Humanitarian organisation Médecins Sans Frontières (MSF-Doctors Without Borders) has asked ViiV Healthcare to withdraw conditions in negotiations for the purchase of preventive HIV drug cabotegravir long-acting (CAB-LA) for key and vulnerable populations. The pharmaceutical company’s “last-minute insertion of terms” are not acceptable in MSF purchase agreements and it was holding up the procurement of this critical drug, MSF alleged.

The conditions undermine supply security for patients, “Because ViiV retains the power to terminate the contract or refuse the purchase order without just reasons, and a confidentiality clause, akin to a Non-Disclosure Agreement (NDA), on the drug’s price and supply terms”, MSF said.

CAB-LA is the most effective form of HIV prevention (pre-exposure prophylaxis [PrEP]) available today, and involves an injection of the drug every two months, which is more long-lasting and discreet than daily oral PrEP pills, facilitating better adherence that would help turn the tide against new HIV infections globally, they explain.

MSF has requested ViiV to withdraw the confidentiality clause on pricing and amend the terms that “undermine timely availability and supply security of CAB-LA.”  The organisation said it was waiting to start offering CAB-LA to key and vulnerable populations in its care in Mozambique and beyond, as soon as ViiV returned with an agreement that guaranteed transparency, ensured supply security and facilitated timely access to the drug.

Dr Helen Bygrave, Chronic Disease Advisor, MSF Access Campaign said, “MSF has been trying to access CAB-LA since January 2022 and are stuck in an infuriating situation: there’s a lifesaving HIV prevention drug at our fingertips, but ViiV, the only corporation producing CAB-LA for at least the next three to four years, is deliberately putting up red tape to delay access for people in our care. “ Further, she added, “We are ready to start offering CAB-LA to people for the prevention of HIV in Mozambique and other countries, but signing a purchase agreement that lacks supply assurance and does not allow us to disclose the prices we pay is untenable – it would perpetuate a system that continues to undermine transparency, limit civil society activism for lower drug prices and restrict supply to low- and middle-income countries. These agreements essentially blindfold governments and procurers during future price negotiations.”

ViiV has not publically reacted to MSF’s statement, yet.

Transparency and accountability

Confidentiality clauses around price and supply in procurement agreements for COVID vaccines and therapeutics were heavily criticised during the pandemic for diminishing the right to information, transparency and accountability in purchases funded by the public, and for hampering governments and procurers’ ability to negotiate lower prices with manufacturers, MSF said. The constitutionality of NDAs within COVID vaccines purchase agreements was contested through a legal challenge in South Africa, and has today resulted in the Pretoria High Court ruling in favour of transparency and ordering the South African government to make all COVID-19 vaccine contracts public within 10 days, they pointed out.

Since MSF first began responding to HIV over 20 years ago, the organisation has refrained from signing any confidentiality agreement or NDA that would block the disclosure of the prices it paid for HIV antiretroviral medicines (ARVs) to donors or to the public, it said.