Devex CheckUp: Who will pay to end the AIDS epidemic?

After decades of painstaking research and development, scientists are confident that they have the tools to help end the AIDS epidemic.

Those innovations were the talk of the International AIDS Society’s scientific conference this week in Kigali, Rwanda. Particularly, the six-month injectable prevention tool, lenacapavir, which received an official World Health Organization recommendation during the conference. That comes alongside other prevention tools, including a daily oral pill, a vaginal ring, and a monthly pill that is currently in Stage 3 clinical trials. Experts say there’s now an opportunity to dramatically slow the spread of the disease, while getting more people living with HIV on lifesaving treatment, which makes it virtually impossible to transmit the virus once they get it to an undetectable level.

The other conversation that dominated the conference was the question of who is going to provide the funding to make sure these innovations reach the people who need them. The Trump administration’s cuts to U.S. support for the global AIDS response threaten to capsize efforts to actually take advantage of many of these tools, including lenacapavir.

For instance, the President’s Emergency Plan for AIDS Relief, or PEPFAR, working with the Global Fund to Fight AIDS, Tuberculosis and Malaria, announced plans in December to reach up to 2 million people in low- and middle-income countries with the long-acting injectable. This month, the Global Fund announced that it would move forward with that initiative, but now seemingly without PEPFAR’s support. Indeed, it is no longer clear if PEPFAR will support any of the new prevention tools.

The U.S. funding cuts also threaten to stifle the development of new innovations that could even further accelerate efforts to reach epidemic control, including the development of a vaccine or a cure for HIV.

“When one funder as large as the U.S. retreats, the whole infrastructure can rapidly change,” says Dr. Sharon Lewin, an HIV researcher.

Read: US foreign aid cuts overshadow HIV research advances

Not so fast

PEPFAR did get a reprieve this week when the U.S. Senate removed the White House’s proposal to withdraw $400 million from the program. The cuts were part of a broader rescissions package — now $9 billion — that Congress had already appropriated and that the Trump administration wants to claw back.

A bipartisan group of Senators rescued the PEPFAR funding, though the House of Representatives still needs to approve the change by Friday. If lawmakers miss the deadline, the rescissions request will expire.

This does not mean PEPFAR has been fully restored. Many of its projects have been terminated by the Trump administration, and it is still operating under a waiver that limits its ability to fund prevention activities. In addition, the U.S. Agency for International Development, which implemented many of the PEPFAR projects, has been dismantled, and the State Department, which inherited USAID’s global health programs, just experienced mass layoffs.

Nonetheless, activists took the withdrawal as a sign that U.S. lawmakers are still willing to defend PEPFAR and might even protect it from the $1.9 billion cut to the program that the administration has proposed for the 2026 fiscal year.

Read: Senate blocks $400M cut to PEPFAR, but it's a shell of its former self

ICYMI: What should a responsible PEPFAR transition look like? (Pro)

Get ExCITD

As the world gets hotter, climate-sensitive diseases such as malaria, tuberculosis, and dengue are resurging in the Asia-Pacific region. The Asian Development Bank is ExCITD to tackle this problem.

The multilateral has announced plans to develop Ending CompleX and Challenging Infectious and Tropical Diseases, or ExCITD. The initiative will mix domestic spending, concessional loans, and grant funding from a variety of partners to try to halt the rise of these diseases. The idea is not to fill the role of a traditional donor, but to approach addressing the diseases as an investment project.

ExCITD, which was announced during the bank’s INSPIRE forum this month, is still in the early stages of development. As country representatives appeared to show early interest, development partners from global and local philanthropies and multilateral and bilateral donors met in a closed-door session during the forum to discuss how they could work under the initiative.

Read: New ADB platform aims to help end malaria, TB, and dengue in Asia-Pacific

No more waiting

The INSPIRE forum also gave countries an opportunity to highlight efforts they are making to improve access to vaccines, therapeutics, and diagnostics. This has been an area of concern in the Asia-Pacific region ever since the COVID-19 pandemic, when countries found themselves forced to wait for vaccines behind the countries where the jabs were being developed and produced.

In order to make sure this doesn’t happen again, some countries are strengthening key regulatory mechanisms to ensure they can quickly approve emerging vaccines, therapeutics, and diagnostics. Others, including Bangladesh, are building vaccine manufacturing facilities with ADB’s support.

However, ADB officials said they are approaching these requests cautiously. It’s not necessary for every country to have its own production facility. One idea that has come up is to develop a network, where some countries specialize in clinical development, while others are responsible for the filling and finishing.

This kind of approach could bind countries closer together, while making sure that the market isn’t oversaturated.

Read more: How can Asia-Pacific boost vaccine access in the next pandemic? (Pro)

+ Not yet a Devex Pro member? Start your 15-day free trial today to access all our expert analyses, insider insights, funding data, events, and more. Check out all the exclusive content available to you.

What we’re reading

Evidence gathered from 210 different incidents over more than 20 years shows that emergency vaccination programs in response to disease outbreaks can cut deaths by around 60%. [BBC]

The South African government’s reluctance to address the impact of the U.S. funding cuts on its HIV response has spurred the revival of a historic AIDS activist movement. [The New York Times]

Research shows that aluminum in vaccines does not increase a child’s risk of developing a wide variety of conditions, including asthma and autism. [STAT]