We welcome the announcement that Merck (MSD) has taken early steps to license generic production of Alimatravir, a once-monthly HIV prevention pill, for many low- and middle-income countries, including countries across Africa. This marks an important milestone for HIV prevention and demonstrates that equitable access planning can begin well before regulatory approval. We commend MSD for recognizing that access should be considered an integral part of innovation rather than an afterthought.

As organizations working across community leadership, implementation, market access, and accountability, we have valued the opportunity to engage throughout this process and remain committed to working alongside MSD, governments, regulators, procurement agencies, donors, generic manufacturers, and civil society to help ensure that, if Alimatravir is proven safe and effective, access planning starts now. The lessons from this process should establish a new benchmark for how future HIV prevention innovations are developed, introduced, and scaled globally.

For African women, adolescent girls and young women (AGYW), and key populations, innovation only matters when it is affordable, available, acceptable, and delivered with dignity. The HIV prevention field has repeatedly demonstrated that scientific breakthroughs alone do not end epidemics. Communities need meaningful prevention choice, including daily oral PrEP, the dapivirine vaginal ring, long-acting injectable options, and emerging products such as Alimatravir, supported by accurate information, respectful services, sustainable financing, and health systems capable of delivering prevention equitably.

We are encouraged that this licensing approach includes African generic manufacturers and supports regional production capacity. However, African manufacturing must be more than symbolic participation in global supply chains. It must include meaningful technology transfer, transparent licensing arrangements, investment in quality-assured production, support for active pharmaceutical ingredient supply, and predictable procurement that enables sustainable manufacturing at scale. African access cannot remain dependent on delayed markets. It is central to health security, equity, economic resilience, and the long-term sustainability of the HIV response.

At the same time, a licensing announcement is only the beginning. Access commitments must be transparent, time-bound, adequately financed, and accountable. Women, AGYW, key populations, people living with HIV, and community-led organisations should have meaningful influence over licensing transparency, pricing, regulatory planning, product introduction, demand creation, service delivery, implementation, and monitoring. Countries excluded from voluntary licensing arrangements, including middle-income countries and countries hosting clinical trials, should not be left behind. Prevention access should be driven by public health need, not income classification alone.

Experience has shown that access depends not only on licensing but also on implementation readiness. Regulatory preparedness, provider training, procurement planning, market shaping, community literacy, demand creation, differentiated service delivery, and sustainable financing should advance well before product approval so that countries are prepared to introduce new prevention options without unnecessary delay. The HIV prevention community should not repeat the years-long introduction gaps experienced with previous innovations.

Importantly, much of this foundation already exists. Through collaborative initiatives, partners have already developed global demand forecasts for next-generation HIV prevention products, including once-monthly oral PrEP, alongside country readiness assessments, market intelligence, and implementation planning tools. These resources provide governments, manufacturers, donors, and procurement agencies with an opportunity to accelerate equitable introduction rather than starting from scratch. They should be leveraged to guide investment, procurement planning, and product rollout from the earliest stages.

The introduction of Alimatravir also presents an opportunity to further democratize HIV prevention by expanding meaningful prevention choice. Every person should have access to the prevention option that best fits their lives, preferences, and circumstances. Achieving this will require moving beyond product availability toward person-centred delivery models supported by community engagement, differentiated services, prevention literacy, and sustainable financing.

We call on MSD, global health partners, donors, governments, regulators, regional procurement mechanisms, and implementing partners to continue working together to ensure that Alimatravir, if proven safe and effective, is introduced through people-centred, women-centred, and community-led programmes. This includes early regulatory submissions, fair and transparent pricing, sufficient generic supply, investment in community literacy and demand creation, sustainable market shaping, provider readiness, and differentiated delivery models integrated within sexual and reproductive health services, youth-friendly services, and programmes serving AGYW, sex workers, men who have sex with men, transgender people, people who use drugs, pregnant and breastfeeding women, and other key and vulnerable populations.

We further urge African governments, regional institutions, donors, procurement platforms, and global partners to begin preparing now for equitable introduction. This includes strengthening regulatory systems, investing domestic resources, supporting African manufacturing, protecting human rights, and embedding community accountability throughout planning, implementation, monitoring, and evaluation. Governments and partners should also invest in introduction readiness, procurement forecasting, provider preparedness, and implementation monitoring while leveraging existing demand forecasts and country readiness tools to accelerate access. Community-generated evidence and community-led monitoring should complement national reporting to identify implementation barriers early and support continuous improvement.

As coalition partners, we stand ready to contribute to this next phase of HIV prevention. Together, our organisations bring expertise in demand forecasting, market shaping, country readiness, prevention literacy, community accountability, implementation support, and monitoring. We are committed to working alongside manufacturers, governments, procurement agencies, donors, regulators, and communities to ensure that scientific innovation translates into equitable public health impact.

The message from African women and communities is clear: prevention choice saves lives. No single prevention product will meet every person’s needs, and no prevention strategy will succeed if it excludes those most affected by HIV. Alimatravir has the potential to become an important addition to the HIV prevention toolbox, but only if equitable access is built from the beginning through partnership, implementation readiness, accountability, and sustained investment.