Executives,
Colleagues,

Welcome. I am delighted that I am able to meet with you today in the company of the Regional Directors from WHO's six regional offices. I am pleased, too, that so many senior people from the pharmaceutical industry have joined us here for this meeting. Like you, we consider that these roundtable events are most important. Today, I want to start with a focus on the challenge of the millennium: poverty.

There is new data about the extent to which ill-health is impacting on the economy of many communities and nations, particularly in Africa. We now know that a few diseases, such as malaria, HIV/AIDS, tuberculosis, the traditional childhood killers and reproductive health conditions, are directly biting into the economic growth of poor countries.

Analysis of data from thirty-one African countries, during the period 1980 to 1995, showed that the annual loss of economic growth due to malaria has been as high as 1.3% per year. If this loss had been compounded for that 15 year period, it means that GNP is 20% lower than it otherwise would have been.

When HIV prevalence reaches 8% in the population - as is the case in at least 21 African countries - per capita growth is reduced by 0.4 percentage points each year. Given that annual per capita growth in Africa for the past three years has averaged 1.2%, this is a significant reduction.

There is an increasing recognition of the sheer difficulty faced by developing nations as they seek economic and social progress. It is becoming clear that health systems which spend less than $ 60 or so per capita are not able to deliver a reasonable minimum of services, even through extensive internal reform. As long as you can’t afford to pay your doctors and nurses proper salaries and fill the shelves with essential medicines and vaccines, a health system will not be performing at a reasonable level.

It should not be like this. A number of health interventions can dramatically reduce mortality from the main killers. Supervised medication regimes for TB; nets impregnated with insecticide against mosquitoes, and wide distribution of malaria treatment among children and pregnant women; prevention programmes for HIV/AIDS – or access to care programmes that can substantially slow down the mortality among those living with HIV. There are many more interventions, proven to be effective on a local or national level.

Quite simply, if we can take these interventions to scale – and by that I mean to a global scale – we have in our hands a concrete, result-oriented, and measurable way of contributing a reduction of poverty.

Heads of State - of developing countries, as well as those of industrialized countries, have established targets for tackling HIV, malaria, tuberculosis and child illness. They have asked for WHO and other organizations of the UN system to do more to help them reduce poverty through effective action against illness. I have called for a massive effort to respond to this challenge.

We need to be clear on the road to follow, and encourage others to join it; we need an agreed framework for thinking and strategy, minimizing the confusion of inconsistency. We need to establish goals and values for our joint action, and ensure that they are shared by the major actors. We need to focus on achieving priority health outcomes among a far larger proportion of the global community - particularly among the nearly 3 billion earning less than $2 per day. And, most of all, we need to show that we have made a difference.

At this stage, a lot of the work lies ahead. But several directions are clear:

• National authorities of developing countries will be stewards of this effort. They have called for it and we in the international community are responding.

• We will build upon existing health or poverty reduction initiatives, scaling them up and bringing tangible benefits.

• We must strengthen health systems. We must also go beyond the traditional health sector – working with people in their homes, their work places, their schools, their community halls and their places of worship.

• We will need stronger partnerships and better mechanisms to channel and disburse more funds in ways that bring clear benefits to poor people.

• We will stimulate development of new drugs and vaccines that can replace those that are threatened by increasing resistance. And break new ground – such as malaria and HIV/AIDS vaccines. We must also work to reduce the prices of medicines so they can become available to all those who need them.

• Finally – and crucially – in order to succeed, substantial new resources are needed. We are talking about the need for sustained, additional financing for 10-15 years.

Current estimates suggest that an additional $1 billion dollars annually will be required to combat malaria effectively. The situation with TB is similar. Another billion dollars annually spent on drugs - linked to work on health systems - could result in a 50% drop in mortality over the next five years. With HIV/AIDS, we need even more. Sums in the order of $ 2.5 billion dollars annually are needed for prevention alone. Add the cost of care, and the figures rise dramatically.

The European Community, G8, other OECD countries and non-governmental organizations are now focusing on a response to this challenge. The European Commission’s roundtable on 28 September represented an important new impetus for improving access to care and promoting health outcomes.

I hope that you will continue to be part of this response, of the ideas and the values of this massive effort towards a common goal for poverty reduction through better health.

One key element of the massive effort is to improve people's access to essential medicines, and to ensure both their rational use, and their quality. It is simply part of the fundamental right to health care.

Four factors are critical:

• appropriate selection and use;

• sustainable financing;

• affordable prices; and

• reliable health and supply systems.

