UNITAID
An innovative mechanism for scaling up
access to medicines and diagnostics for
HIV/AIDS, tuberculosis and malaria
Jorge Bermudez, Executive Secretary, UNITAID
WHO/UNICEF Technical Briefing Seminar on Essential Medicines Policies,
18 November 2009, Geneva
Innovative mechanisms: a long way forward
 Building the way
 The Leading
Group on
Innovative
Financing (Paris
Conference 2006):
 Sixth plenary
session of the
Leading Group
2000 - The Millennium Development Goals
2002 - Monterrey International Conference on
Financing for Development
2004 - The Global Action against Hunger and
Poverty
2005 - New York Declaration on Innovative
Sources of Financing for Development
55 member countries and 3 observer
countries, major international organizations
and NGOs
– a platform for discussion and promotion
of innovative financing
New resources,
New sectors,
New mechanisms
(Proof by example: why expand
innovation?). Paris, 28-29 May 2009
A global challenge for Health…
Medicines are in the North,
patients in the South
Less developed countries represent:
84% of the world population
Less than 11% of the global
health expenditure
More than 93% of the disease
burden globally
UNITAID's role within Global Health System
• Aligns with major internationally-agreed goals, such
as the Millennium Development Goals
• Complements work of other global health actors
• Funds and works through Implementing Partners
engaged in improving access to health products
• Engages with NGOs and civil society to ensure that
the needs of patients and communities are met
• Ensures partners work meets country demand and
procedures and aligns with national health systems
Rationale: Why UNITAID?:
• Strategically deployed funds in time-limited
interventions
• Credible funding commitments necessary for
sustained market impact
• Targeted interventions in global markets to improve
patient access to health products
• Leverage investments to produce global public goods
that generate positive externalities
• Ability to transition at the end of the project is essential
to ensure sustainability
Five founding countries (September 2006)
Official signature of the five founding countries when UNITAID was launched,
on 19 September 2006, at the United Nations General Assembly, New York
UNITAID membership
From 5 founding
countries (2006):
Brazil, Chile, France,
Norway, UK
Now (2009):
supported by 29
countries and the
Gates foundation
5 further countries in the final
stages of negotiation and to
join shortly
Resource Mobilization:
• Funding from multiple countries from both North and
South
• Predictable funding gives UNITAID flexibility to respond
quickly
• UNITAID will pursue measures that increase funding
through
– Strengthen donor commitments
– Increased number of country contributors
– Support the Voluntary Solidarity Contributions on airline tickets,
through the Millennium Foundation
Long term financing = commitment to projects = ability to impact markets
A flexible 'air tax' approach
Mission, Goals & Objectives:
Mission
UNITAID’s mission is to
contribute to scaling up
access to treatment for
HIV/AIDS, malaria and
tuberculosis, primarily for
people in low-income
countries, by leveraging
price reductions for quality
diagnostics and
medicines and
accelerating the pace at
which these are made
available.
[Constitution]
GOAL
Using innovative, global
market based approaches
to improve public health
by increasing access to
quality products to treat,
diagnose and prevent
HIV/AIDS, tuberculosis,
malaria and related comorbidities in developing
countries.
Objectives
To increase access to
efficacious, safe and
assured quality products
that address Public Health
problems
To support adaptation of
products targeting specific
populations
To ensure affordable and
sustainably priced
products
To assure availability in
sufficient quantities and
timely delivery to
patients
93 countries already receive UNITAID support…
HIV / AIDS
49 recipient
countries
Malaria
29 recipient
countries
- Pediatric ARV
- Second line ARV
-PMTCT
- ACT
- LLIN
- AMFm
US$476 m
US$318 m
- Cross cutting programs:
Tuberculosis
72 recipient
countries
-
First line TB
Paediatric TB
MDR-TB
Diagnostics
US$211 m
US$109 m for PQ of drugs & diagnostics and transversal programs
UNITAID funded projects worldwide
Tuberculosis
Malaria
HIV/AIDS
3
0
9
24
4
6
Europe
6
0
2
North Africa and the
Middle East
7
0
2
Sub Saharan Africa
32
25
29
Total
72
29
49
Americas
Asia
Refining current strategy
Identify Public
Health problems
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Public health impact?!
