Open letter to Gilead: Prevention should not be a privilege
MSF calls on Gilead for direct access to lenacapavir, as the current rollout falls far short of the needs.
Doctors Without Borders/Médecins Sans Frontières (MSF) calls on Gilead to sell lenacapavir directly to organizations ready to purchase it, and to take additional concrete steps toward ensuring global access to this breakthrough in HIV prevention.
On February 18, 2026, MSF met with Gilead to request the purchase of a limited supply of lenacapavir for use in MSF’s humanitarian programs around the world. In that meeting, Gilead refused to sell lenacapavir directly to MSF, a position it has now maintained across multiple requests over several months.
Lenacapavir, a twice-yearly, long-acting HIV prevention tool, represents one of the most promising advances towards ending AIDS as a public health threat to date. Gilead has an obligation to ensure that access is not restricted by where people live, who they are, or what their country can pay. That this drug’s development was supported by public funding — and through the trust of communities who participated in clinical trials, many of them in countries now excluded from affordable access — makes the current restrictions even more unconscionable.
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.
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.
MSF is making use of these doses and will continue to do so, but this allocation is capped, demand far exceeds supply, and every dose directed to MSF is a dose unavailable to another program. This is why we have repeatedly asked Gilead to sell lenacapavir to MSF directly, outside the capped Global Fund allocation. We are not asking Gilead to redirect supply from an already stretched pool. We are asking to purchase additional supply so that we can scale up access for the people MSF serves—including those in conflict zones, and key populations like men who have sex with men, transgender individuals, and sex workers — without reducing what is available to others. We are asking Gilead to sell to us directly, outside the capped allocation, as it does for buyers in high-income markets.
Your own words suggest this is eminently achievable. On November 18, 2025, at a press briefing with the US Department of State, you, as Gilead CEO, stated: “We’re targeting 2 million people, but if it needs more than that and we can implement more, we have the capability to produce more.” MSF is asking you to do exactly that. Gilead has refused.
In our February meeting, Gilead defended their refusal to sell to MSF on three grounds.
First, Gilead mischaracterized the allocation of capped supply as solely the responsibility of the Global Fund, rather than acknowledging the restrictive terms and supply limits Gilead itself has imposed — the conditions that have made rationing inevitable. The problem is not the Global Fund’s allocation decisions. The problem is a cap that need not exist.
Second, Gilead pointed to the projected arrival of affordable generics in 2027, while fully aware that its own licensing agreements prohibit generic manufacturers from selling lenacapavir in more than two dozen countries, including most of Latin America, parts of Asia and Eastern Europe, and the Middle East and Northern Africa. Many of those excluded regions are experiencing rapidly rising HIV infections. Deflecting responsibility to future generics, while having no plan to supply much of the world during the first two years of launch, is unacceptable.
There were willing buyers across LMICs prepared to procure additional doses in 2025 and 2026, and these requests should be honored just as readily as those from high-income markets, where lenacapavir sells for about $28,000 per person per year.
Finally, Gilead suggested that negotiating supply contracts is “a lot of work” and could take months. From our perspective, the arrangement should be straightforward: Gilead is a pharmaceutical company, and MSF is a medical humanitarian organization ready and able to purchase medicines for people who urgently need them. We are willing and ready to start today.
While MSF does not expect lenacapavir to be free, we and all our partners do expect transparency, fair pricing, and the ability to procure the tools needed to prevent people from acquiring HIV when and where needed.
We hope to meet with Gilead again in the coming days to press for a shift in approach with respect to humanitarian access.
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.
Sincerely,
Tirana Hassan
Chief Executive Officer, MSF USA
Dr. Tom Ellman
Director, Southern Africa Medical Unit, MSF Southern Africa
