Sub-Saharan Africa has been struggling with the world’s largest AIDS/HIV epidemic since the 1970s. While the region only contains 11% of the world’s population, it simultaneously holds 69% of the world’s HIV-infected population. The average life expectancy in sub-Saharan Africa is around 63 years. These high mortality rates are no longer because of an insufficient supply of antiretroviral drugs available in the region, but because of the high cost of HIV prevention medication like CAB-LA. Despite the fact that CAB-LA received the approval from the U.S. Food and Drug Administration, many face a long wait until they can get it at an affordable price.
What is CAB-LA?
CAB-LA stands for long-acting injectable cabotegravir. Developed by ViiV Healthcare, CAB-LA is an injectable form of pre-exposure prophylaxis (PrEP). This means it is an antiretroviral drug (ARV) for people at substantial risk of HIV infection. Clinical trials show that injections of CAB-LA every two months are a highly effective method of preventing infection. These trial results have been so promising that the World Health Organization (WHO) has been quick to encourage countries to obtain and distribute CAB-LA as soon as possible.
The WHO is not the only organization to recognize the potential of CAB-LA in fighting the HIV pandemic. Speaking on behalf of the UNAIDS, deputy executive director Matthew Kavanagh recently called CAB-LA “potentially the most effective biomedical prevention tool to come along in a decade.”
The Problem with CAB-LA
Unfortunately, CAV-LA’s high price makes it inaccessible to the resource-strained communities that most need it. ViiV has estimated the non-profit price of a year’s supply of CAB-LA for one patient to be between $240 and $270, according to The Guardian. This comes as a shock to many considering the calculated cost of the ingredients by the Clinton Health Access Initiative (CHIA) to be $20-$40 dollars.
Asia Russel of HealthGap calls CAB-LA “pandemic-altering science” and denounces ViiV for “putt[ing]profits before protection from HIV,” The Guardian reports. While CHIA has come out with this cost estimate, it is hard to tell whether it is entirely accurate. ViiV’s head of government affairs and global public health, Helen McDowell, shot back by emphasizing the complex technological design of CAB-LA. According to McDowell, ViiV cannot viably offer the treatment for the $50 to $60 per patient for a year that PrEP pills cost.
Are There Any Alternatives?
There is an oral version of PrEP available, except it is a daily pill and not injectable. While the pill has been shown to be effective in preventing HIV infection by up to 99%, many find it hard to take them consistently, according to The Guardian. This is where CAB-LA is the better alternative. Individuals receiving injections only need to administer the drug once every two months to adhere to treatment, whereas individuals taking the pill need to consume the drug every single day without fail. There is also an element of added discretion with CAB-LA over the daily pill, as the patient would not have to carry around or have their drug in close proximity.
What’s at Stake?
According to UNAIDS, approximately 4,900 adolescent girls and women were infected with HIV on a weekly basis in 2021. Being a woman in a country that is more gender unequal, it is even harder to discreetly receive and take pills let alone pay for CAB-LA, according to The Guardian.
Lowering the price of CAB-LA is thus a matter of women’s rights. The HIV/AIDS epidemic has also slowed economic growth and social development by keeping hundreds of thousands of people from work and school. Making CAB-LA more accessible could be the first to kickstart sub-Saharan economies and communities.
There is often a sense that Aids is a problem of the past. This is in part due to the COVID-19 pandemic becoming the centerpiece of all global health discussions. It is important that countries continue to work with international health organizations like the WHO, Unitaid, UNAIDS and the Global Fund to harness enough energy and resources to eliminate the AIDs epidemic once and for all. “The virtual elimination of HIV really can be done,” says Professor Sharon Lewin, president-elect of the scientific International Aids Society. “We want the optimism to be seen everywhere,” The Guardian reports.
– Lauren Kim