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We might have found a preventative cure for HIV/AIDs – but no one wants to pay for it

PrEP could be a huge step forward in battling HIV/AIDs, but the health sector can't agree whose responsibility it is to fund it. Flavia Garcia explores the economics behind the debate

There’s a major debate going on in the UK at the moment over an approach to combatting HIV/AIDs called ‘PrEP’. Why? Well, you know how when a new product is released, and everyone’s super excited until someone asks them to pay for it? That’s kind of what’s happened with PrEP. Except here, we’re not just talking about a new feature on Spotify – we’re talking about something that could save lives.

What’s PrEP?

The PrEP method was originally used to treat HIV/AIDS, but was later found to also work as a preventative measure for the condition – which is big news considering we’ve been battling HIV/AIDs for about 35 years. In the UK alone, 6,151 people were newly diagnosed as HIV positive in 2014, and that number continues to grow. PrEP has already been used in the US for four years and has shown pretty positive results. In San Francisco, as a result of PrEP, over the last three years new infections have been cut by a third – with wider distribution of the PrEP medicines, that figure could increase to 70%.

Sounds great. Let’s buy loads of the stuff!

Not so fast. This summer, the PrEP Policy Working Group of the HIV Clinical Reference Group recommended a roll out of PrEP on the NHS. There was then supposed to be a public consultation, but this never happened. NHS England then announced it wasn't responsible for funding PrEP anyway.


Wait, why doesn’t NHS England want to fund PrEP?

  1. The drug would cost them around $13-26 million per year (£10-20 million), and they don’t think they have room for it in their budget
  2. They say they’d have to cut funding for other diseases, including treatment for children with cystic fibrosis and knee replacement prosthetics for amputees
  3. While PrEP is effective, there are cheaper alternatives that can also prevent HIV like condoms (although condom use can't be guaranteed), early testing, and sexual health education. Local authorities are the ones that provide these preventative treatments. So, according to NHS England, the duty to fund preventative treatments lies with local authorities, not with them


But not everyone in the health sector is on board with these arguments. Here’s why:

PrEP seems expensive, but could actually be seen as ‘cost-effective’

PrEP’s price tag mainly relates to the cost of the drug Truvada, made by Gilead Sciences. NHS England has said that the $13-26 million per year figure is too high. But PrEP has actually been shown to be cost-effective. The lifetime cost of treating a person with HIV is around $495,000. As people live longer and if more people continue to contract the disease, this amount will only increase meaning prevention is cheaper than treatment. There’s strong evidence to show that HIV can be preventable through PrEP close to 90% of the time. So upfront, it’s costly – but in the long-run, the health sector might actually save money.

Patients of other diseases don’t agree with the idea of competing over funds

In a letter to the Times last week, the Terrence Higgins Trust along with many other patient organizations from different disease areas called the NHS out on its ‘divide and rule’ tactic. “All patients and all conditions matter,” they said. What’s needed is a way to solve this lack of funding problem, not pit diseases against each other. The Twitterverse took on this cause under #PatientsTogether to show their support, be they patients, doctors, MPs or advocates.

Not everyone thinks local authorities should be responsible for preventative treatments

The NHS is suggesting that local authorities should foot the bill. But exactly what their role is in prevention is unclear. The National AIDs Trust (NAT) says that as NHS England are the central authority for all things medical, they should be the ones to fund the treatment. The Local Government Authority (LGA) argues that as per the NHS and Care Act 2010, NHS England has the responsibility of funding HIV therapies (which PrEP falls under). But NHS England says that as per the health reforms that took place in 2012, they now only have responsibility for treatment; prevention is up to local authorities. To which LGA said that’s only correct in the case of providing sexual health education, testing and providing condoms, not for funding therapies like PrEP.

If we reform the patent system, the problem might just fix itself

Couldn’t NHS England just renegotiate the price of Truvada with Gilead? Well, they’ve tried – but the patent system is getting in their way.

Patents protect the drugs created by pharmaceutical companies from being copied, which means no one else can sell that same product for a certain period of time. To ensure Gilead can fund research and make more drugs they need to recover the costs from producing the drug in the first place, especially when the investment to make a drug from start to finish can be upwards of $2 billion. The patent is there to incentivize them to make the investment, because they’re guaranteed to reap the benefits for a certain period of time.

But patents run out. And as soon as Truvada loses theirs, any other company will be able to create drugs that initiate PrEP and sell it far cheaper. In other words, the will be broken up, and that may solve the problem on its own. But this means a waiting game that many people at risk of contracting HIV can’t afford.

What next?

Earlier this year, 194 countries came together to pledge their support to eliminate HIV/AIDS and viral hepatitis by 2030. For the UK, achieving these goals means overcoming the barriers to funding for PrEP.

But people have stopped paying attention. When Martin Shkreli (aka Pharma Bro) raised the price of an HIV medication by 5000%, there was an outcry. We need the public to engage with this issue too, because it throws up some big questions about who’s responsible for funding health care that could affect all of us at some point, whether it’s in relation to HIV/AIDs or anything else. Understanding the economics behind it all might just help us, and the courts, make up our minds about where to go from here.

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