Transcript Access to Essential Medicines for HIV/AIDS

Access to essential medicines for HIV/AIDS
update on WHO activities within UN access framework
Peter Graaff
Department of Essential Drugs and Medicines Policy
Department of HIV
World Health Organization
Selection
1. Rational selection and use
2002:
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WHO guidelines for a public health approach to on
scaling up antiretroviral therapy in resource limited
settings : http://www.who.int/HIV
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standardized and simplified regimens
simplified patient monitoring
12 ARVs on WHO Model EML & WMF
2003 (planned)
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Update and prioritization  ? Global stand. 1st line
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Department of Essential Drugs and Medicines Policy
Affordable prices
2. Affordable prices for governments, healthcare
providers and consumers - strategies:
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National policy
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Market dynamics
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exemption from taxes, import duties
price regulation (producer prices, distribution margins)
WTO/TRIPs provisions
generic competition
Procurement management
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price information
patent status and regulatory status
price negotiation
group purchasing (public, NGO - national, regional)
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Department of Essential Drugs and Medicines Policy
Affordable prices
Indicative price information promotes
transparency and competition
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MSH-WHO essential drugs price indicator
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UNICEF, UN-AIDS, WHO Sources and Prices
(selected medicines and diagnostics)
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Pharmaceutical starting materials
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Antiretroviral drugs in the Americas
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AFRO Essential Drugs
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Department of Essential Drugs and Medicines Policy
Affordable prices
Advocacy, corporate responsiveness, &
market forces have reduced antiretrovial
prices >95% in a few years
Annual cost per person for triple therapy (US $)
$12,000
$10,000
$8,000
$6,000
$4,000
UN Drug Access Initiative
Generic competition in Brazil
5-company offer
$2,000
Generic company offer
$0
1991
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Department of Essential Drugs and Medicines Policy
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UNDCP
UNDP
UNESCO
UNFPA
WIPO
Financing
3. Sustainable financing
In over 38 countries public drug expenditures are
<US$2 per capita - inadequate by most estimates
Key actions:
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Increase public funding for cost-effective drugs
Expand drug benefits in health insurance
Seek external funding for the poorest populations (e.g. Global
Fund)
NB: This “leg” of the access table needs to be strengthened
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Department of Essential Drugs and Medicines Policy
Reliable systems
Pilot Procurement, Quality and Sourcing
Project
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Objective:
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Partners:
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Establish a Model Quality Assurance System for
Procurement of Pharmaceuticals
Pre-qualification of suppliers of HIV/AIDS-related
pharmaceutical products
Quality standards of newer HIV medicines
Improved capacity of national regulatory bodies
UNAIDS, UNFPA, UNICEF, WHO, World Bank
Products:
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50 ARVs, 44 mono, 5 double and 1 triple combination
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Department of Essential Drugs and Medicines Policy
New developments …….. 3x5
Scale up access to ARV to 3million by 2005
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300,000 out of 6,000,000 who should be on
treatment in the developing world receive ARVs
(Africa: 50,000 out of 4,000,000)
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22/09/03 emergency declaration
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01/12/03 World AIDS day. Present implementation
plan to include:
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Intensified country support (priority countries)
Tools (simplified) to move beyond capital and medical
doctor
“AIDS drug and diagnostic facility”
……..
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Department of Essential Drugs and Medicines Policy
4. Summary
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UN, WHO and partners are active in all aspects of
access to HIV/AIDS medicines
Key tools available to governments and NGOs:
Treatment guidelines and essential medicines list
 Price information
 Pre-qualified suppliers and products
 Patent status and regulatory status
 Guidance on use of TRIPS safeguards
 Policy and training tools in supply management
(pricing, donations, procurement and supply management)
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3x5 should “affect” us all
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Department of Essential Drugs and Medicines Policy