Handing out the rights to make a medicine before you know for certain that it works is an unusual move in the drug business. Merck did exactly that, and Aspen Pharmacare, the South African drugmaker, is one of the winners. Aspen has signed a royalty-free licence to make alimatravir, an experimental pill taken once a month to help prevent HIV. It is still in late-stage trials, with results due in the first quarter of 2027.
The prize is reach. Aspen's rights cover 129 low- and middle-income countries, including every African nation, for both public and private patients. It is one of seven manufacturers Merck has licensed, three in sub-Saharan Africa and four in India; the other two African makers sit in Kenya and Uganda. If the drug clears its trials, it would be the world's first monthly pill you swallow to prevent HIV.
One tablet, one week's forgiveness
"It's one tablet, once a month. It takes one hour to work, and you have one week's forgiveness," said Aspen's head of strategic trade, Stavros Nicolaou. He called it a superior product to lenacapavir, the twice-yearly prevention shot, while allowing that injectables still have a place; a pill, he argued, is easier to roll out at scale because it needs no healthcare worker to administer. The stakes are highest at home, where South Africa still records one of the highest numbers of new HIV cases in the world.
Made close to home
Merck's readiness to license African makers before the trials have even finished stands in contrast to rival Gilead, criticised for granting no such licences to sub-Saharan manufacturers for lenacapavir. Building production close to the regions that will use the drug means stock can be ready the moment regulators approve it. Health Minister Aaron Motsoaledi welcomed the deal, saying local manufacturing means "South Africans are not left waiting at the back of a global supply queue." Investors have taken note: Aspen's shares are up about 25% this year.
For all the optimism, everything still hinges on the trial data due early next year. If it lands, Aspen will have a head start on making a medicine the continent badly needs.
