John Butler

For the first time in the four-decade fight against HIV there is a “miracle” drug that can all but eliminate the risk of infection, but in the Latin American countries where it was tested almost no one can get it. Trials show that Lenacapavir, made by Gilead Sciences, is almost 100 per cent effective in preventing HIV infection. With just two shots a year, those taking it will avoid contracting the virus even when frequently exposed. The drug, which many believe could bring an end to the global HIV pandemic, costs $14,000 a dose in the United States. Gilead has agreed to licence generic versions of the pre-exposure prophylaxis (PrEP) medication at around $40 a dose in 120 low-and middle-income countries, but almost all of Latin America is excluded. Brazil, Mexico, Argentina and Peru are among those with serious HIV epidemics that are shut out, despite having run some of the clinical trials that proved the drug works. Their status as “upper-middle income countries” means they are too rich to qualify for the cut price generic version and yet they remain too poor to pay the US price....

The most important thing to know about the Ebola epidemic in DRC is this: bringing it under control will rely almost entirely on health workers winning the TRUST of local communities. This may sound dull, even woke, when compared to talk of experimental vaccines etc. But it’s true, not to mention hugely difficult, resource intensive and dangerous. The logic is this: you have one of the most frightening infectious diseases spreading in a huge uneducated population that has been subjected to horrific poverty and violence for many years. Yet there are no vaccines or special treatments. The only way to stop it is to break the chains of transmission and this requires the full cooperation of the population. Winning trust won’t be easy. More than 2m have been displaced by a conflict that has frequently been marked with mass rapes and village massacres — violence that seemingly occurs without rhyme or reason. There is no understanding of science or politics, and superstition and paranoia understandably fill the gap. This is what hundreds of local health workers employed by the Red Cross, WHO, MSF and others are walking into. To slow and eventually end the outbreak they must convince people with symptoms to come forward so they can be isolated away from their families and treated by people clad head to toe in PPE. Even in death, of which there will be much, they must explain that victims must be separated from their loved ones and forego burial and grieving rites that are central to their faith and understanding. When we think about the Ebola outbreak in DRC we should think about what we would do in such a situation. How we would win the trust of terrified families were we charged with doing so. We should think too about the resources that are needed to pay for and support those putting their lives on the line on our behalf. As things stand, the money needed for the emergency response is only about 40% funded and yet it must last for many months, probably years, if the epidemic is to be successfully brought under control.