Three South African pharmaceutical manufacturers have been shortlisted as potential candidates to make Gilead’s HIV prevention injection lenacapavir, deputy health minister Joe Phaala said on Wednesday. The development comes as pressure mounts on Gilead to expand access to lenacapavir, which is widely seen as one of the most promising new tools for changing the trajectory of the HIV/Aids epidemic. The shot is administered every six months, and provides almost complete protection against HIV infection. Gilead has come under fire at the 26th International Aids Conference in Rio de Janeiro this week, because it has committed to making only 3-million doses of lenacapavir available over three years. AVAC estimates that 5-million doses a year are needed to make a significant impact on the epidemic.Gilead has been criticised for excluding sub-Saharan pharmaceutical firms from the voluntary licences awarded to generic manufacturers to make cheaper copies of its patent-protected shot, despite the fact that the region is home to two-thirds of the world’s people living with HIV. And it has taken flak from activists at the conference because the voluntary licences it awarded to generic pharmaceutical manufacturers restrict sales to low- and middle-income countries, which means many Latin American nations — including Brazil — face much higher prices. Phaahla said the South African National Aids Council had evaluated the bids it received in response to its call for expressions of interest for local production of lenacapavir and shortlisted three firms. He declined to disclose the names of the companies.We are completely behind the idea of having a South African licensee for any or all components of the lenacapavir manufacturing process, and are working with the government of South Africa so that they determine who would be best— Jared Baeten, Gilead senior vice-president for clinical development One company will be selected in consultation with Gilead, and is expected to manufacture lenacapavir for the Sadc region, he said. Phaahla would not be drawn on whether the health department would be prepared to pay a premium for locally manufactured lenacapavir. Gilead senior vice-president for clinical development Jared Baeten referred Business Day’s request for an update on the process for identifying a potential South African licensee for lenacapavir to the health ministry. “We are completely behind the idea of having a South African licensee for any or all components of the lenacapavir manufacturing process, and are working with the government of South Africa so that they determine who would be best,” he said. The six firms in Egypt, India and Pakistan that were initially awarded voluntary licences will all be making the active pharmaceutical ingredient in lenacapavir, a capability that few South African drug makers possess.South Africa has set aside $29.2m (R485.8m) from a grant from the Global Fund to Fight Aids, Tuberculosis and Malaria to purchase more than 450,000 doses of lenacapavir at $40 (R666) per person a year. It has received only 37,920 doses so far, which activists estimate is enough to reach less than 1% of the people in need. The rollout began at public clinics in six provinces in June.Elzette Rousseau from the Desmond Tutu Health Foundation said preliminary research indicated that when offered a choice of HIV prevention tools, most people opted for lenacapavir, rather than the monthly injection cabotegravir or daily pills. There had been strong interest from men as well as women, she added.Kahn’s travel to the 26th International Aids Conference was sponsored by the International Aids Society.Business Day