The jab, given every two months, has been offered on a non-profit basis, but it can’t compete with a cheap daily HIV-prevention pill
The South African health department says the reduced cost of a new anti-HIV injection is still three times more than it can afford to pay.
British pharmaceutical company ViiV Healthcare has reduced the price of R729 per shot (£32) to between R540 and R570 (£23. 66 to £24. 97).
The drug, taken every 8 weeks, necessarily eliminates the risk of contracting HIV through sex. It includes an antiretroviral drug, cabotegravir, which is released over a two-month period. The drug is called CAB-LA (short for long-acting cabotegravir).
With more than 13% of the South African population infected with HIV, the country has the largest HIV epidemic in the world. An estimated 164,200 people in the country were infected with the virus in 2022.
CAB-LA’s nonprofit value is much cheaper than in the U. S. It costs around £3,700 (£2,975) for an injection, but is still four times higher than what the South African Department of Health will pay. an HIV prevention tablet (£2. 85 for a month’s pay per patient, depending on the service).
“For CAB-LA to be profitable for the South African government, the value would have to be within a moderate range of oral PrEP [the daily pill], which costs R129 [£5. 68] for a two-month supply. We can’t pay double or triple the value, especially in the context of the budget cuts our branch has faced,” said Khadija Jamalodien, Chief Procurement Officer at the National Department of Health.
“What’s more,” Jamalodien said, “is that the nonprofit value of ViiV doesn’t come with the distribution costs, so it will be even higher than the R540 to R570 announced lately per vial. “
One way to circumvent the maximum value of CAB-LA is to allow donors such as the U. S. government’s Emergency Plan for AIDS Relief (Pepfar) to allow donors to be able to use the CAB-LA Emergency Plan for AIDS Relief (PEFAR). The U. S. Department of Homeland Security should pay for the funding. Pepfar has paid maximum cash for antiretroviral treatments in Africa and has also budgeted for oral PrEP in several African countries.
ViiV has already sent Pepfar-sponsored materials to Malawi, Zambia and Zimbabwe, which will arrive by the end of November, according to Mitchell Warren of the Coalition to Accelerate Access to Long-Acting PrEP. Between 2023 and 2025, Malawi is expected to receive 10,000 vaccines, Zimbabwe between 10,000 and 12,000, and Zambia between 8,000 and 10,000.
Warren, and several South African HIV researchers, said Pepfar has told them that South Africa is on the list for donations in early 2024, although Pepfar has not confirmed this.
However, the health department says it is yet to decide if it will accept CAB-LA donations. Jamaloodien said the country needs to ensure that its programmes are sustainable and that relying on donations means the rollout would have to stop if the funding came to an end. In the case of HIV treatment, South Africa pays for its antiretroviral drugs itself.
“It’s certainly not something we will outright refuse, but we also need to look at sustainability,” said Jamaloodien.
In March, ViiV legalized three Indian drug brands to produce less expensive generic versions of CAB-LA in collaboration with the Medicines Patent Pool, a UN-backed organization that is helping poorer countries with medicines. One of the companies, Cipla, has a factory in Durban, where it plans to manufacture the drug.
But Cipla first wants to set up the technology, build facilities, and then run tests to prove that its product works the same way as the branded product.
Generic versions won’t be available until 2027 at the earliest, Warren said.
“ViiV has indicated that as volumes increase and they get orders from primary buyers like Pepfar, the Global Fund, and governments like South Africa, the value [of nonprofits] can drop significantly,” Warren said. “We thought about the next few years, the brand-name product could charge closer to $100 or $120 for one-year injections [as opposed to the current $175]. “
But even that price would still be more than double what the daily HIV prevention pill costs the South African government, and therefore unaffordable because it won’t be cost effective, the department said.