UNAIDS study shows that the impact on production and logistics caused by COVID-19 could have a significant effect on antiretroviral therapy supply worldwide, but steps taken now could lessen the damage done

A new analysis by UNAIDS has revealed the potential impacts that the COVID-19 pandemic could have in low- and middle-income countries around the world on supplies of the generic antiretroviral medicines used to treat HIV.

The UNAIDS survey discovered that the lockdowns and border closures imposed to stop COVID-19 are impacting both the production of medicines and their distribution, potentially leading to increases in their cost and to supply issues, including stock-outs over the next two months.

“It is vital that countries urgently make plans now to mitigate the possibility and impacts of higher costs and reduced availability of antiretroviral medicines,” said Winnie Byanyima, Executive Director of UNAIDS. “I call on countries and buyers of HIV medicines to act swiftly in order to ensure that everyone who is currently on treatment continues to be on it, saving lives and stopping new HIV infections.”

Since 24.5 million people were on antiretroviral therapy at the end of June 2019, millions of people could be at risk of harm—both to themselves and others owing to an increased risk of HIV transmission—if they cannot continue to access their treatment. A recent modelling exercise estimated that a six-month disruption of antiretroviral therapy in sub-Saharan Africa alone could lead to 500 000 additional AIDS-related deaths.

The production of antiretroviral medicines has been affected by several factors. Air and sea transport is being severely curtailed, hampering the distribution of the raw materials and other products, such as packaging material, that pharmaceutical companies need to manufacture the medicines. Physical distancing and lockdowns are also restricting the levels of human resources available in manufacturing facilities. The combined result of shortages of materials and workforces could lead to supply issues and pressure on prices in the coming months, with some of the regimens for first-line treatment and those for children projected to be the severest hit.

An array of circumstances are conspiring to add pressure on the overall cost of finished antiretroviral medicines. Increased overhead and transport costs, the need for alternative sourcing of key starting materials and active pharmaceutical ingredients and currency fluctuations caused by the forecasted economic shock are combining to push up the cost of some antiretroviral regimens. It has been estimated that a 10–25% increase in these could result in an annual increase in the final cost of exported antiretroviral medicines from India alone of between US$ 100 million and US$ 225 million. Considering that in 2018 there was an HIV financing shortfall of more than US$ 7 billion, the world cannot afford an added burden on investments in the AIDS response.

UNAIDS and partners are working to mitigate the impact. The Global Fund to Fight AIDS, Tuberculosis and Malaria (Global Fund) is providing immediate funding of up to US$ 1 billion to help countries to respond to COVID-19 and is expanding the use of its procurement platform to non-Global Fund recipients. The United States President’s Emergency Plan for AIDS Relief is promoting continuity of HIV care, implementing new strategies, such as telemedicine, and allowing some programme flexibility in reporting requirements, staffing and funding re-allocation. The World Health Organization is compiling, exchanging and analysing information on HIV services that have been impacted and is liaising with manufacturers of antiretroviral medicines for emergency supply and with countries to switch to available quality alternative products and on possible mitigation measures. UNAIDS has been coordinating efforts to address the procurement and supply management challenges of antiretroviral therapy caused by the COVID-19 response.

However, a series of policy recommendations on the coordinated action that should be taken by governments and suppliers in order to resolve these issues map out how to minimize the impacts on supply chains and prices. By managing effectively current and future stocks of antiretroviral medicines, supply can be continued for all who need treatment.

The UNAIDS analysis collected information from the eight generic manufacturers of antiretroviral medicines in India that together account for more than 80% of generic antiretroviral medicine production worldwide. Government departments in seven other countries that produce generic antiretroviral medicines and that account for most of the production of generic antiretroviral medicines in low- and middle-income countries domestically were also surveyed.