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Additional
Complementary
Efficient
Globally equitable
Pro-health approach to
intellectual property
Transparent
Effective
Flexible
Innovative
Forward looking
Identify Market
shortcomings
- Propose interventions to address market shortcomings
- Assess the Expected Market impact
Deliveries by the end of 2008
QUANTITIES
DOLLAR VALUES
Number of treatments delivered
Update end 2008 - WB income classification
LI
HIV/AIDS
TB
404,443
Malaria
889,398
LMI
Dollar amount
UMI
$ Value
Total
64,680
10,817
479,940
HIV/AIDS
91,673
11,277
992,348
TB
Malaria
10,049,374
259,276
0
10,308,650
Malaria
Total
11,343,215
415,629
22,094
11,780,938
Total
148'968'528
28'559'294
9'865'711
US$ 187'393'532
Better products at lower price
Pediatric ARVs
Before:
Single dose syrups
16 bottles of syrup monthly
US$ 200 per patient per year
Now (partnering with CHAI):
Fixed dose combination
3 tablets a day
US$ 60 per patient per year
Better products at lower price
Tuberculosis
• A rotating stockpile that treats 5800 patients a year
• New faster diagnostics
that can detect MDR-TB
in just two days
(previous test
took six weeks)
Better products at lower price
Malaria
• Investing in prevention with long lasting insecticide
treated bed nets
• Provision of ACTs
at lower costs
• UNITAID's recent
commitment to the
AMFm
What is a Patent Pool?
What is a Patent Pool?
Portfolio of patents and other relevant IP held by various
actors made available on a non-exclusive basis to third
parties, (e.g. generic manufacturers) against the payment
of royalties.
Patent Pools come in different shapes and forms and
are set up for different purposes
While we learn from existing 'standards' pool, the ARV
Patent Pool Initiative is quite different
History of Medicines Patent Pool
2006
2008
2009
CIPIH 2006
recommendation:
"Patent pools of upstream
technologies may be
useful in some
circumstances to promote
innovation relevant
to developing countries.”
May 2008
WHO Global Strategy and
Plan of Action included
Patent Pools
Currently working on
a full implementation plan.
and
proposed to UNITAID to
set up a medicines patent
pool.
July 2008
UNITAID EB
‘Green light 'to establish a
medicines patent pool
Patents on New ARVs
Product
+/- Expiry date
Atazanavir (Novartis)
2017
Darunavir (Tibotec)
2023
Etravirine (Tibotec)
2019
Fosamprenavir (GSK)
2018
Raltegravir (MSD)
2025
Ritonavir hs (Abbott)
2024
Tenofovir DF (Gilead)
2018
Maraviroc (Pfizer)
2019
21
President Obama on humanitarian licensing
• Increase Access to Affordable Drugs: Barack Obama and Joe
Biden believe that people in developing countries living with
HIV/AIDS should have access to safe, affordable generic drugs to
treat HIV/AIDS. They will break the stranglehold that a few big drug
and insurance companies have on these life-saving drugs. They
support the rights of sovereign nations to access quality-assured,
low-cost generic medication to meet their pressing public health
needs under the WTO’s Declaration on Trade Related Aspects of
Intellectual Property Rights (TRIPS). Barack Obama and Joe Biden
also support the adoption of humanitarian licensing policies
that ensure medications developed with U.S. taxpayer dollars
are available off-patent in developing countries.
22
http://www.barackobama.com/pdf/issues/FactSheetAIDS.pdf
Similar thinking in different settings…
• “On the part of rich countries,
there is excessive zeal for
protecting knowledge through an
unduly rigid assertion of the right
to intellectual property, especially
in the field of health care.”
–
–
*“Encyclical Letter Caritas In Veritate Of The Supreme Pontiff Benedict XVI To The Bishops Priests And Deacons Men
23 And
And Women Religious The Lay Faithful And All People Of Good Will On Integral Human Development In Charity
Truth,” June 29, 2009.
http://www.vatican.va/holy_father/benedict_xvi/encyclicals/documents/hf_ben-xvi_enc_20090629_caritas-inveritate_en.html.
Take the Plunge!
–(…)
–Today patent pools are a
favoured system in
technology sectors that
require common standards,
such as the MPEG-2, DVDvideo, DVD-ROM and radio.
Medicines, though, are
trickier terrain.
–(…)
–UNITAID may be able to pull
it off with some luck and lots
of hard work. (…) They have
a delicate and onerous task
before them. Millions of
people are waiting hopefully
at the patent poolside."
–Latha Jishnu/ New Delhi July
23, 2008
What next?