MSF HIV PREVENTION: Gilead announcement does not address why people can’t access groundbreaking HIV prevention medicine
Gilead must immediately do more to increase people's access to lenacapavir
Yesterday’s announcement that US pharmaceutical corporation Gilead Sciences will be supplying the highly effective HIV prevention medication lenacapavir to one million more people in a limited number of low- and middle-income countries (LMICs) does not address the fundamental barriers keeping people from accessing this medicine, Doctors Without Borders/Médecins Sans Frontières (MSF) said today.
Gilead had previously announced that it would be supplying doses to two million people, bringing the total to three million in three years. This is not nearly enough to meet the global need, and excludes people in some of the places where HIV is most prevalent.
Approximately 1.3 million people worldwide acquire HIV every year, including in many of the places where MSF runs medical programs. Lenacapavir is an injectable version of pre-exposure prophylaxis (PrEP) that only needs to be administered two times per year—a game-changer for key populations everywhere who face stigma and additional barriers accessing health care, like men who have sex with men, transgender individuals, and sex workers; as well as people caught in conflict or living in fragile humanitarian settings.
Gilead fiercely controls the production and distribution of this newer medicine, keeping it out of reach for some of the people most at risk of getting HIV. The company sells it at exorbitant prices — $28,000 a year per patient in the US even though it could be sold at a profit for less than $40. Supply is also a major issue. While Gilead has made a deal with select generic manufacturers to make the medicine at this lower price, countries like Argentina, Brazil, Mexico, and Peru — where clinical trials leading to the drug’s approval were conducted — are excluded from that deal. In fact, a quarter of new HIV infections are happening in countries excluded from this deal. Giving additional producers permission to make it, without restricting where they can sell it, to help boost the global supply, is necessary to reach everyone who needs this medicine.
MSF has been trying for a year to buy lenacapavir directly from Gilead, but the company still refuses to sell it to us. Instead, Gilead has repeatedly told MSF to procure the medicine through The Global Fund to Fight AIDS, Tuberculosis and Malaria — even as their limited supplies in countries like Eswatini and Kenya have run short.
Dr. Tom Ellman, director of MSF’s Southern Africa Medical Unit (SAMU), said today:
"Any expanded access to lenacapavir is a good thing, but reaching only one million more people in three years is a tiny fraction of what's needed to make a real dent in the HIV epidemic.
"For decades, MSF has played a central role in caring for and working with people living with HIV. We stood with communities in the 2000s when they couldn't access antiretroviral drugs, and we're standing with them now to demand access to lenacapavir. History is dangerously close to repeating itself.
"It is not enough for this groundbreaking medicine to only be available to people living in wealthy countries who can pay $28,000 per year, or to be drip fed to certain LMICs through the Global Fund. To truly curb HIV transmission, lenacapavir must be affordable and accessible for vulnerable people across the world who are at the highest risk of contracting the virus. Prevention should not be a privilege.
"That's why MSF has been trying for a year to buy lenacapavir from Gilead directly to use in our medical programs. But, for a year, the pharmaceutical corporation has been refusing to sell it to us while telling us to access it through the Global Fund. In Eswatini, which has the highest rate of new HIV infections in the world, we received only 70 doses, which were depleted in weeks. In Kenya, we are working with a clinic with a paltry 39 doses.
"The number of doses announced today — spread over multiple years, split between countries, and then divided among health facilities — is insufficient. If Gilead has the capacity to produce more, it’s indefensible and inhumane that they’re choosing not to.
"At a time when much funding for HIV/AIDS programs is on the chopping block, it's more crucial than ever to prevent infections in the first place. Gilead must stop manufacturing this sense of scarcity that puts profits before people.”