Devex Newswire: HIV prevention has game-changing tools, but access lags

To tackle the global health challenges in low- and middle-income countries, it's vital that the health community finds new ways of doing things. We bring you the first installment of five health innovations that have the potential to bring huge change — and the barriers to their implementation.

Also in today’s edition: The ticking clock on Sustainable Development Goals, and what’s going on in U.K. aid.

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Global access for HIV prevention

HIV prevention has made huge progress, especially with preexposure prophylaxis — aka PrEP — a game-changer that helps stop infections before they start. The most common form is a daily pill for people at high risk, but global uptake has been slower than expected. By 2023, only 3.5 million people were using PrEP, far from the 2025 goal of 10 million.

Daily pills can be a hassle and stigma still exists, so researchers are developing new options such as injectables, patches, and implants. The dapivirine vaginal ring, approved by the World Health Organization in 2021, offers a discreet, female-initiated option. Another breakthrough is cabotegravir, or CAB-LA, an injectable that’s 79% more effective than the daily pill and only needs to be taken every eight weeks. Gilead’s lenacapavir, the twice-a-year HIV-prevention superstar, has also shown 100% effectiveness in trials for women and girls.

The challenge? Accessibility. While CAB-LA was approved in the U.S. in 2021, many in sub-Saharan Africa still can’t get it. Activists are pushing Gilead to speed up access to lenacapavir, arguing that “100% effectiveness demands 100% access.” Making these lifesaving tools available globally is crucial to winning the fight against HIV.

+ Devex readers interested in more of the emerging lifesaving tools in global health can download our free report: 5 innovations in global health.

Lenacapavir pricing protest

Lenacapavir’s sky-high price tag of over $42,000 a year in the U.S. has also stirred up quite a protest. At the International AIDS Conference in July, activists called on Gilead to allow generic versions of the drug, especially since researchers say it can be made for just $40 per patient per year.

Last week, Gilead responded by signing agreements with six pharmaceutical companies, including one in Africa, to produce and sell generic lenacapavir in 120 resource-limited countries. They also promised to sell the injectable "at no profit" until generics can meet demand, my colleague Jenny Lei Ravelo tells me. The move came after consulting with over 100 global health experts.

But not everyone is satisfied. Some middle-income countries with high HIV rates were left out of the licensing agreements, and UNAIDS pointed out that the exact nonprofit price is still unclear.

In Indonesia, a patient group is pressing on with their fight to revoke an extension of Gilead's patent, hoping to allow local manufacturers to produce lenacapavir at lower prices. However, the process is lengthy and could take up to a year. Their second court hearing took place this week, and they are due back in court on Nov. 5. Patient groups in Argentina, Vietnam, and Thailand are also challenging the patent.

Although Indonesia provides free HIV testing and treatment, there’s concern that lenacapavir’s steep U.S. price will make it too expensive for the government to afford. Activists hope that winning the patent battle will help bring the cost down, making the drug accessible to more people.

ICYMI: Activists demand access to groundbreaking HIV prevention tool

SDGs behind globally

Time is running out! With just six years left to achieve the U.N.’s Sustainable Development Goals, less than 20% of the targets are on track, and 20% have actually regressed. Global hunger is worse than in 2015, and over 1 in 5 children will still face stunted growth by 2030.

Education is also struggling, with 70% of 10-year-olds in low- and middle-income countries unable to read a simple text, and child marriage rates remain high, with girls from poorer families being twice as likely to be married off.

While interconnected challenges such as natural disasters and conflicts are worsening the situation, there are glimmers of hope. Sierra Leone recently banned child marriage, with violators facing up to 15 years in prison.

Inger Ashing, CEO of Save the Children, urged governments to invest in health and education systems and prioritize budgets, but financial freedom is needed to do so. As U.N. Secretary-General António Guterres puts it, the world has received a “failing grade” on the SDGs.

Read: Where do the UN Sustainable Development Goals stand? (Pro)

ICYMI: SDGs were doomed to fail from the start, new Oxfam chief warns (Pro)

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Starmer maintains DFID merger

U.K. Prime Minister Keir Starmer rejected advice to reinstate the country’s Department for International Development, or DFID, at minimal cost, opting to keep the controversial merger of diplomacy and development from the Conservative government. While Starmer hasn’t explained his decision, Foreign Secretary David Lammy cited modern challenges such as China and climate change as reasons against a full DFID revival.

A new book by former DFID officials argues that Starmer may regret not being bolder, warning that leadership without fresh ideas won’t gain international respect. Despite previous promises to bring back DFID, Labour stuck with the merger in its 2024 manifesto, aligning development more closely with foreign policy — a shift from Labour's past focus on development for its own sake.

The book also highlights the risks of tying aid to diplomatic goals, noting that such strategies in the past wasted billions.

Read: UK's Starmer was advised to bring back aid department — but said no (Pro)

Maasdorp takes BII helm

The U.K.'s development finance institution has broken new ground with its appointment of a new boss believed to be the first African CEO of any European or North American DFI, my colleague Rob Merrick tells me.

Leslie Maasdorp will succeed the retiring Nick O’Donohoe at British International Investment later this year, the next step in a career that began in the trade union movement in apartheid-era South Africa and which took him, most recently, to a key role in the setup and growth of the BRICS New Development Bank where he was vice president.

Maasdorp described himself as “thrilled and deeply honoured” to take over at an organization born in 1948 as the Colonial Development Corporation and which — after several transformations — now employs more than 600 people and boasts investments in nearly 1,600 companies across 65 countries.

“The private sector is the principal engine of economic growth and prosperity. BII plays a vital role in supporting economies to grow, create jobs and raise living standards in Africa, Asia and beyond,” Maasdorp said in a statement.

BII is charged with increasing its investments in the poorest and most fragile countries above the 50% mark by 2030 and with becoming “the most transparent” bilateral DFI in the world, under an inherited blueprint the U.K.’s new Labour government appears to be taking forward.

O’Donohoe told Devex recently that “the biggest question” facing his successor would be how to juggle poverty-fighting in the poorest countries with the rising demand for climate finance —  giving his own answer very clearly.

Related: ‘Core’ task is poverty not climate, outgoing BII chief tells DFIs (Pro)

In other news

The United Nations is considering suspending relief operations, including food aid, in Ethiopia’s Amhara region after deadly attacks on aid workers during the first six months of 2024. [Reuters]

Cholera cases in Sudan have surged by nearly 40% in less than two weeks, alarming U.N. health officials. [AP]

Brazilian nun Sister Rosita Milesi, who has spent 40 years aiding refugees and migrants, won the U.N. Refugee Agency's Nansen prize. [DW]

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