E-Paper
Rethinking how anti-retroviral drugs reach patients
This article is authored by Umesh K, associate president & head, Global Access & Licensing, Aurobindo Pharma.
Over the last three decades, the pharmaceutical industry has fundamentally changed the trajectory of HIV. What was once a fatal diagnosis is now a manageable chronic condition for millions, thanks to continuous innovation in anti-retroviral (ARV) therapy. But from where I sit, I am acutely aware that discovery is only half the story. The real test of our leadership as an industry lies in how effectively those breakthroughs travel from the lab bench to the patient.
Today, more than 25 million people rely on uninterrupted ARV treatment, most of them in low- and middle-income countries. At this scale, access is no longer a downstream problem — it is the core outcome by which our success must be judged. Scientific excellence matters, but without resilient manufacturing, regulatory alignment and supply chains, even the best therapies fail the people they are meant to serve.
We are entering a new era of HIV innovation. Long-acting injectables, novel delivery systems and next-generation therapies have the potential to dramatically improve adherence and quality of life. From a scientific perspective, this is extraordinary progress. From an industry perspective, it also presents a familiar paradox: Innovation can widen inequity if access planning lags behind development. We have lived through this before. In the early 2000s, effective ARVs existed — yet millions in the Global South died waiting for them.
The challenge today is less about invention and more about industrial translation. New ARV modalities often involve complex chemistries, specialised devices and tightly controlled manufacturing environments. Scaling these innovations for high-burden, cost-sensitive markets requires deliberate choices around licensing, technology transfer and early engagement with generic partners. Access cannot be an afterthought added at launch; it has to be built into the development strategy itself.
Manufacturing remains one of the most powerful levers we have. The global ARV response would simply not exist in its current form without high-quality generic manufacturers, particularly from India, who proved that scale, quality and affordability can coexist. That model reshaped pricing and enabled public health programmes to reach millions. At the same time, the concentration of production and API sourcing has exposed vulnerabilities. The Covid-19 pandemic made it clear how fragile medicine supply chains can be when logistics stall and borders close.
From my perspective, diversifying and regionalising manufacturing — including through stronger capacity in Africa — is not just about equity or optics. It is sound risk management. Technology transfer, predictable demand signals and supportive policy frameworks are essential if we want a system that can absorb shocks without interrupting patient care.
Regulation and procurement play a quieter but equally critical role. Mechanisms such as WHO pre-qualification and stringent regulatory approvals have helped align quality standards globally, while pooled procurement has given manufacturers the confidence to invest in capacity. As treatment paradigms evolve, these systems must keep pace. Long-acting therapies, paediatric needs and differentiated care models demand tighter coordination to prevent stock-outs and resistance-driven substitutions.
If there is one lesson ARVs have taught me, it is this: pharmaceutical leadership today is about systems, not silos. Ending AIDS as a public health threat will require us to embed access thinking far earlier — in how we design trials, structure licences, choose manufacturing footprints and partner with governments.
We have shown what is possible when innovation, generics, donors and policymakers align. The next chapter of the HIV response demands the same ambition — not only to discover better medicines, but to ensure that delivery is timely, reliable and equitable for every patient who depends on them.
(The views expressed are personal)
This article is authored by Umesh K, associate president & head, Global Access & Licensing, Aurobindo Pharma.
