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Mr McKinnell,
President Mbeki,
Colleagues,
For global health, the last year has been one of
extraordinary opportunity. The landscape in which we are working has
begun to change in fundamental ways.
As a result of these changes we meet at a time of
unprecedented international political support for reducing poverty.
And at a time when health occupies centre stage in the development
arena. It is increasingly accepted as one of the most powerful
strategies to transform the lives of poor people.
We know that the poor suffer disproportionately
from the ravages of communicable diseases. In 1998, communicable
diseases were responsible for about 34% of the total burden of disease
world-wide, but nearly twice that - 64% - among the fifth of the
global population living in countries with the lowest per capita
income. Most of these diseases can be prevented or easily cured with
available vaccines and drugs, but poor countries and poor people
cannot easily gain access to them.
We know too that HIV/AIDS, TB and malaria are
themselves major causes of poverty. The success or failure of
our collective response to these threats is critical. It holds the key
to the economic and physical security - not just of individuals and
communities - but of nations and continents.
HIV/AIDS is a particular challenge: in terms of
resources, infrastructure, equipment and access to medicines. The
pandemic is running ahead of us, and the level of the international
response is way below what is needed. The matter is urgent, we cannot
afford to waste time.
We are all feeling the pressure: governments in
countries with high disease burdens and low budgets; UN agencies,
funding institutions and donor countries, and you in the health care
industry.
On the other hand, we cannot ignore the reality
that today’s essential drugs are not an ordinary commodity. Access
to health care is a human right and governments and the international
agencies have the moral obligation to work ceaselessly until this is a
reality. Access to drugs is part of this obligation.
The industry has made admirable efforts to live up
to this obligation through drug donations, and limited price
reductions. Well-conceived and appropriately managed drug donations
save lives and improve health. These have made valuable contributions
to the fight against diseases such as lymphatic filariasis,
onchocerciasis, leprosy and malaria.
Drug donations contribute to health in the
short-term. And they may make the critical difference for time-limited
disease eradication programmes. But for most diseases we need to think
about more sustainable solutions.
The aim of donations has always been to do good,
while retaining the existing pricing and marketing structure. One of
the most ambitious collaborations ever initiated by the industry and
the UN agencies to increase access to care, the Joint Effort to
Enhance Access to HIV/AIDS-related Care, has shown some of the
opportunities and also the inherent weaknesses in this kind of an
approach.
Six months into this significant experiment, we
could sum up the situation as follows: HIV/AIDS care is now firmly on
the global agenda; several significant price reductions and drug
donations have been announced; in some countries support for HIV/AIDS
care has been intensified; there is greater interest on the part of
funding agencies to finance AIDS care initiatives; and the endeavour
has helped further the public debate on the relationship between
international trade agreements and health.
Yet, the Joint Effort has not been without
controversy.
On one hand it has certainly raised expectations,
but it has also exposed our limited capacity to support and respond to
countries that seek assistance. We all have a role to play - agencies,
industries and countries - in enhancing the global capacity to
respond.
In many countries, AIDS care was never on the
agenda because it was generally accepted that it was too expensive.
This has now changed - and Ministries of Health are having to face
some very tough choices about the use of public funds.
The endeavour has highlighted the fragmented nature
of many of our efforts to provide care to people living with HIV and
AIDS. And shown the need for comprehensive and user-friendly standards
and tools for developing better policies and programmes.
It has put the spotlight on the need for more
openness in the way that companies handle pricing, donations and
negotiation with countries.
We now need to see this endeavour in a broader
framework: enhancing co-ordination and harmonizing similar initiatives
around a core set of shared goals and values: tailored, of course, to
the specific needs of individual countries.
This will mean improving our communication with
stakeholders and the public at large about what we are jointly trying
to achieve. We have to be crystal clear that our joint efforts are
about enhancing access to all aspects of HIV/AIDS-related care and
support, and that they are linked to prevention. We are not merely
focusing on reducing the price of antiretrovirals.
Looking at access to essential drugs and vaccines
in general, I believe the past year has shown that there is an
unstoppable political - and an increasing commercial - force that
points toward a change in the way drugs are priced for those countries
with the least financial resources and the greatest need.
WHO, UNAIDS - and through the recent WHO-IFPMA
Action Paper, the pharmaceutical industry - have all recognized that
access to essential medicines needs to be seen as a table with four
legs. These four legs are: rational selection, reliable supply
systems, sustainable financing, and affordable prices. No matter how
strong one or two legs - all four must be in place to ensure equitable
access to medicines. This four-part framework requires that we respect
the roles and responsibilities of all the different actors.
Ensuring rational selection and building reliable
supply systems are the responsibility national public, private and
not-for-profit health services. WHO and its partners can assist, but
the responsibility rests within countries. In the area of sustainable
financing, there have been some very strong indications from the G8
and European Commission that we may see dramatic increases in support
for countries most in need.
It is on the issue of affordable prices, that the
world is looking to us - the health care industry and WHO.
As I see it the challenge is this: how can we make
sure that low income countries can purchase essential medicines at
prices they can afford? And, in the case of on-patent medications, how
best to contribute to equitable access through enlightened pricing
strategies?
We know some of the things that it will take to
make more equitable pricing work in practice. We have to protect
patent rights. We need them to ensure the R&D will yield badly
needed new tools and technologies. We need mechanisms to prevent
re-export of lower priced drugs into richer economies. We must also
recognize the concern of companies that lower prices in the developing
world not be used as a lever to influence negotiations in countries
that can easily afford to pay more.
In sum, I believe that together we can use the
provisions of the existing TRIPS agreement, and combine these with
novel ways of offsetting the financial risks of R&D. Creative
solutions for a more equitable and prosperous world. That must be our
goal. Such a shift will not only benefit the health of the one third
of the world that cannot access essential drugs. It will be equally
beneficial for the health of the health care industry itself. Are
there ways in which WHO can work with you to make this happen and so
contribute to equitable access? To more people in more countries
deriving real benefits. To ensuring that these benefits are evident to
all, transparently and clearly?
Thank you. |
