Memorandum submitted by Glaxo Wellcome
plc
As a leading researcher and provider of treatments
for HIV/AIDS, Glaxo Wellcome is acutely aware of the growing epidemic
in Africa and other parts of the developing world, and of our
responsibilities in responding to it. In developed countries,
well-resourced prevention campaigns have stabilised and in some
cases reduced HIV infection rates. Sophisticated combination antiretroviral
therapy is dramatically reducing the number of deaths from AIDS.
The challenge now is to find ways of closing the gap in HIV infection
rates and AIDs deaths between rich and poor countries.
While there are considerable obstacles to improving
HIV care and prevention in developing countries, we believe that
there is much that can be done now to reduce the impact of HIV.
Our experience over the last decade in helping to tackle these
problems convinces us that a multi-sectoral response involving
the UN, national governments, communities, industry and NGOs is
crucial. For this to be successful, a strong political lead at
the national and international levels is an absolute prerequisite.
Prevention of Mother to Child Transmission of
HIV
One area where there has been some success has
been in the prevention of mother-to-child transmission (MTCT)
of HIV through short courses of antiretrovirals. Since 1996, Glaxo
Wellcome has been collaborating with the international programmes
of clinical trials coordinated by UNAIDS. The results of the first
of these trials have demonstrated the effectiveness of short course
regimens, including Retrovir (AZT) and Epivir (3TC). In January
1998, we announced preferential pricing of up to 75 per cent below
global prices on our antiretrovirals for use in MTCT programmes
in developing countries. We are now supporting the UNICEF-led
international programme in 25 developing countries, providing
free initial start up supplies of 30,000 treatment courses of
Retrovir, as well as working with the UN and NGOs to engage the
support of local communities. In addition, we have worked with
the national governments of other countries to establish similar
programmes, again with the offer of preferential prices, including
Botswana and Burundi. Similarly, in South Africa, we have been
in discussion with the Ministry of Health about such a programme
since 1997. It is estimated that the total cost of a national
programme would be some £9 million a year, of which the drug
cost would account for £2.7 million. So far the Ministry
has declined to implement the programme on grounds of affordability;
but we remain committed to working with the Government to make
such a programme available and sustainable in the South African
context.
UNAIDS Treatment Access Initiative
Glaxo Wellcome is also a founding partner of
the UNAIDS Treatment Access Initiative. The aim of this two-year-old
programme is to evaluate how limited healthcare infrastructure
can be adapted to support standards of HIV treatment found in
the industrialised world. Besides providing financial and technical
support for the establishment of the programme itself, the company
has also made available its antiretrovirals at preferential prices.
However, as the Treatment Access Initiative
has demonstrated, the cost of medicines is by no means the only
barrier to improved care for people living with HIV/AIDS. Political
will to establish the necessary HIV public health context is fundamental.
One of the main successes of the UNAIDS initiative has been the
establishment of National Advisory Boards, which have placed treatments
in the broader context of the country's commitment to prevention
and care. In addition, adequate health infrastructure, including
effective laboratory services, and trained health care professionals
are crucial to ensure the effective use and monitoring of combination
antiretroviral therapy.
New Public-Private Partnership to Accelerate Access
to Care and Treatment
Building upon this experience, in May 2000,
Glaxo Wellcome joined a new multisectoral collaboration with four
other pharmaceutical companies (Boehringer Ingelheim, Bristol
Myers Squibb, Hoffman La Roche and Merck) and five UN agencies
(UNAIDS, UNICEF, UNFPA, World Bank and World Health Organisation),
under the auspices of the International Partnership Against AIDS
in Africa initiative (IPAA). The aim is to find practical and
specific ways of working together more closely to make HIV/AIDS
care and treatment available and affordable to significantly greater
numbers of people in need in developing countries.
The participants have adopted a set of principles
that reflect a common vision of how the HIV/AIDS epidemic can
be more effectively tackled in developing countries: unequivocal
and ongoing political commitment by national governments; strengthened
national capacity; engagement of all sectors of national society
and the global community; efficient, reliable and secure distribution
systems; significant additional funding from national and international
sources; and continued investment in research and development
by the pharmaceutical industry.
