A Promising Advance in HIV prevention Faces a Critical Challenge: Scaling Access Beyond Initial Doses
The arrival of lenacapavir in Zambia and Eswatini marks a genuine turning point in the fight against HIV. This twice-yearly injection boasts an remarkable 99% success rate in preventing HIV infection, offering a powerful new tool in our prevention arsenal.The swift rollout – just five months after FDA approval and delivery of the initial 1,000 doses - is a testament to the potential of collaboration between the State Department, Gilead Sciences, and the global Fund.
However, as a long-time HIV advocate with three decades in healthcare communications, I’m deeply concerned that this initial success could be overshadowed by a looming crisis: the planned downsizing of PEPFAR, the U.S. President’s Emergency Plan for AIDS Relief. The current transition, framed as “burden sharing,” risks undermining the very progress we’re celebrating.
The Aspiring Goal, and Why it Falls Short
While the commitment to deliver 2 million doses of lenacapavir by 2028 is a positive step, it’s frankly insufficient. Consider this:
* Dosage Needs: Lenacapavir requires administration every six months.
* Reach: 2 million doses will only protect 1 million people.
* The Reality of New Infections: UNAIDS reports approximately 1.3 million new HIV infections globally each year.
To truly reverse the HIV epidemic, we need to dramatically expand access. UNAIDS is calling for reaching 20 million people with this medicine – a goal requiring a staggering 40 million doses annually. The current plan simply doesn’t meet the scale of the challenge.
Manufacturing Hurdles and the Need for Investment
Gilead’s decision to delegate manufacturing to six generic drug companies for low- and middle-income countries is a welcome move. However, scaling up production of complex injectable biological medicines isn’t guaranteed. We’ve seen recent struggles with both COVID-19 vaccines and GLP-1 injections (used for weight loss and diabetes) demonstrate the difficulties in rapidly increasing manufacturing capacity.
Successfully navigating these hurdles demands a important, coordinated global investment in a dedicated and robust supply chain. This isn’t just about money; it’s about building infrastructure, ensuring quality control, and establishing reliable distribution networks. Unfortunatly, in the current climate of fiscal retrenchment, securing this investment is far from certain.
The PEPFAR Transition: A Cause for Concern
The PEPFAR transition is happening at a critical juncture. Reducing funding now, just as we have a game-changing prevention tool like lenacapavir, is profoundly short-sighted. it risks reversing decades of progress and jeopardizing the health of millions.
You might be wondering what this means for you and the global fight against HIV. It means we need to be vigilant, advocate for sustained funding, and demand a more ambitious plan for scaling access to lenacapavir.
A Call to Action: Updating a Historic Slogan
For years, HIV activists powerfully declared, “Silence = Death.” Today, that message needs an update to reflect the current threat.
Perhaps this World AIDS Day, we should remember:
Silence (+ Slashed Funding) = Death.
The promise of lenacapavir is immense. But without a renewed commitment to funding, a robust manufacturing plan, and a truly global strategy, this breakthrough will remain out of reach for far too many. We must act now to ensure that this powerful tool reaches those who need it most.
Disclosure: I have worked in health care public relations for 30 years, with extensive involvement in HIV advocacy for nonprofits, pharmaceutical companies (including Gilead), and public health entities.
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