By Michael Gwarisa
The Kingdom of Eswatini has received its first shipment of the lifesaving HIV prevention drug Lenacapavir, a few months after becoming one of the few African countries earmarked for the rollout to take delivery. The twice-a-year injectable drug will be introduced under the America First Global Health Strategy, which guides the United States’ global health programming across the continent.
Launched in September, the America First Global Health Strategy aims to shift the United States’ global health efforts toward strengthening African health systems and building market-driven partnerships. Under the strategy, the United States says it will remain a global health leader, but in closer collaboration with African governments.
Speaking during a virtual press briefing hosted by the U.S. Department of State’s Africa Media Hub, Brad Smith, Senior Advisor for the Bureau of Global Health Security and Diplomacy, said the U.S. Department of State and the Global Fund are jointly procuring more than two million doses of Lenacapavir.
We initially intended to buy 500 doses in year one of the programme. We are increasing the U.S. commitment from 250,000 doses to 325,000 doses in year one, 2026,” said Smith.
Gilead Sciences has 600,000 doses available for 2026. With the increased U.S. commitment and the Global Fund purchase, all 600,000 doses have now been secured. Smith added that demand and production capacity are expected to rise, enabling procurement of the full two million doses by mid-2027 or earlier.
Eswatini remains one of the countries most affected by HIV. At the peak of the epidemic in 2015, nearly one in three people were living with HIV. Today, the country has exceeded the ambitious 95-95-95 targets, with 98 percent of people living with HIV receiving treatment. Current estimates show 220,000 people living with HIV in Eswatini, and PEPFAR supports treatment for 216,000 of them. More than 95 percent of individuals receiving treatment in the country rely on PEPFAR-funded support.
Despite progress, the risk of acquiring HIV remains high. The United States says the introduction of Lenacapavir will support more than 6,000 people at high risk, with particular focus on preventing mother-to-child transmission.
Gilead Sciences Chief Executive Officer Daniel O’Day described the rollout as historic.
“It’s the first time in history that a new HIV medicine is reaching a country in sub-Saharan Africa in the same year as approval in the United States. This sets a new bar for global access. We are proud that through our work with the U.S. government via PEPFAR and with the Global Fund, we can provide Lenacapavir at a non-profit price to countries with the highest HIV burden,” said O’Day.
He said the priority has always been speed and partnership to ensure communities most affected by HIV benefit quickly from this innovation, which could significantly accelerate efforts to end the epidemic.
Global Fund Executive Director Peter Sands praised Gilead for developing a drug he said will be transformative in the global HIV response.
“These are the first tranche of Lenacapavir injectables that the Global Fund has procured under the Global Access Agreement we signed earlier this year. Lenacapavir is a game-changer. There is no way of understating it,” said Sands.
Regarding allocation, Gilead said distribution among countries is based on HIV disease burden. Within each country, Gilead is working with governments to develop distribution plans targeting the areas and populations most affected by HIV.
