Micro-contributions on telecommunications could fund antiretroviral drugs

2016-07-26 11:30

The 21st International AIDS Conference (AIDS 2016)—the largest conference on any global health or development issue—was held in Durban last week.  This year’s theme was “Access Equity Rights Now” and it was a call to action to work together to reach those people who still lack access to comprehensive treatment, prevention, care and support services.  The conference attracted about 18 000 delegates from around the world, including 1 000 journalists.

There are some 36.7 million people worldwide living with HIV/AIDS, mainly in sub-Saharan Africa.  More than 60% of those living with HIV remain without antiretroviral (ARV) therapy: women and girls, men who have sex with men, transgender people, sex workers, young people, people who use drugs, and other marginalised groups.  Of particular concern are the more than 2 000 young people under the age of 24 in sub-Saharan Africa who are newly infected every single day and almost half of the people living with HIV who are undiagnosed.

Referring to Africa’s huge young population entering the risky age for catching the disease, billionaire philanthropist Bill Gates warned: “If we fail to act, all the hard-earned gains made in HIV in sub –Saharan Africa over the last 15 years could be reversed.

The United Nations has set a target of ending the AIDS pandemic by 2030 and the Secretary-General, Ban Ki-Moon has said: “As a global community, we must move quickly and decisively towards achieving the targets that will help us finally bring this epidemic to an end.”

By working with intellectual property holders and sharing intellectual property, the UNITAID-founded Medicines Patent Pool (MPP) brokers public health licences on HIV medicines and has enabled the development of appropriate fixed dose combinations and children’s formulations sorely needed in countries with limited resources.

Partnership and Innovation is a key concept for success.  The MPP has signed licencing agreements with six patent holders: AbbVie, Bristol-Myers Squibb, Gilead Sciences, the US national Institutes of Health, MSD and ViiV (a joint venture among GlaxoSmithKline, Pfizer and Shionogi) covering twelve priority antiretroviral drugs and the organisation is managing more than 50 medicine development projects.

The MPP’s voluntary licences and access agreements are specifically designed to improve public health outcomes and are very different from bilateral business originator-to generic deals. These agreements are broad in geographical scope enabling:

  • the manufacture of generic medicines and their sale in countries where 87% to 93% of people with HIV in the emerging countries live
  • the incorporation of a series of unique conditions favourable to public health conditions two examples of which are options for technology transfer and waivers for data exclusivity.

What has resulted from all this hard work and initiative is access, speed and innovation.

Access: The MPP has focused on the key regimens that the World Health Organisation (WHO) recommends as the preferred treatment for people living with HIV and seeks to spur competition among low-cost manufacturers to bring down prices on existing HIV medicines.

Speed: By licencing promising ARVs immediately after approval or in late-stage development, the normal 5 to 10 year timeline for the delivery of generic versions of these medicines to emerging countries has been cut dramatically.

Innovation: The MPP’s mandate also includes a focus on speeding up the development of new fixed-dose combinations and better adapted formulations specifically for infants and children.

The above shows what can be done to level the playing fields in the provision and access to quality medicines.  However, the “old bugbear”—how to finance these initiatives still remains.  The creativity in the procurement and supply of medicines for emerging countries must be matched by creativity in financing these goals—this is of the utmost importance.

If we are to meet the challenges that lie ahead, we will need to maximise all three sources of development finance—assistance, investment and domestic resources.

One secure and sustainable way of providing the revenue is to focus on domestic resources and Innovative Financing for Development (IFD) to determine new sources of revenue and manage, leverage and protect these revenues—at the same time lessening the dependence on external aid.

There are a whole range of potential revenue-creating opportunities that could be explored.  Micro-contributions on telecommunications and money transfers are funding many different projects in a variety of fields in emerging countries who have harnessed the power of IFD.  The revenues from IFD mechanisms generated in this way could be used to fund comprehensive treatment, prevention, care and support services and the purchase of antiretroviral drugs.

UNITAID, a global novel financing mechanism, together with the Global Fund and the United States President’s Emergency Plan for AIDS Relief (PEPFAR) that raises funding through a micro-contribution on airline tickets has drastically changed the lives of people living with HIV.  But what about the estimated two million people with HIV/AIDS who still do not have access to the medicines they need?

When we look at the enormous success of the UNITAID initiative, I believe we cannot but acknowledge the power of Innovative Financing for Development in generating revenue for socio-economic development: health, education, water supply, infrastructure, electricity and security.  Revenues from IFD mechanisms could be ploughed into supporting emerging governments to provide access to AIDS prevention and treatment programmes and the provision of vital antiretroviral drugs.

I am convinced that we no longer have a choice in this matter.  We can no longer sit on the side lines or on the fence with regard to the HIV/AIDS pandemic.  If we fail to answer the call to action to provide appropriate support for those with this dreaded disease now, this will end up affecting us all.  The time to act is now.

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