But to get there we need to make sure that everyone, everywhere has equal access to groundbreaking new preventive drugs and treatments.
British health authorities recently announced that they hope to prevent all new cases of HIV in England and officially make the country the first in the world to “defeat the virus” by 2030.
They say they will achieve this through a series of new deals they made with pharmaceutical companies to ensure the availability of effective new medicines across the country.
This is undoubtedly good news for the people of England. Nonetheless, as we realised since the beginning of the COVID-19 pandemic, no country can definitively “defeat” a virus on its own. Viruses do not recognise borders. The way to end a pandemic is not through localised pharma deals, but global solidarity.
Today, truly, globally defeating HIV is indeed within reach thanks to miraculous new drugs and treatments already on the market and in development – but only if we work together and make sure that most efficient preventive drugs and treatments are available to everyone in need, anywhere in the world.
The new drug England hopes will help it “defeat” HIV for good in less than a decade is the long-acting injectable form of established HIV drug cabotegravir. The drug is not only a great treatment for people who are HIV positive, but it is also highly effective as a preventive treatment.
In July 2022, the World Health Organization released its guidelines for the use of long-acting injectable cabotegravir (CAB-LA) as pre-exposure prophylaxis (PrEP) for HIV and called for “countries to consider this safe and highly effective prevention option for people at substantial risk of HIV infection”.
This drug is seen as a potential game changer in the fight against HIV, mostly because it provides sufficient protection through bimonthly injections.
According to the WHO, the initial randomised trials showed that the “use of CAB-LA resulted in a 79 percent relative reduction in HIV risk compared with oral PrEP, where adherence to taking daily oral medication was often a challenge”.
All signs indicate CAB-LA has the potential to help us finally confine AIDS to the dustbin of history. However, the battle to deliver this miraculous drug to everyone who needs it is only just beginning. This most effective form of HIV prevention is still out of reach for people at the highest risk of contracting HIV.
Putting profit before lives
CAB-LA is patented and produced by ViiV Healthcare, an offshoot of pharmaceutical corporations Pfizer, GlaxoSmithKline and Shionogi. Like all pharmaceutical companies, ViiV Healthcare is profit oriented.
This is why it has not yet made CAB-LA available across the world at an affordable price.
At first, the company blocked production of generic, low-cost CAB-LA anywhere in the world by refusing to issue voluntary licences to producers of generics in the developing world, citing “the complexities of manufacturing, regulatory requirements, capital investment needs and unpredictable demand”.
After considerable backlash from civil society organisations, activists and health institutions, the company made a U-turn and in July 2022 reached an agreement with the UN-backed Medicines Patent Pool to enable access to the generic formulation of CAB-LA to 90 low and lower to middle-income countries.
The news of the voluntary licensing agreement was celebrated widely, but even this commitment did not give all those in need immediate access to this crucial HIV drug. It is expected to take up to four to five years for generic manufacturers to develop CAB-LA, scale up manufacturing, complete all necessary tests and submit the registration.
This means affordable CAB-LA will not be available in most countries for years to come and it will still be up to ViiV Healthcare to provide the medicine to all markets.
ViiV has a stated policy of providing its medicines to low-income developing countries, including those with very high HIV incidence in sub-Saharan Africa, “at cost”. However, the company did not yet officially announce what that price would be for CAB-LA. Medecins Sans Frontieres says ViiV informed them in July 2022 that the non-profit price is $210-$240 per person per year and is “subject to change at any time”.
This number is over 10 times higher than what the Clinton Health Access Initiative (CHAI) estimates a generic price for CAB-LA could be: less than $20 per year. These delays in making the groundbreaking injection available in countries that need it the most will result in thousands of new HIV infections that could and should have been prevented.
Sadly, ViiV Healthcare’s actions are not out of the ordinary. Since the very beginning of the HIV epidemic, pharmaceutical giants like ViiV have been delaying the Global South’s access to groundbreaking medicines to protect their profit margins.
In the 1990s, when most countries in Southern Africa were being devastated by AIDS with death rates from the virus far surpassing birth rates in many communities, for example, the Pharmaceutical Research and Manufacturers of America, an alliance of the largest 100 drugs companies in the US, lobbied aggressively against an attempt by South Africa to produce and deliver to patients generic AIDS drugs at the fraction of the price charged by US patent holders.
Their lobbying and consequent legal warfare significantly hindered South Africa’s efforts to control the virus and led to countless preventable deaths.
We cannot allow this sad history to continue repeating itself. With CAB-LA, we finally have a weapon strong enough to defeat HIV for good – not only in England, but across the world.
But if we are serious about ending transmissions any time soon, we need to make sure all those at high risk of contracting HIV, including those in Africa, have access to this drug at an affordable price, not in a decade or a few years, but now.
The writer is a fellow of the World Ethical Data Foundation and a technology journalist.