Science progresses when people share what they learn, not when they retreat behind borders or institutions.

That was true when my colleagues and I first discovered a protein, known today as interleukin-2, which enabled growth of human T cells in the laboratory, leading to our breakthrough discovery of the first human retrovirus, HTLV-1, a cause of adult T cell leukemia; and subsequently our co-discovery of another retrovirus, HIV, and development of the blood test to detect it. Researchers around the world then worked together at remarkable speed to implement blood screening and innovate the historical first development of successful antiviral therapy for any systemic viral disease.

Today, we confront emerging threats from a range of respiratory viruses, insect-transmitted viruses, and viruses we have not yet identified. Reflecting on lessons from the HIV/AIDS crisis — including progress and the challenges that defined it — can support future pandemic preparedness.

Extraordinary scientific progress has transformed HIV from a near-certain death sentence into a chronic, treatable condition, yet the epidemic is far from over. Approximately 40 million people around the world are living with HIV today, and around 630,000 people died of AIDS-related illnesses last year. In that same period, an estimated 1.3 million people acquired new HIV infections worldwide. These numbers demonstrate both the power and the limits of treatment.

They also reveal a profound economic reality: in the U.S. alone, the annual direct medical cost for a person living with HIV now averages an estimated $30,000 to $50,000, mainly driven by the price of antiretroviral therapy and the management of chronic comorbidities. Over a lifetime, this can exceed $400,000 in discounted costs. These are preventable economic burdens, and they grow each year the epidemic persists.

One of the most overlooked realities is that HIV disease continues to progress in many individuals despite effective therapy suppressing the virus to undetectable levels. Even when viral replication is controlled, people living with HIV face elevated risks of cardiovascular disease, cancers, neurocognitive decline, chronic inflammation, and premature mortality. These complications remind us that while we have controlled the virus, we are far from fully controlling the conditions it causes.

And yet, at a time when deeper research is urgently needed, federal support for HIV science has been contracting. A substantial number of HIV-specific grants have been discontinued, and several government-funded program areas have seen reductions in dedicated staff, making critical research increasingly difficult to pursue.

I was reminded of the human cost of this trend at a recent meeting, when two men approached me after my talk. One of them, living with HIV, told me he was 58 and had already survived a heart attack. He described what he sees throughout his community: even with complete viral suppression, many people aging with HIV have comorbidities such as higher rates of cancer, heart disease, cognitive decline, and other chronic conditions.

He said he feared what might come next. He asked me, almost pleading, to keep pushing the science to understand why this is happening. His words were a powerful reminder of the stakes and that the questions we face are not abstract. They affect millions of people who are living longer but not necessarily living well, and they deserve answers grounded in rigorous, sustained research.

However, this ongoing challenge is not simply a medical issue; it is also a policy issue. Governments often dramatically increase funding for infectious disease research during a crisis, only to let it decline, or even collapse, once the crisis fades. We saw it with HIV in the 1990s, and now it is even more severe with HIV today. We’ve also seen it more recently with the COVID pandemic and the significant reduction in funding. The world applauds science when an emergency erupts, then quietly dismantles the infrastructure needed to finish the job and prevent the next one.

Science journalism also plays a critical role; when pandemics are not visible, public attention fades unless journalists continue to explain the stakes and sustain interest in preparedness.

As noted, COVID-19 exposed that weakness again. It showed how fragile our systems of surveillance, coordination, and trust have become, and how quickly misinformation can undo years of scientific progress. Pandemic preparedness, like public health itself, suffers from a paradox: when it works, it becomes invisible. And because it is invisible, it is chronically underfunded.

HIV provides a roadmap for the future. It led to the creation of global surveillance networks, community-based care models, and clinical research collaborations that helped reshape modern virology and immunology. It catalyzed numerous innovations that now underpin responses to multiple infectious threats. The AIDS response proved that sustained global cooperation saves lives, but HIV research, like preparedness itself, is too often forgotten once the immediate crisis fades.

Further, the social dimensions of HIV — including stigma, inequity, and misinformation — persist. We saw them mirrored during COVID-19. And we continue to see them in debates around funding, where cuts threaten everything from vaccine development to laboratory readiness. The economic burden of HIV, which remains substantial even with modern therapies, makes these funding debates even more consequential. Every new infection adds decades of clinical and financial responsibility to health systems worldwide.

The lessons of HIV point us to three urgent policy commitments:

1. Sustained and predictable funding for biomedical research, not boom-and-bust cycles tied to emergencies. Stable investment enables discovery, supports young scientists, and prepares institutions for what we cannot yet see.
2. Modernized global and domestic surveillance systems so we can detect viral threats before they become unmanageable.
3. Expanded investment in long-term prevention and care for people living with HIV, particularly in understanding why chronic inflammation and immune dysfunction persist despite therapy. This knowledge will shape not only the future of HIV care but also our approach to other viral infections, including COVID-19. Strong prevention and cure-focused research are also economically sound strategies, given the long-term cost of lifelong treatment.

I frequently think of the patients who endured the early years of the AIDS epidemic with courage, and of the clinicians and researchers who devoted their lives to understanding this virus. Their legacy calls us not only to remember, but to prepare.

Robert C. Gallo, MD, is co-founder and international scientific director of the Global Virus Network (GVN), founding director of the Institute for Translational Virology & Innovation at the University of South Florida Morsani College of Medicine, and director of the Microbial Oncogenesis Program at Tampa General Hospital Cancer Institute.

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