This seems like one “access” argument Gilead could afford to bend a lil’ on.

The twice a year drug will make tens of billions in each year, in the post industrial world, for several years, now.

And in any event, with generic versions coming into at least some markets in about a year, Gilead could let Africa and South America receive near generic pricing.. today. The doctors’ charitable group is right: these vast advances in standard of HIV care should be made as widely available as possible. [Much like the river blindness drug Ivermectin, which Merck has made available for free in Africa for decades now.]

My buddy, Ed Silverman is excellent on this timely topic (but just FYI, that is a paid subscription link — for Stat subscribers, only). And so, here is the original MSF letter, to Gilead’s CEO, Daniel O’Day:

…Both the pace of the current lenacapavir rollout and the scope of ambition for future scale-up fall far short of what the moment demands and the needs of the world’s most marginalized communities. The plan to reach 2 million people over three years is a fraction of the estimated need. When requests for purchase are refused, access is restricted, and prices remain secret, it is hard to believe Gilead is committed to equitable access rather than maintaining control over the product for maximum profit….

MSF currently accesses a limited number of lenacapavir doses through the Global Fund, which Gilead has supplied with enough lenacapavir for 2 million people over three years. 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 (LMIC) until generic versions come online in 2027….

We call on Gilead to respond by April 13, 2026 clarifying:

Whether you will sell lenacapavir directly to MSF?

If not, why, given your stated production capacity?

If yes, at what price and how soon can delivery begin?

The health of many people depends on your answers to these questions….

Indeed — and, onward, grinning — with our crew headed out, toward the Moon, with a “Wiley E. Coyote” move (and one to get back home!). Smile….

नमस्ते