Even though he avoided limelight throughout his life, last week he was a headline in all Kolkata newspapers including The Statesman. And, in all international newspapers earlier in the month. John C. Martin, 1951-2021, was widely known for his scientific contributions and widely respected for his contributions to humanity. The John C. Martin Center for Liver Research and Innovations was inaugurated on December 11 in Sonarpur, West Bengal, as the R&D arm of the Liver Foundation, West Bengal.

The establishment of this Centre was made possible by a generous philanthropic grant from the Science Foundation that also bears his name. Gilead Sciences, a USA-based biotechnology company of which John Martin was the CEO for 20 years and later the Chairman of its Board of Directors created a drug that the reputed journal Science has named as its 2024 Breakthrough of the Year. Since 1988, World AIDS day is celebrated on December 1 to honour the 32 million people who have died from acquired immunodeficiency syndrome (AIDS) related illnesses. The human immuno-deficiency virus (HIV) causes AIDS. There is no vaccine to prevent HIV infection. The Centers for Disease Control and Prevention (CDC) published its first scientific report describing AIDS on 5 June 1981. At that time and in the early years of the HIV/AIDS pandemic, a HIV diagnosis was widely considered to be a death sentence. Throughout the 1990s, AIDS-related deaths increased.

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It peaked in the mid-2000s, with nearly 2 million deaths annually. After then, the number of deaths steadily declined. HIV still infects over 1 million people annually. Great strides have been made in treating HIV. Gone are those days when a HIV infection meant rapid weight loss and rampant infections resulting from a decimated immune system caused by HIV. Gilead Sciences discovered an injectable drug, Lenacapavir, that can be used as longterm pre-exposure prophylaxis (PrEP); that is, to guard against disease after infection if taken before infection. Earlier in 1996, researchers had shown that cocktails of some drugs could suppress HIV and prevent development of AIDS.

Current antiviral drugs are even more powerful. They not only allow treated HIV-infected individuals to live for a long time with mild symptoms of disease, but also prevent others from getting infected; “treatment as prevention.” In 2012, with its approval in the USA, Gilead transformed the treatment landscape with the world’s first oral PrEP pill, which combined three HIV drugs into a single pill. The PrEP pill offered protection. More PrEP pills followed from Gilead, with increased power to protect. “We must continue to innovate to make our own products obsolete,” was what John Martin preached in Gilead. In men who have sex with men, the PrEP pills helped drive new HIV infection to near-zero. However, high costs limited the access to the PrEP drugs.

Low- and lower middleincome countries were hit the hardest, accounting for more than 95 per cent of new infections. Martin became increasingly aware that it is not sufficient to develop innovative medicines to improve public health. He invested in Gilead’s initiatives that promoted prevention, the strengthening of healthcare systems’ infrastructure, education, and financial support to the most vulnerable communities around the world. Lenacapavir is an injectable drug that protects people for six months with each injection. Such long-lasting drugs are impactful because infected people often forget to take pills that need to be taken daily or weekly. Lenacapavir is an outcome of basic scientific research. The HIV has some proteins, called capsid proteins, that provide protection to the genetic materials of the virus.

At first, the capsid proteins were not considered to be “druggable” targets, but new research showed this to be untrue. Lenacapavir blocks capsid’s interactions with other proteins and does more to prevent the formation of new viral particles. A large efficacy trial among adolescent girls and young women in Africa has shown that Lenacapavir is 100 per cent efficient; it reduces HIV infections to zero. Doubts on this astonishing result were removed when a similar trial conducted three months later across four continents reported 99.9 per cent efficacy in gender diverse people who have sex with men.

This year, Gilead Sciences has signed agreements with six pharmaceutical manufacturers to make and sell generic lenacapavir in high-incidence, resource-limited countries. One of these manufacturers is Dr. Reddy’s Laboratories in India. Even after his death, John Martin’s vision for equitable access to medicines, especially that life-saving treatments should be available to those in need, lives on in the company to which he provided steadfast leadership for many decades.

(The writer is National Science Chair, Government of India.)