Photo: A woman in Zimbabwe receives a rapid HIV test. Credit: Flickr/DFID (CC BY-NC-ND 2.0)
Activists and advocates are demanding universal access to a new life-saving anti-HIV drug with the potential to turn the tide against the epidemic in the Global South. The new drug has been found to have a 100% effectiveness rate at suppressing HIV, but the developer, U.S. biopharmaceutical company Gilead Sciences, is charging over $42,000 a year to get it.
Lenacapavir, sold under the brand name Sunlenca, was first approved for medical use in the U.S. in late 2022 to treat HIV infections. Lenacapavir is an antiretroviral medication delivered by injection every six months. A study published last month in the New England Journal of Medicine found a 100% effectiveness rate for the drug in a study of 2,134 women in South Africa and Uganda.
Dr. Andrew Hill of Liverpool University, who led the research, told the UK Guardian: “You’ve got an injection somebody could have every six months and not get HIV. That’s as close as we’ve ever been to an HIV vaccine. [emphasis added]”
Human Immunodeficiency Virus is a virus that kills its victims by destroying their immune systems, making even a small infection into a potentially deadly one. In this state of immune vulnerability, the disease is called Acquired Immunodeficiency Syndrome. Multiple medications exist that can prevent HIV from progressing to AIDS and even reverse the process, but no vaccine or cure has been found.
Since it was first clinically observed in 1981, HIV has killed between 35.7 million and 51.1 million people around the globe. Development of treatments took more than a decade due to rampant homophobia and racism, since it was stereotyped as a disease that primarily affected gay men, transgender women, and oppressed minority groups such as Haitian-Americans. However, as the virus spread across the Global South, it rapidly lost its association with the LGBTQ community and became a problem faced by all populations.
HIV/AIDS in Africa
According to statistics from the UN AIDS Organization (UNAIDS), between 36.1 million and 44.6 million people currently have HIV, with 1 million to 1.7 million new cases in 2023 and between 500,000 and 820,000 people dying of the disease that year. Two-thirds of the world’s HIV cases are in Africa, and while it has an incidence rate of between 0.6% and 1.2% in the rest of the world, in southern Africa it has reached 10%.
Of the 25.6 million Africans with HIV, more than 20 million technically have access to some kind of antiretroviral medication, but the routine of taking a daily pill can be difficult to maintain, and the drugs are not perfect. However, Lenacapavir is administered as a shot once every six months, meaning that maintaining a treatment schedule would be vastly easier. With a 100% effectiveness rate, it could be possible in just a few years to dramatically reduce both the transmission of HIV and deaths from the disease to near-zero, while enabling those still living with the disease to live full, healthy lives.
However, Gilead at present charges $42,250 for an annual two-shot regimen — a price obviously far out of reach for working and oppressed people. Producing the drug costs Gilead just $28, meaning the company is collecting a 1,500% profit on each treatment!
Expectedly, the company has faced harsh criticism for this. At the International AIDS Conference in Munich, Germany last month, UNAIDS and Doctors Without Borders demanded Gilead lower the price to just $40, noting this price would still give them a respectable 30% profit, and agree to allow generic production of lenacapavir by other drugmakers, who could also sell them for a low price.
This is far from the first time Gilead has used intellectual property rights to profit off the HIV/AIDS epidemic: the company also holds the patents for two pre-exposure prophylaxis (PrEP) medications, Truvada and Descovy, which can prevent HIV infection from taking place altogether. The company has been accused of manipulating the patent in order to maintain its monopoly on the PrEP medications, which can cost $24,000 a year.
Close ties to imperialism
Western corporations making bucketfuls of money while depriving the Global South of equal access to the necessities of life is a dynamic that should be familiar to many: it is imperialism, the highest development of the capitalist system. The U.S. capitalist state has played a key role in creating this global medical apartheid that has killed untold millions across the Global South and among highly oppressed populations inside the imperial core.
Almost from the beginning, Gilead was guided by some of the mainstays of U.S. imperialism: formed in 1987, its first Board of Directors chairman was Donald Rumsfeld, who had by this time already been U.S. Secretary of Defense, U.S. Representative to NATO, and White House Chief of Staff. George Shultz, one of the chief architects of the “pre-emptive war” of the Bush Doctrine that underpinned U.S. imperialist actions in the 2000s, joined Gilead’s board in 1996, seven years after retiring from being President Ronald Reagan’s Secretary of State. In that position in the 1980s, Shultz had helped Reagan lay the groundwork for what became the World Trade Organization by pushing free trade agreements on other countries.
