Yearly, round 1.5 million individuals are contaminated with HIV. This quantity is falling, though not quick sufficient to succeed in a United Nations goal of fewer than 370,000 new infections a 12 months by 2025. Final month’s choice by the World Well being Group (WHO) to suggest a brand new drug that protects folks towards HIV an infection is a promising improvement.
The outcomes of a randomized scientific trial confirmed that the drug cabotegravir (Apretude), taken as an injection six occasions a 12 months, is simpler at stopping an infection than is the usual technique of pre-exposure prophylaxis — a every day oral dose of tenofovir disoproxil fumarate and emtricitabine — that’s in use world wide (S. Delany-Moretlwe et al. Lancet 399, 1779–1789; 2022).
The WHO’s suggestion, that cabotegravir is a “secure and extremely efficient HIV prevention device”, opens the way in which to together with it in HIV-prevention programmes. Cabotegravir’s producer, ViiV Healthcare in London, has pledged to cost a not-for-profit worth for public programmes within the lowest-income nations. Chief government Deborah Waterhouse calls it a “game-changing second in HIV prevention”.
Whether or not this seems to be the case will depend on whether or not the drug will be rolled out to these most in want, specifically women and girls aged 15 to 24 within the lowest-income nations. Final 12 months, some 250,000 ladies and ladies on this age group have been contaminated with HIV, greater than 80% of them in sub-Saharan Africa. Success would require cabotegravir to be supplied on the lowest worth attainable. For this to occur, transparency over how the worth is calculated is crucial.
Drug corporations don’t normally disclose such calculations, partly due to the necessity for industrial confidentiality. Governments anticipate to be supplied with information for audit and benchmarking functions, however they don’t publish what they know, both — as Members of the European Parliament (MEPs) found in the course of the COVID-19 pandemic. Though European Union member nations have spent tens of billions on COVID-19 vaccines and therapies, the suppliers and contracting governments haven’t defined the premise for his or her pricing when requested to take action by MEPs.
In the USA, the industrial worth for cabotegravir has been set at $3,700 per dose (equal to an annual worth of $22,200 per individual). The not-for-profit worth is but to be made public, but it surely could possibly be considerably much less.
David Ripin, chief scientific officer on the Clinton Well being Entry Initiative, a philanthropic group primarily based in Boston, Massachusetts, has calculated that generics corporations might make cabotegravir for $23 per individual, per 12 months; this might fall to $16 if scale-up is achieved. These figures are primarily based on including up the price of the lively ingredient, the price of making it into an injectable substance and the price of sterilizing the ensuing product. A abstract of Ripin’s calculations has been printed on-line (see go.nature.com/3bdoa8x).
A 74-strong coalition of campaigners, public officers and researchers that features Winnie Byanyima, the top of the Joint United Nations Programme on HIV/AIDS (UNAIDS), is urging Waterhouse to cost cabotegravir as shut as attainable to $60 per individual per 12 months. That is equal to the quantity governments and philanthropic funders are presently paying for oral pre-exposure prophylactic medicine.
ViiV Healthcare has advised Nature it can not match this worth, however that it’s dedicated to permitting cabotegravir to be copied by generics producers in order that the drug will be made and distributed shortly, and that it’ll cost a not-for-profit worth. These are welcome steps. However the firm might go one higher: let the world know what the worth can be and supply a breakdown of the way it was calculated.
Within the meantime, extra researchers might make their very own estimates, which might assist to supply governments and different funders with a benchmark determine for his or her discussions on what to pay. The outlook for additional home and worldwide funding for HIV/AIDS isn’t good, in keeping with the most recent replace from UNAIDS, printed final month (see go.nature.com/3zkhaix). If cabotegravir can’t be supplied at a worth corresponding to or, ideally, decrease than present oral therapies, nations might face some troublesome selections. Members of the general public should know what their governments are paying — and why.