Timothy Hildebrandt is associate professor of social policy and development at the London School of Economics and Political Science

In a ruling last week, the high court overturned the drug patent extension for Truvada, a highly effective anti-HIV drug, opening the door for generic versions of the pre-exposure prophylaxis (PrEP) drug to be made available in the UK at a fraction of the cost. The hope of many sexual health campaigners is that this lower price will compel NHS England to provide full access to the drug.

Despite large studies in the UK and worldwide that have demonstrated its effectiveness in preventing HIV and research showing how access to it could save billions of pounds in lifetime treatment costs for those newly infected with HIV, in June 2016 the NHS decided it would not fund the drug. While the high court overturned this decision just months later, NHS England continued to drag its feet. Claiming that issues around large-scale PrEP implementation were not sufficiently understood, another trial – involving 10,000 individuals over three years – was launched .

That trial was led by a charity, St Stephen’s AIDS trust, in keeping with the government’s move toward contracting more public service provision to charities and other third-sector organisations. But as has been shown elsewhere, such “big society” arrangements are not foolproof: just months into the trial, St Stephen’s suddenly closed amid reports of financial concerns, jeopardising PrEP access for thousands of participants.

In light of this, and the countless medical studies demonstrating unmatched protection from HIV, and now two high court rulings, NHS England has nearly run out of excuses for not providing wider access to PrEP. The only remaining obstacle seems to be its fears that funding the drug will lead to a public outcry.

Such fears are not unfounded. Debates during the EU referendum demonstrate how public reverence for the NHS has taken on a protectionist quality; promises to redirect £350m a week from the EU to the health service were central to the leave campaign’s victory in the June 2016 vote. Read more via Guardian