This means producers working to reduce prices; health care managers to improve distribution; policy-makers to influence the equitable financing of medications. Sometimes it is easier to blame others for difficulty than to take action that would make a difference. The massive effort is about trying to find the time and energy to work just a little harder, go further, avoid disputes and achieve results. We can each contribute so much from our own political, technical and economic perspectives.

Colleagues,

We know that there are important factors that influence the ways in which you can work with WHO. For you, a key concern is to maximize shareholder value. We are here together because we know there are ways to combine this goal with that of improving access, of rational use and quality of essential medications; and of finding ways to reduce prices for poor people in poor countries.

The WHO-IFPMA working groups are proof of this. They have provided important impetus - on quality assurance, research and development and improving access. This must continue.

WHO's work in this field is conditioned by the views of our constituency - the governments and peoples of our member states. On that basis we have articulated some of the principles to which we are committed.

We do see patent protection as a necessary and effective incentive for research and development for needed new drugs. But essential drugs are not simply just another commodity. Therefore, patents must be managed in a way that benefit both the patent holders and the public.

We respond to governments' requests for help with enacting national legislation which takes advantage of more open trade and the better regulated international system. Protectionism has never benefited public health. As part of this process, however, governments are incorporating safeguards into their national legislation, such as compulsory licensing. These safeguards are explicit elements of the WTO TRIPS agreement which can be used to protect the public.

Priority-setting for research and development in the pharmaceutical market does not respond to people's health needs. We are delighted with the progress of the WHO-IFPMA Working Group on this subject. We will hear from them this afternoon.

As we discussed last year, equity pricing - or differential pricing - is a valuable means to improve access to newer essential drugs in lower income countries.

We have some extraordinary examples of the potential for public-private partnership to reduce the costs of tackling major public health issues in poor countries. The limitless donation of ivermectin for onchocerciasis control has enabled effective action to reduce suffering from river blindness. The well-being of millions of people at risk of river-blindness has been improved. You and your companies have been involved in similar partnerships to tackle leprosy, lymphatic filariasis, trachoma and fungal infections. These extraordinary actions are having a widespread impact.

Six months ago, you proposed a dialogue on ways to improve access to care for the millions of people living with HIV in developing countries. By now, six months on, we have already seen the price of several antiretrovirals drop in some countries in Africa while there have been substantial donations and care programmes in some other countries. This is good, given the extraordinary complexity of making these drugs widely available.

The access to HIV care initiative is a promising step forward. But this is only a beginning. Let me be clear. We must develop streamlined and transparent "eligibility" processes which allow any country that meet these criteria to benefit. We must also explore how such initiatives can be extended to the non-profit and private sectors which provide the majority of medicines in most developing countries. And I would like to see us build on this precedent to expand beyond antiretrovirals.

HIV/AIDS is not the only area where we have progress in equity pricing. We are also having productive discussions about improving access to combination anti-malarial therapies - and a significant reduction in prices for Co-Artem within developing countries. This joint work has exposed the goodwill and the realization about the future of equity pricing among the pharmaceutical companies.

In short, what we want is to go beyond exceptional examples: we need systemic change.

I would like to see equity pricing automatically applied to all newer essential drugs. We will discuss this issue later this afternoon.

WHO supports efforts to ensure prompt availability of generic medications upon patent expiration. We sense that the competition created by national policies on the use of generic medications increases their affordability and their accessibility. It also stimulates innovation within the research-based industry, and encourages increased production efficiency by the manufacturers of generic preparations. I would hope that there is scope for us to agree on the important impact of policies on the prescribing of generics to improve poorer people's access to effective health care.

During the last year we have witnessed the potential of public-private co-operation for the development of new medicines - for tuberculosis and malaria. We have seen co-operation on the development of new vaccines for children, within the context of the Global Alliance for Vaccines and Immunisation. We have also seen continued joint initiatives on vaccines for malaria and HIV.

I hope that we will now find more opportunities to work together, within the context of the massive effort needed to tackle the health conditions linked to poverty. I recognize that the differences in the objectives and accountability of the research based pharmaceutical industry and WHO mean that joint working is not easy. We are all subject to the continuous scrutiny of WHO's member states, your Boards and shareholders, and NGOs campaigning for increased access to medications. Hence the importance of our continued dialogue, seeking better ways to serve the public good. We have to debate and analyse our differences with care, within an overall environment of trust and understanding fostered by this round table process. I am committed to sustaining it, and to being able to report real benefits that result from our joint efforts. I know that, through working together, we can make a big difference and look forward to another round of useful discussion this afternoon.