JOHANNESBURG — JOHANNESBURG (AP) — South Africa's health minister called on Tuesday lenacapavir, world's first biannual HIV vaccine a 'revolutionary' tool to fight the disease, but warned initial donations would be limited to nearly half a million people in the African country with highest prevalence rate.
This comes just weeks after the US announced plans to buy 2 million doses of HIV prevention drug for low income countries.
Initial deliveries to South Africa will begin in April 2026 and will be funded by a US$29.2 million Global Fund grant, as well as an additional US$5 million from the HIV and AIDS Network of South Africa (NACOSA).
Speaking at the national health roundtable in Johannesburg, Minister Aaron Motsoaledi said the Global Funds' catalytic commitments would provide about 456,000 lenacapavir initiations over two years, equating to 912,000 doses.
“We plan to initially introduce lenacapavir in about 23 high-incidence districts in six provinces, targeting about 360 high-performing government clinics in these districts for the first phase of rollout,” the minister said.
“Around half a million people will be able to start using lenacapavir with this support, but demand is likely to outstrip supply at first,” Motsoaledi said, stressing that research suggests that prioritizing vulnerable populations in areas with high infection rates first will have the greatest effect in preventing new infections.
The minister was quick to warn against complacency about initial investment after South Africa's health system was hit hard by the crisis. sharp reduction in funding from USAID and other US government sources at the beginning of 2025. These cuts have had a major impact on HIV/AIDS and tuberculosis (TB) treatment, prevention and research programs across the country.
While Motsoaledi expressed gratitude that Gilead had reduced the price from the US$28,000 originally quoted to US$40 per person per year, he said South Africa was committed to funding its program itself, with long-term funding dependent on the integration of lenacapavir into local systems such as the essential medicines list.
The World Health Organization in July recommended a six-month course of HIV prevention, which is already being implemented. approved in the USA and Europeas an additional prevention option within combination approaches. Gilead is accelerating registration in 18 high-incidence countries, including South Africa, to supply lenacapavir until generic versions become available in 2027.
In early October, Gilead Sciences announced that it had entered into voluntary, non-exclusive, royalty-free licensing contracts with six pharmaceutical companies in Egypt, Pakistan and India to manufacture and market generic lenacapavir. Despite participating in clinical trials of the drug in recent years, South African companies have been excluded from Gilead Sciences' voluntary licensing, prompting fury from civil society.
“This is not an Ubuntu principle,” said Sheila Mbele-Khama, referring to the South African philosophy that values principles such as human dignity and justice.
Mbele-Khama, speaking on behalf of the South African National AIDS Council (SANAC), said during the roundtable that one in four new HIV infections occurred in the 26 countries not licensed by Gilead. “You can’t come into the house and ask us to let you study and then run away, you don’t include us anymore.”
According to Wendy Cupido, regional manager at Gilead, South African manufacturers assessed in 2024 did not meet the specifications for producing sterile injectables at that time. However, she said Gilead remained willing to consider further voluntary licensing if the South African manufacturer could develop the necessary capabilities and meet quality standards.
Welcoming the investment of more than US$34 million, UNAIDS South Africa Director Eva Kiwango said that at a time when cuts in foreign aid funding could lead to an additional 6 million HIV infections worldwide by 2029, long-acting injectable medicines are “a new option for all people at risk”.
“It is not a cure or a vaccine, but it could be a game-changer if it becomes available to everyone who could benefit from it,” Kiwango said. “For many, lenacapavir expands choice, enhances freedom of choice, and reduces barriers associated with stigma, disclosure, or daily adherence to treatment.”
The roundtable is a two-day event that ends on Wednesday.
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