U.S. PIVOTS, BETS BIG ON LENACAPAVIR. Devex Newswire.
The United States has upped its goal for distribution of the twice-yearly HIV prevention treatment lenacapavir, aiming to get it to 3 million people in three years. Supply is ready — but demand is already outstripping the rollout.
State Department official Jeremy Lewin, speaking at a Center for Strategic and International Studies event on the sidelines of the IMF-World Bank Spring Meetings, said the target for the injectable HIV prevention drug is now 3 million people in three years, up from 2 million. The logic: Cut old programs, free up cash, and go big.
“One of the things that we did through the sort of creative destruction of the last year was to free up resources for things like this,” he said, arguing legacy efforts “don’t deliver when you look at the reality of today’s world.”
Supply isn’t the problem. “We at Gilead are not supply constrained,” said Daniel O’Day, CEO of the American pharmaceutical company that developed the drug. “As we go from 2 million to 3 million, we will meet that. If it goes beyond that, we will meet that.” Accelerated manufacturing of generic versions of the drug are also part of the plan.
The rollout is already moving fast, writes my colleague Elissa Miolene — “by far the fastest rollout of a global health medication in the developing world,” Lewin says — but demand is moving faster. “[Lenacapavir] is literally flying off the shelf,” said AVAC’s Mitchell Warren.
Warren also warns that the 3 million goal isn’t enough, saying at least 5 million people must be using the drug in order to push down prices. And beyond that, he said, the destruction of USAID has destabilized HIV prevention programs across the world. According to one analysis, 71% of USAID’s HIV-related awards were canceled.
“I worry we are building lenacapavir programs on a foundation of sand,” he said.
Washington is teeing up another sharp pivot: less aid, more deals.
A new “Trade Over Aid” initiative, circulated to U.N. member states ahead of an April 15 deadline, takes direct aim at the traditional model.“For decades, government aid has been flowing from developed to developing countries with only limited impact,” the U.S. note says. “It has not solved the world’s economic development challenges, and it has often created dependency, inefficiency, and corruption.”
The pitch: swap grants for growth. “The old model has been government-centered and one-directional,” the note argues. “The new model emphasizes mutually profitable business relationships between private sectors and countries.”
U.S. Ambassador to the U.N. Mike Waltz puts it more bluntly: “This old model of sovereign nations providing taxpayer dollars to aid organizations, to a network of NGOs, I do not believe is sustainable in the long run.” The goal, he adds, is to “pull in the private sector” and ultimately “move these aid grants and organizations out of business, right, over the long term, which should be all of our goals.”
Not everyone’s shocked, writes Devex Senior Global Reporter Colum Lynch. “While there’s some exaggerated language that might be off putting to the U.N. community, I view this initiative as very positive insofar as the U.S. is engaging substantively on issues related to development and economic affairs,” one U.N. official tells Devex. Still, it’s unclear how many other governments will sign on to the initiative.