Gates Foundation commits to providing lenacapavir as PrEP next year

On 2 June 2025, the Gates Foundation celebrated its 25th anniversary with a broadcast talk and panel discussion about healthcare in Africa and future international support.

This included a 30-minute talk from Bill Gates, covering the history of an organisation that has spent more than $50 billion since 2000 (and $8 billion in 2024) on grants in 130 countries. He also outlined future plans and commented on the current US-initiated funding crisis.

This work began with a growing interest and investment in reducing child mortality in Africa, cutting the cost of vaccines, for example against rotavirus, and supporting governments to prioritise primary healthcare. The Foundation helped establish GAVI in 2000 and the Global Fund in 2002 to focus on HIV, TB and malaria.

Although not covered in detail, it is important that future plans include a commitment to roll out access to 6-monthly injectable lenacapavir as PrEP “over the next year”. Other 20-year goals are to eradicate malaria and the latest variant of polio (which developed after the main strain of polio was eradicated in 2016) and to use AI technology to provide services in many low-income countries, where it should roll out first.

“We are sitting here at a time of significant crisis in part of this system where there has been partnership between countries. A lot of cuts are being made in foreign aid programmes.

Some of these cuts are being made so abruptly that there have been complete interruptions in trials, and medicines are still sitting in warehouses and are not available.

These cuts are something that I think are a huge mistake. In fact, I will be as strong a voice as I can to get as much of that restored as possible. It is coming also at a time when the fiscal indebtedness of many countries has them paying out more in interest than they are on things like health and education.

We see that for the next few years, and for the first time in 25 years, the number of children who die will go up instead of down.”

Over the next 20 years Gates is also committed to giving away the more than $100 billion he has accumulated, with the majority to be spent in Africa on five basic goals.

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This public commitment is important given the withdrawal of US international aid for HIV prevention services, including PrEP.

Widespread access to lenacapavir PrEP is too important and will depend on strategic funding.

Hopefully, more details will become available shortly, including whether this is based on generic formulations, as these are not expected to be available until 2027. Next year, there may only be 2 million person-years of lenacapavir available directly from Gilead. However from 2027 the mass produced generic forms could be used more widely.

It is also significant that the Gate Foundation is prepared to be openly and publicly critical of the policy changes in the new US administration.