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Global Fund Pushes Ahead with HIV Prevention Jab Rollout Despite US Funding Cuts
The Global Fund for HIV, TB, and Malaria has reaffirmed its commitment to funding the rollout of the twice-yearly HIV prevention injection, lenacapavir, in low-income countries, including South Africa. This pledge comes amid uncertainty over continued support from the US President’s Emergency Plan for AIDS Relief (PEPFAR), which has faced significant cuts under former President Donald Trump’s administration.
Peter Sands, the executive director of the Global Fund, emphasized the importance of lenacapavir as a breakthrough in the fight against HIV.
“We remain committed to the rollout of lenacapavir for pre-exposure prophylaxis (PrEP),” Sands said. “This injectable, long-acting prevention method is nearly 100% effective. While it may not be the right fit for everyone, we need real-world experience to understand its full potential.”
PrEP is a preventative treatment for individuals at high risk of contracting HIV through sexual contact. Unlike traditional daily oral PrEP, lenacapavir requires just two injections per year, making adherence easier.
In December, PEPFAR and the Global Fund, alongside the Children’s Investment Fund Foundation and the Gates Foundation, announced plans to fund the initial rollout of lenacapavir. Their goal was to provide at least two million people with the jab over three years, pending regulatory approval.
However, following Trump’s decision to halt most US support for PEPFAR, concerns have mounted over whether the US will honor its financial commitments to this initiative.
Gilead Sciences, the pharmaceutical company behind lenacapavir, has submitted regulatory applications to key agencies, including the US Food and Drug Administration, the European Medicines Agency, and the Medicines for All project, which includes South Africa.
Clinical trials have already demonstrated the injection’s effectiveness. In one study, none of the 2,134 young women who received lenacapavir contracted HIV. Another trial showed that among gay men, transgender, and non-binary individuals aged 16 and older, the injection reduced HIV risk by 96%.
With or without PEPFAR’s support, Sands stressed that the Global Fund would push ahead with its share of the funding. “We cannot afford to miss such a game-changing opportunity,” he said.
Since its inception 23 years ago, the Global Fund has invested $26.6 billion (R495 billion) in HIV programs worldwide. Every three years, it seeks funding from international donors, with the US traditionally contributing nearly a third of the total amount.
This year, the Global Fund is requesting $18 billion from global donors, which it estimates could prevent 400 million new infections across HIV, TB, and malaria and save 23 million lives by 2029. However, there are concerns that the US contribution may be significantly reduced or even eliminated.
A study conducted by Imperial College London found that every dollar invested in successful health interventions yields a $19 return. Alan Whiteside, a global health policy expert, warned that abandoning past investments would be a waste.
“Walking away from previous commitments not only hurts financial returns but also undermines long-term progress. Investing in health yields far greater benefits than the initial cost,” Whiteside explained.
Experts agree that immediate investment in the branded form of lenacapavir is crucial while waiting for more affordable generic alternatives. Linda-Gail Bekker, head of the Desmond Tutu Health Foundation and lead researcher in the lenacapavir trial for young women, stressed the need for careful planning.
“If resources are limited, we need to convene experts quickly to determine the most equitable and impactful way to distribute the available supply,” Bekker said.
Despite the funding uncertainty, the Global Fund remains determined to move forward, ensuring that millions of people in need gain access to this life-changing HIV prevention method.
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