The participants in the effort acknowledge that
affordability of HIV/AIDS-related care and treatment is an issue
in developing countries-though only one among many obstacles to
access, including social/political/structural and economic issues,
healthcare financing, physical barriers, and information gaps.
They are willing to work with committed governments, international
organisations and other stakeholders to find ways to broaden access
while ensuring rational, affordable, safe and effective use of
drugs for HIV/AIDS-related illnesses. The companies, individually,
are offering to improve significantly access to, and availability
of, a range of medicines.
Within UN-supported and nationally led HIV prevention
and care programmes, Glaxo Wellcome is now extending its programme
of preferential pricing to include Retrovir, Epivir and Combivir
(the fixed dose combination of AZT and 3TC). The price of a double
combination would be around £1.30 per day. These preferential
prices are offered for use in international partnership programmes
in developing countries which simultaneously address the healthcare
infrastructure and drug distribution aspects which are necessary
to ensure access to safe and effective on-going treatment.
Positive Action: Community Care Support and Education
Improving the quality of HIV care and prevention
also means reducing stigma and discrimination, as well as improving
the social and economic conditions of people living with and affected
by HIV/AIDS. An additional aspect of Glaxo Wellcome's commitment
to combat HIV/AIDS in developing countries is Positive Action,
a long-term programme of community care, support and education.
Since its launch in 1992, Positive Action has collaborated extensively
with HIV community groups and NGOs to help affected communities
to develop effective, sustainable and culturally appropriate responses
to the epidemic. Positive Action jointly developed with the international
HIV/AIDS Alliance (UNAIDS collaborating centre) a three year programme
designed to help developing country community groups to improve
the quality of their HIV/AIDS work and the support given to community
groups by regional and international policy-makers and donors.
The programme is being conducted in Senegal, Burkina Faso, Zambia,
Ecuador, Sri Lanka, Bangladesh and Cambodia. Positive Action is
launching a new initiative to increase the involvement of people
living with HIV in support of the UN-International Partnership
Against AIDS in Africa. Grass-roots community groups will be strengthened
through direct training and technical support from similar groups
in the continent.
Glaxo Wellcome's Response as an Employer
Glaxo Wellcome has operated a global HIV policy
and education programme since 1996; these have been used and adapted
by a number of other international companies. Within Glaxo Wellcome,
the policies have been put into practice in supporting individual
employees around the world who are living with or affected by
HIV/AIDS.
Glaxo Wellcome was a founder member of the Global
Business Council on HIV/AIDS, which was established by the Chief
Executives of 15 international companies in 1997 with the support
of UNAIDS. Through its programme of support for national business
HIV coalitions in developing countries, and advocacy with other
multinational companies, it is seeking to strengthen the response
from the broader corporate sector globally, through workplace
education programmes, care for affected workers, and corporate
responsibility outreach programmes.
Intellectual Property Rights and Access to Treatment
It is sometimes claimed that the current lack
of access to HIV/AIDS care and treatment in developing countries
is caused by the cost of medicines, which itself results from
the intellectual property rights attaching to those medicines.
It is further argued that abrogating those rights would bring
prices down, thereby improving access to treatment.
However, in many developing countries, current
antiretrovirals do not benefit from intellectual property protection.
Generic versions of zidovudine (AZT) are legally available in
countries such as India, and yet the problems of access to treatment
are severe. We believe that in countries which have decided to
make HIV/AIDS a public health priority, companies such as Glaxo
Wellcome can make a significant contribution, through preferential
pricing of our medicines, and as full partners in a broader multi-sectoral
response.
It is essential that the research-based pharmaceutical
industry is recognised as part of the solution. Despite the hope
offered by combination therapy, there is still no cure for HIV/AIDS.
Efforts to develop vaccines must be accelerated. In addition,
industry's extensive research and development capabilities must
continue to be harnessed in order to produce new, easier-to-use
medicines that will be increasingly useful in developing countries.
Our ability to continue to invest in R&D is, however, critically
dependent upon the existence of intellectual property protection.
CONCLUSION
Glaxo Wellcome is committed to playing a full
part in international efforts to combat the HIV epidemic in developing
countries. To this end, we will continue to establish new and
innovative partnerships with UN agencies, governments, local communities
and NGOs.
Glaxo Wellcome plc
June 2000
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