We are looking at a remarkable opportunity for countries everywhere, and the international donor community, both public and non-profit, to take a major step in addressing HIV prevention. The new vaccine Yezturgo Lenacapavir (“Lenacapavir”) was developed by Gilead Sciences Inc., and offers a practical means to avoid this infectious disease that in the past, has killed or destroyed the lives of so many.
The History of HIV/AIDS
In 1983 French scientists at the Pasteur Institute discovered the virus that causes AIDS and by 1987 there was first widely recognized antiretroviral drug to treat HIV. What followed in subsequent years was heightened attention in both the Global North and South to the devastation being caused, and an unprecedented ramping up of resources both domestically and huge funding by the international community.
These were highly focused and prioritized efforts for years by so many and widely considered a success. The World Bank Multi-Country AIDS Program for Africa (MAP program) was the first, in 2000, to commit separate vast amounts of grant funds to deal with the HIV/AIDS pandemic, ultimately committing over $1.2 billion in 33 Sub-Saharan African countries, and this at a time when no treatment existed and the principal prevention options were education and condoms.
The U.S. President’s Emergency Plan for AIDS Relief (PEPFAR), launched in 2003, aimed to reduce HIV/AIDS in countries heavily affected by the virus. It began with an initial $1.9 billion, these amounts significantly increasing until today, as a result of the Trump Administration funding freeze, disruptions and limitation of PEPFAR’s scope and services, and the uncertainty of what the 2025 budget will provide, it any at all.
There were many others, such as GAVI, non-profit foundations, individuals and companies which came forward to tackle the huge challenge HIV/AIDS posed for all. Alas, the donor landscape has changed as will be discussed below.
What to Know about Lenacapavir
“Lenacapavir” is an injection that provides users with up to six months of protection, a hugely significant advancement in the fight against HIV/AIDS. The drug works by blocking the virus’s ability to enter human cells, thus preventing infection. Its effectiveness in preventing HIV transmission is crucial, particularly for high-risk populations.
Lenacapavir has been recently approved by the U.S. Food and Drug Administration and in February 2025, the European Medicines Agency (EMA) validated Gilead’s European Union”EU-M4all” application for lenacapavir for pre-exposure prophylaxis (PrEP). Through the EU-M4all procedure, national regulatory authorities in low- and lower-middle-income countries can leverage the EU opinion to expedite their review processes, potentially accelerating access to Lenacapavir for PrEP.
And on May 19, 2025, the World Health Organization (WHO) Director-General announced that WHO expects to conclude both the guideline and prequalification processes for lenacapavir this year.
In terms of production and availability, Gilead has entered into licensing agreements with other companies to allow for the manufacture and supply of low-cost versions of Lenacapavir to approximately 120 low- and middle-income countries. The stated aim at present is to supply approximately two million people in these countries (available research suggests that with competition, Lenacapavir could be mass-produced for under $100 per person, and possibly as low as $41 for large scale production).
Lenacapavir’s Potential Impact
Lenacapavir represents a critical step in reducing the transmission rates of HIV. By providing a long-lasting preventive option it offers individuals a practical way to protect themselves from the virus.
For this drug to make a significant impact, there must be health systems with supply chains, trained staff, and access for those most needing such protection. Alongside medical advancements and facilities, there must be demand from the potential beneficiaries, which requires extensive education and public awareness campaigns.
We know that in many countries, whether in the Global North or South, trust in new vaccines is a major challenge, and this will be the case even with the widespread knowledge about HIV/AIDS in Sub-Saharan Africa (SSA).
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Where Donor Support Is Most Needed Now
Sub-Saharan Africa remains heavily affected by the HIV/AIDS epidemic, with millions of people living with the virus. Recent estimates are that around 25 million people in this region are living with HIV, accounting for about two-thirds of the global total of people with HIV.
Not all SSA countries have the same level of health facilities, social services, or public and private finances. In this regard, there are Sub-Saharan African countries that rank as upper-middle-income countries, namely:
- Botswana: A landlocked country known for its diamond industry and strong economic growth.
- Equatorial Guinea: Relies heavily on oil revenue, contributing to its middle-income status.
- Gabon: Another oil-rich nation, also with significant forestry resources.
- Mauritius: A diverse economy with strengths in tourism, textiles, and financial services.
- Namibia: Rich in mineral resources like diamonds and uranium.
- South Africa: The most industrialized country in Africa, with a complex economy.
It is fair to suggest that these countries could provide for their people at HIV risk, making substantial contributions in any burden-sharing arrangement. Such is far less the case for the many low-income countries in the region, which are characterized by having a gross national income (GNI) per capita below a certain threshold, which is currently US$1,046, according to ISS African Futures.
Especially for these countries, various global health organizations, foundations, regional and bilateral institutions are involved in funding essential drugs in the Global South. What presents a major hollowing of donor support is the drastic loss of PEPFAR as a significant funder, but it is not the only case in which traditional donors are reducing support.
Germany has reduced its aid budget in 2023 and further in 2024, as did France, Italy, and Spain, 2024. In the UK, the aid budget is expected to be the lowest on record.
Could the World Bank Step in Now?
The history of massive HIV/AIDS grant programs began in 2000 with the World Bank Multi-Country AIDS Program for Africa. It was an innovative regional approach that allowed individual countries and subregions to draw from the same grant pool. It was not perfect but opened developing countries reluctant to borrow money to deal with HIV/AIDS for their own people, much less for refugees.
Now, after over a quarter of a century, there is a real pathway for infection prevention. It would be proper fitting for the World Bank to take the initiative now. and create a grant window specifically to assist low- and some middle-income countries provide this prevention treatment. Its legacy and reputation will be strengthened should it do so.
Editor’s Note: The opinions expressed here by the authors are their own, not those of Impakter.com — Cover Photo Credit: Afif Ramdhasuma.
