By Michael Gwarisa
Doctors Without Borders, also known as Médecins Sans Frontières (MSF), has accused pharmaceutical company Gilead of refusing to sell lenacapavir, a long acting injectable used to prevent HIV infection.
MSF says the refusal follows multiple requests made over several months, including a formal meeting in which the organisation sought to purchase a limited supply of the drug for use in its humanitarian programmes around the world. According to MSF, Gilead has consistently declined to sell lenacapavir directly.
In an open letter co authored by MSF USA Chief Executive Officer Tirana Hassan and Dr Tom Ellman, Director of the Southern Africa Medical Unit at MSF Southern Africa, the organisation expressed strong concern over the decision, describing it as a setback for global HIV prevention efforts.
“Pharmaceutical companies are in the business of selling medicines. We have long challenged Gilead’s pricing practices, but their outright refusal to sell lenacapavir is deeply troubling,” MSF said.
MSF currently accesses a limited number of doses through the Global Fund, which has received enough supply from Gilead to cover two million people over three years. However, the organisation says this channel is insufficient.
“This is currently the only avenue available to us. Gilead has indicated that this is all the supply available for low and middle income countries until generic versions become available in 2027,” MSF said.
The organisation noted that while it is making use of the available doses, the allocation is capped and demand far exceeds supply. It warned that every dose directed to MSF reduces availability for other programmes, further straining access.
MSF said its request to Gilead has been consistent. It is not asking for a redistribution of existing supplies, but rather the opportunity to purchase additional doses outside the capped Global Fund allocation. This, it argues, would allow the organisation to expand access without disadvantaging others.
The group emphasised that additional supply would support vulnerable populations, including people living in conflict zones and key populations such as men who have sex with men, transgender individuals, and sex workers.
“We are asking Gilead to sell to us directly, outside the capped allocation, as it does for buyers in high income markets,” MSF said.
The access dispute comes amid emerging data that is likely to intensify pressure on the pharmaceutical company. New estimates show that generic lenacapavir could be produced at a price up to 1,000 times lower than Gilead’s current price of 42,250 dollars per person per year in high income markets.
With mass production, analysts estimate that the cost of generic lenacapavir could initially fall to around 100 dollars per person per year, with further reductions to as low as 40 dollars as demand increases. The findings have raised fresh concerns about affordability and equitable access, particularly for low and middle income countries bearing the highest HIV burden.
MSF argues that such pricing disparities highlight the urgency of expanding supply and improving access now, rather than waiting for generic competition years down the line.
The organisation also pointed to earlier remarks by Gilead’s leadership suggesting that scaling up production is possible. During a press briefing with the United States Department of State on November 18, 2025, Gilead’s Chief Executive Officer stated that the company had the capacity to increase output if needed.
“We are targeting two million people, but if it needs more than that and we can implement more, we have the capability to produce more,” the CEO said at the time.
MSF says its request aligns directly with this statement, yet Gilead has still refused to supply additional doses.
During a February meeting, Gilead reportedly defended its position on three main grounds. MSF disputes each of them.
First, MSF said Gilead mischaracterised the role of the Global Fund by suggesting that allocation decisions rest solely with the fund. According to MSF, it is Gilead that has imposed restrictive supply limits, creating the need for rationing in the first place.
“The problem is not the Global Fund’s allocation decisions. The problem is a cap that need not exist,” MSF said.
Second, Gilead cited the anticipated arrival of affordable generic versions in 2027. However, MSF argues that the company’s own licensing agreements prevent generic manufacturers from supplying more than two dozen countries, including much of Latin America, parts of Asia and Eastern Europe, as well as regions in the Middle East and North Africa.
MSF warned that many of these excluded regions are already experiencing rising HIV infection rates, making delays in access particularly dangerous.
Deflecting responsibility to future generics while failing to supply large parts of the world during the early years of rollout is unacceptable, the organisation said.
MSF also highlighted that there are willing buyers across low and middle income countries ready to procure additional doses in 2025 and 2026. It argued that these requests should be treated with the same urgency as those from high income markets, where lenacapavir is priced at around 42,250 dollars per person per year.
Finally, Gilead reportedly said that negotiating supply agreements would be complex and time consuming. MSF rejected this argument, saying the arrangement should be straightforward.
“Gilead is a pharmaceutical company, and MSF is a medical humanitarian organisation ready and able to purchase medicines for people who urgently need them. We are willing and ready to start today,” the organisation said.
MSF stressed that it does not expect lenacapavir to be provided for free. However, it called for transparency, fair pricing, and the ability to procure essential HIV prevention tools when and where they are needed.
The organisation said it hopes to meet Gilead again in the coming days to push for a change in approach to humanitarian access.
MSF has called on Gilead to respond by April 13, 2026, clarifying whether it will sell lenacapavir directly, and if not, the reasons behind the decision. It also wants to know the potential price and how quickly delivery could begin if the company agrees.
“The health of many people depends on your answers to these questions,” MSF said.
