In March 2025, HIV activists from around the globe gathered at the World Community Advisory Board (CAB) meeting convened by ITPC Global in Barcelona, where they met with representatives from pharmaceutical companies to advocate for access to lifesaving vaccines and medicines in low- and middle-income countries (LMICs).
“It is shocking that the crisis facing the global HIV community has been met with such a resounding silence from big pharma after all the money it has made off HIV,” said Othoman Mellouk from ITPC Global, Morocco.
Funding cuts by the United States and other donor governments have left millions of people without access to prevention, testing and treatment for HIV, tuberculosis, and other life-threatening illnesses. Public health experts predict these cuts will lead to as many as 10.75 million new HIV infections, and nearly 3 million AIDS-related deaths by 2030.[1]
The funding crisis affects programmes through which the majority of big pharma’s medicines and vaccines reach the global poor, yet none of the companies appear to have a plan to address the current crisis. Activists at the CAB sought answers from Merck about the impact of defunding GAVI in LMICs, where it supplies Merck’s HPV vaccine, but got none.
“Merck is unwilling to do anything to ensure that cancer-preventing HPV vaccines continue to reach adolescent girls and young women in low- and middle-income countries,” said Mari Chokheli from TB People, Georgia.
At the same time, big pharma continues to abuse the intellectual property system – filing and enforcing evergreening patents – and profiteering from the lives and health of millions in LMICs.
“While Merck has no strategy to ensure access to its HPV vaccine in LMICs, it has been filing evergreening patents on its cervical cancer treatment pembrolizumab to prevent the development of more affordable biosimilars,” said Laia Ruiz Mingote from VAX CAB, Spain. “This is a deeply cynical strategy to stall access to affordable prevention and treatment of cervical cancer, jeopardizing thousands of human lives with the excuse of further enriching already rich people.”
Access to long-acting HIV medicines like lenacapavir – that studies show has the potential to prevent nearly all HIV infections – remains in doubt due to multiple patents filed by Gilead that prevent generic competition and an extremely restrictive voluntary license (VL) that excludes far too many LMICs.
“My country, Argentina, is excluded from this license. It is shocking that Gilead expects Argentina to host its lenacapavir HIV prevention trials without any arrangement to ensure access after its approval – this is a violation of the Helsinki Declaration. To counter Gilead’s commercial strategy, we are working hard to oppose every patent application the company is seeking in our country.” said Lorena Di Giano from Fundacion GEP, Argentina.
“It is shocking to see that big pharma is maintaining its dedication to profit over lives, even as we are witnessing decades of progress against HIV, tuberculosis, cervical cancer and other deadly threats to global public health being erased,” said Chalermsak Kititrakul from the Thai Network of People Living with HIV/AIDS (TNP+), Thailand.
LMIC governments taking action to ensure access to generic medicines are facing pressure and lawsuits from big pharma. This is the case with the compulsory license (CL) on the WHO-recommended, first-line antiretroviral dolutegravir, issued by Columbia, which has dropped the drug’s price from US$100 to US$4, and enabled the country to provide it for 50,000 people.
“It is outrageous that ViiV insists on suing my country – Colombia – for using a legal public health safeguard to provide dolutegravir, which is the global standard of care, to people living with HIV. Access to health is a right that cannot be taken away from us. We insist and resist.” said Juliana Lopez from IFARMA, Colombia. “We will not be intimidated by the three lawsuits ViiV and its affiliates have filed and we will fight to uphold the right to health over profits,” she added.
Activists at the CAB firmly believe that ppharmaceutical companies must prioritize lives over profit amidst the current funding crisis in healthcare. By improving access to affordable medicines and vaccines, big pharma can prevent countless deaths and suffering, and ensure equitable healthcare for all, regardless of income or geography.
Big pharma could meet the moment by measures to improve access to affordable medicines and vaccines across LMICs, such as:
- Immediately lowering prices, so that governments of LMICs and global institutions can afford to continue providing life-saving medicines for their people
- Committing to non-enforcement of patents to remove barriers to affordable generic and biosimilar versions of medicines and vaccines in LMICs
- Providing transparency about drug pricing and procurement
- Stopping the filing of unmerited patents on medicines, “evergreening” – making minor modifications to a medicine – to extend market exclusivity
- Dropping groundless lawsuits against countries using their legal rights to issue compulsory licenses to ensure access to affordable medicines for their people
- Abandoning so-called ‘access criteria’ based on World Bank country income classifications, to justify the arbitrary and unacceptable exclusions of countries from voluntary licenses, donation programmes and price discounts.
Instead of taking these – or any other actions – big pharma representatives said only that they were “talking to people every day” to address the current crisis.
World CAB members were stunned by the collective unwillingness of big pharma to commit to any actions to help address the sudden disruption of the global aid architecture that so many people rely on for access to diagnostics, medicines and vaccines.
“If big pharma lets people in low- and middle-income countries die needlessly, it is a double failure: a crime against humanity – and a terrible business model,” said Edward Low from the Positive Malaysian Treatment Access and Advocacy Group (MTAAG+), Malaysia.
“They have made billions. It is time for them to step up, or be held accountable for thousands of needless deaths, millions of new infections with preventable diseases, and countless suffering in the name of greed,“ said Sibongile Tshabalala from Treatment Action Campaign, South Africa, adding that “people who live in low- and middle-income countries want to live as much as people in high-income countries do, and their lives are just as valuable.”
[1] https://www.thelancet.com/journals/lanhiv/article/PIIS2352-3018(25)00074-8/abstract
