The breakthrough HIV drug is real—but so is the truth about who made it possible and who gets to decide its value.
Lenacapavir is one of the most novel advances in HIV therapeutics in years. It is a first-in-class capsid inhibitor that disrupts multiple stages of the viral lifecycle. By enabling long-acting pre-exposure prophylaxis, lenacapavir—though not a vaccine—may be the most important technological advance in HIV prevention to date.
That breakthrough, however, has become a flashpoint in a familiar—and increasingly contentious—debate: who gets to decide how a transformative drug is priced and distributed?
Gilead Sciences developed lenacapavir, shepherding it from concept through the long, failure-prone path of drug development to regulatory approval. That process is neither quick nor guaranteed. It requires massive capital investment, years of clinical trials, and the willingness to absorb losses when candidates fail—as most do. In this context, Gilead’s claim to the product is not incidental; it is foundational. Without the company’s investment and execution, lenacapavir would not exist as a usable therapy.
The conclusion is straightforward: Gilead has both the legal and moral right to determine how lenacapavir is priced and distributed. Pharmaceutical firms are not charities; they are commercial entities accountable to shareholders. Their ability to take on high-risk biomedical innovation depends on the expectation of returns when they succeed.
Critics often respond by pointing to the role of publicly funded science, particularly through the NIH. The argument is that taxpayer support, even indirectly, entitles the public to greater control over the resulting product. But this line of reasoning collapses under scrutiny. Government funding overwhelmingly supports basic science—the early, exploratory work that maps biological mechanisms and identifies potential targets. Such funding can crowd out private investment in basic science. In the case of lenacapavir, NIH-supported research contributed to understanding HIV capsid biology. It did not produce the drug itself, nor does the NIH hold any patent claim over it.
If the mere presence of upstream public funding were enough to render downstream products “public property,” then virtually every modern medicine would fall into that category.
These are not new arguments. During the 2016 debate over pneumonia vaccine pricing, similar claims were leveled against pharmaceutical companies. In a piece I wrote at the time, I argued that efforts by advocacy groups to pressure companies like Pfizer were less about specific funding claims and more about a broader discomfort with the idea of profit in medicine. You can read that essay here: Pfizer Should Resist Doctors Without Borders’ Bullying, where I make a similar argument. The contours of this debate have not changed much since. Certain groups have continued to push for lower prices, sometimes even rejecting donations.
In truth, the NIH funding argument often functions as a smokescreen. Even if lenacapavir had emerged with no connection whatsoever to taxpayer-funded science, many of the same critics would object to Gilead’s pricing and distribution decisions. The criterion to silence them would only be met if Gilead actually lost money on lenacapavir.
The bottom line is simple, even if it is uncomfortable for some: without Gilead, there would be no lenacapavir. If we deprive pharmaceutical companies of the profits they earn from drugs they create, we will be depriving ourselves of the next generation of life-saving treatments.