Western patents block drug access
The WTO was formed in 1995 and with it came the Agreement on Trade-Related Aspects of Intellectual Property Rights (TRIPS). The TRIPS agreement codified extremely strict intellectual property rights into international trade, which in the medical sphere blocked would-be manufacturers from producing cheaper, generic versions of drugs. For drugmakers like Gilead, that meant they could retain exclusive control over access to medications and vaccines they had patented and were able to set whatever price they wanted for them.
While the complexities of HIV had long confounded scientists trying to find treatments, rampant homophobia in both biomedical corporations and the U.S. government also had a smothering effect on efforts to develop an effective medication. By the time the first effective anti-HIV drug treatments were announced in 1995, more than 9.4 million people had died of AIDS around the world, according to UN statistics. In the United States, that total was roughly 300,000.
By 2000, AIDS-related deaths in the imperial core had declined dramatically, but new cases in the Global South skyrocketed. Two-thirds of all HIV cases were in Africa, where access to those live-saving drugs was basically impossible since the medications were so expensive. While the Indian company Cipla successfully reverse-engineered several of the key medications, India was compelled by the WTO to amend its patent act in 2005, severely hamstringing the operation. However, for several years, AIDS activists in African countries successfully smuggled in the Indian generic drugs and distributed them in defiance of the TRIPS agreement and of Western imperialism.
In 2006, as fears rose that the global spread of avian influenza among birds might turn into a human pandemic, the cost of antiviral influenza treatments skyrocketed, pricing more than three-quarters of the world’s nations out of access. Cipla again reverse-engineered a Western drug, Tamiflu, which had been developed by Gilead and made by Roche, another American biomedical firm, and offered up the generic version for a fraction of the price charged for Tamiflu. Roche is also the patent owner of saquinavir, the first truly effective anti-HIV drug, which debuted in 1995 and was one of those made affordable by Cipla’s reverse-engineering.
Medical apartheid and COVID-19
When vaccines against SARS-CoV-2, the virus that causes COVID-19, began to be distributed in late 2020 and 2021, the same medical apartheid reared its murderous head once again. The majority of the world’s vaccines were developed by companies based in the U.S. and U.K., which charged extortionate prices for them even when the companies offered scaled-down prices. Companies like Pfizer, which had raked in billions of dollars on HIV-related medications, once again made record profits on SARS-CoV-2 vaccines.
One 2021 report by the Bureau of Investigative Journalism found that Pfizer had effectively ransomed Latin American populations, forcing the governments of Argentina and Brazil to offer up sovereign assets — which can include federal bank reserves, embassies, and even military bases — as collateral against any future legal costs related to potential lawsuits over side-effects of the vaccines.
While the majority of SARS-CoV-2 vaccines administered in Africa have come from Western sources, most of which were donated through the UN’s COVAX program, in the first year of vaccinations, the vast majority of those distributed in Africa came from the People’s Republic of China, which supplied the continent with some 1.2 billion shots.
Only socialism can end global medical apartheid
This kind of global inequality is woven into the very fabric of the capitalist system which creates, perpetuates, and profits off of denying the necessities of life to most of the world’s population. The governments of the core imperialist nations, the so-called Group of Seven, have imposed this system on the rest of the planet through force, all to serve the interests of these ultra-powerful corporations and their insatiable hunger for profit.
Those profits come from the institution of private property and the right to deny access to anyone unable to pay for it. When access is a question of medical need in order to preserve someone’s life or their quality of life, the immorality of this institution becomes obvious. In order to ensure that all of humanity can get the medicine they need, in order to truly beat epidemics like HIV, pandemics like COVID-19, and the myriad of ailments that plague mankind year after year, we must end the capitalist system.
A socialist system that puts the people over profiteering corporations is what we need. The major medical corporations should all be nationalized, taken over by the people and run as public services, and their research and inventions made available and accessible to the entire world. Until then, this medical apartheid will continue, and the poorest and most oppressed will continue to suffer unduly.
