At the 5th HIV Research for Prevention Conference (HIVR4P) in Peru, groundbreaking data on the lenacapavir injection revealed its remarkable efficacy in HIV prevention. With a single injection every six months, the drug completely halted new HIV infections among women and girls. It achieved a 96% risk reduction for other gender-diverse individuals aged 16 and up.
Despite lenacapavir’s transformative potential, a flawed licensing deal restricts affordable access to 120 countries only after a three-year delay. While South Africa is on this priority list, the need for broader and immediate access across middle-income countries is pressing.
Why South Africa must lead with compulsory licensing
South Africa, with other middle-income countries, should consider issuing a compulsory license to manufacture generic versions of lenacapavir. This would allow these countries to bypass restrictive patents and meet urgent health demands – a necessity given the high stakes of the HIV epidemic.
The upcoming G20 Summit in Brazil on November 18-19 offers an ideal platform for South Africa and Brazil to challenge monopolistic practices in the pharmaceutical industry. With topics like access to medicines and local manufacturing already on Brazil’s agenda, this is a prime moment to push for global health equity.
A call for global unity and action
South Africa’s proactive stance could inspire a movement across nations to stand against pharmaceutical monopolies. Lenacapavir’s efficacy calls for widespread, affordable access, and countries like South Africa and Brazil must take the lead in challenging current barriers to access.
Gilead’s licensing agreements appear generous, but a closer look reveals deep inequities. Countries excluded from this access list cannot benefit from lenacapavir’s potential, and those allowed may still face high prices. Moreover, restrictive clauses prevent affordable generic alternatives from reaching many countries in need.
Lessons from past advocacy
South Africa has historically stood firm on equitable access to medications. The government’s push for affordable COVID-19 vaccines set a precedent; similar courage is needed now. By issuing compulsory licenses, South Africa could catalyse a global response to ensure that lenacapavir reaches all populations in need.
The HIV epidemic demands urgent, equitable solutions. Lenacapavir’s potential can change lives, but only if we act now. Middle-income countries must advocate for access by issuing compulsory licenses and mobilising around this critical health need at the G20 Summit and beyond.
This licensing deal is not as inclusive as it seems. Excluded countries and the anti-diversion clauses place middle-income nations in a vulnerable position, unable to protect their populations from rising HIV rates due to high costs or lack of access.
- Tian Johnson is the founder and strategist of the non-profit African Alliance, a pan-African health advocacy organisation; Fatima Hassan is a human rights lawyer and the founder of the non-profit Health Justice Initiative; Asia Russell is the executive director of the Health Global Access Project (Health GAP); Sangeeta Shashikant is a legal and policy adviser for Third World Network, a research and advocacy organisation.