “With more than 70 per cent of individuals living with HIV residing in low to middle-income countries, SHC Therapeutics is committed to accessibility in these regions,” said Andrew Farrow, SHC Therapeutics co-founder and chief commercial officer In low-income countries such as Uganda, HIV treatments and care using generic ART can cost approximately US$1,000 per person every year, representing a lifelong expense and a significant cumulative burden on health systems. In contrast, in high-income countries such as Canada and the United States, branded drug pricing, laboratory monitoring and clinical care raise the annual cost of ART to approximately US$30,000 or more per person per year. Because HIV treatment costs vary widely by region, a safe and effective one-time cure would provide economic benefits everywhere. Building capacity in biotherapeutics strengthens Canada’s biomedical sector, creates high-quality jobs and positions Canadian institutions as leaders in equitable innovation. “Scientific success alone is not enough,” said Arts.

“The best cure in the world is meaningless if it cannot be produced at a large scale and affordable cost in resource-limited settings, because otherwise people cannot safely access it. And they will not trust it.” – Eric Arts, Schulich Medicine & Dentistry professor

 

Community engagement is key

The alignment of scientific excellence and equity is central to IMMUNEQUITY’s vision. The goal is not simply to cure HIV. It is to pioneer a new model of biomedical innovation, one that closes the historical gap between discovery and access. If successful, the impact could extend far beyond an HIV cure. The same framework of co-development, frugal engineering, local manufacturing and embedded community partnership could be applied to other infectious diseases and even chronic conditions in in low- and middle-income countries. In the global fight against HIV, science has already made remarkable progress. The researchers behind IMMUNEQUITY want to ensure the next breakthrough, an accessible HIV cure, belongs not to the privileged few, but to everyone bringing about an end to the HIV epidemic. “IMMUNEQUITY represents a fundamental shift in scientific thinking. Equitable access is not a distribution problem to be solved after discovery. It is a driving principle from the very start,” said Arts.