The ledger
1984 → 2026 · TWO COLUMNSOne epidemic, two responses. The left column is the world's longest wait; the right column is what arrived instead. Read them together and the modern epidemic makes sense: the vaccine never came, and the prevention did.
| YEAR | VACCINE LINE | PREVENTION LINE |
|---|---|---|
| 1984 | Heckler promises a vaccine in two years PROMISE |
— |
| 1995 | — — UNAIDS: ~3.2M new infections 1995 (curve estimate) |
Global infections peak at ~3.2M/year PEAK |
| 1998 | VaxGen Phase III opens RUNNING |
— |
| 2003 | VaxGen fails FAILED |
— |
| 2007 | STEP halts FAILED |
— |
| 2009 | RV144: 31.2% 31.2% Rerks-Ngarm NEJM 2009 |
— |
| 2012 | Post-RV144 programs launch RUNNING FDA 2012-07-16 |
Oral PrEP approved (Truvada) DELIVERED |
| 2016 | HVTN 702 + AMP launch RUNNING |
— |
| 2020 | HVTN 702 futile; mRNA saves COVID instead FAILED NEJM 2021; FDA 2021-12 |
Cabotegravir beats oral PrEP (HPTN 083/084) DELIVERED |
| 2021 | Imbokodo fails FAILED FDA 2021-12 |
Long-acting PrEP approved (Apretude) DELIVERED |
| 2023 | Mosaico terminates FAILED |
— |
| 2024 | PrEPVacc ends — no efficacy trials left FAILED NEJM doi:10.1056/NEJMoa2407001; Science 2024-12 |
PURPOSE 1: 0 infections / 2,134 women; Science Breakthrough of the Year DELIVERED |
| 2025 | Germline targeting in Phase 1 (G002 signal) REBUILDING FDA 2025-06; G002 Science 2025 |
Yeztugo (lenacapavir) approved — 2 shots/year DELIVERED |
| 2026 | No efficacy trial running — field rebuilds REBUILDING UNAIDS 2024 report (verify per-use) |
Global new infections ~1.3M/yr and falling; UNAIDS 2030 target NOW |
Straight answers
FAQ- If prevention works so well, why keep chasing a vaccine?
- Scale. Prevention products require reaching hundreds of millions of people every year, forever, with clinics and supply chains. A one-course vaccine is the only tool that could end HIV everywhere at once — which is why the failures are recorded here rather than filed away.
- What's the state of the epidemic overall?
- New infections have fallen roughly 60% from the mid-1990s peak to about 1.3 million per year (UNAIDS 2024) — driven by treatment scale-up and PrEP, not vaccines. About 40 million people live with HIV today.
How to read this table. Each row is a year in which at least one
line moved. Vaccine-line statuses: FAILED (stopped for futility/harm), 31.2% (the one partial
signal), RUNNING, REBUILDING (current Phase 1 generation). Prevention-line: DELIVERED means
approved and in clinics. Sources inline; grades at evidence.