Public figures across various fields and industries signed an open letter on Tuesday, calling on the British drug company ViiV Healthcare to ensure equitable global access to its newly developed HIV prevention drug cabotegravir (CAB-LA), a long-acting injectable.

The letter acknowledges the remarkable achievement of the scientists working at ViiV Healthcare to develop the groundbreaking drug, which acts as pre-exposure prophylaxis (PrEP) to protect against HIV, but argues that the discovery would be in vain if the price of the treatment is too high for the majority of the world’s population. 

The signers include the Nobel Prize-winning economist Joseph Stiglitz, former New Zealand Prime Minister Helen Clark, billionaire entrepreneur Sir Richard Branson, singers Adam Lambert and Olly Alexander, and UNAIDS Executive Director Winnie Byanyima, along with major players in the public health space.  

“HIV prevention drugs have disproportionately reached people in wealthy countries while millions of those most in need around the world have limited access,” the letter says. “If CAB-LA is not widely available and affordable, it will deepen the inequalities that both fuel the AIDS pandemic, and that are exacerbated by it. Access to life-saving science cannot and must not be dependent on the passport you hold or the money in your pocket.” 

What makes the new drug so revolutionary is that it provides long-term protection with regular injections, as opposed to the traditional oral PrEP that comes in pill form and needs to be taken daily in order to maintain protection. When medication demands daily diligence, there’s a higher chance of missed doses, either for financial reasons or other factors such as "pill fatigue." But if these long-term injections are only available to people in wealthy countries, then its profound benefits will be squandered, according to the letter. 

Although significant progress has been made in the effort to curb the AIDS pandemic, the disease remains a leading public health threat worldwide, the letter points out. 

“There are 1.5 million new infections annually and a person still dies every minute from AIDS,” it says. 

The majority of new cases, as well as deaths, occur in low-income countries that have little access to preventative medication and sexual health funding. Africa is the region most severely impacted by the health crisis, accounting for two-thirds of global cases, according to the World Health Organization. In fact, 1 in 25 adults in Africa is infected with the virus. 

Major strides have been made to expand access to HIV drugs in the past. In the late 1990s, pharmaceutical companies fought to prevent newly developed HIV medication from being priced at reasonable levels, depriving tens of millions of people of essential health care. Since then, prices have been reduced and patents have been loosened. Now, around 20 million Africans access HIV treatment for less than $100 a year

These efforts saved an estimated 16.5 million lives, the letter says. But more than 10 million people still do not have access to adequate medication for HIV/AIDS, a disparity that causes 680,000 preventable deaths each year. 

The breakthrough development CAB-LA could both blunt the spread of the pandemic and shield millions of people from contracting the virus. 

But only if an equitable approach, grounded in public health, is taken. To its credit, ViiV has pledged to make the drug available at a “non-profit price” to low-income countries until a generic becomes available, according to the Guardian

The authors urge the ViiV to take four specific actions: 

1. Announce a lower price for the long-acting injectable ARV for prevention, CAB-LA, as close as possible to that of other HIV prevention medicines (PrEP). The current best PrEP option is approximately $60 per person per year. Make the price public and transparent, and include the cost of the accompanying syringe.

2. Quickly finalize licenses to produce generic versions of this long-acting ARV through the Medicines Patent Pool. License across the world’s low- and middle- income countries on a non-exclusive basis, with a broad geographic scope for both treatment and prevention.

3. Share know-how and technology. Enable producers in Africa, Asia, Latin America, Eastern and Central Europe, and beyond to seek transfer and begin producing.

4. Commit to making enough to meet demand until generic producers come online.

Organizations such as the Global Fund to Fight AIDS, Tuberculosis, and Malaria will be key to actualizing these goals because of its extensive footprint in countries worldwide, which gives it the ability to work with health care facilities and ensure proper delivery of medications. 

Ahead of its replenishment this September, the Global Fund aims to mobilize $18 billion for 2024-2026 in order to save 20 million lives, reduce the mortality rate across the three diseases by 64%, and stop more than 450 million infections.

The open letter, which seeks to generate momentum and public awareness for equitable access, also notes the 24th International AIDS Conference on July 27 and 28 as an opportunity to enshrine these goals. 

“ViiV can show the world that we can continue to accelerate progress against AIDS by ensuring the best new prevention and treatment technologies can reach the millions of people who need them most — to stop the virus and support long lives with HIV,” the letter says. 

“New HIV prevention and treatment options are always exciting; the introduction of long-acting antiretrovirals could change the game, hasten the end of AIDS, and positively impact efforts against future pandemics.”


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