Select Committee on International Development Minutes of Evidence

Letter to the Chairman of the Committee from Mr James Cochrane, Executive Director, Glaxo Wellcome plc

  Thank you for your letter of 7 December to Sir Richard Sykes, who is now out of the office until the New Year.

  You enclosed a newspaper article about the supply of AIDS treatments to developing countries and asked about Glaxo Wellcome's policy in this matter. The article is all too typical of unsatisfactory media coverage of this issue and I welcome the opportunity to set the record straight.

  You may recall that I gave oral evidence to the International Development Committee on 29 June about Glaxo Wellcome's response to the HIV/AIDS crisis in the developing world. I enclose a copy of our written evidence for ease of reference. In this, and at the hearing, we drew attention to the new public-private partnership to accelerate access to care and treatment for HIV/AIDS. (It is now known as the Accelerating Access Initiative or AAI). I am pleased to report that the initiative has made significant progress since it was announced on 11 May.

  The Accelerating Access Initiative is facilitated by UNAIDS, working with WHO, World Bank, UNICEF and UNFPA and with five research-based pharmaceutical companies—Boehringer Ingelheim, Bristol-Myers Squibb, Glaxo Wellcome, Merck & Co, Inc and F Hoffman-la Roche. Its aim is to increase sustained access to appropriate, good quality interventions, through the establishment of new alliances involving committed governments, industry, the UN agencies, development organisations, NGOs and people living with HIV/AIDS.

  Real progress has been made in turning the May announcement into action in a number of countries. Sixteen countries have so far formally sought information or expressed interest in participating in the endeavour. They are Burkina Faso, Burundi, Botswana, Cameroon, Central African Republic, Chile, Cote D'Ivoire, Ethiopia, Gabon, Kenya, Nigeria, Swaziland, Senegal, Uganda, Ukraine and Zimbabwe. Other countries have made informal requests to the UNAIDS secretariat. While the first expressions of interest have come largely from African countries, the involvement of developing countries in other regions is also strongly encouraged.

  The UNAIDS secretariat and WHO have arranged missions to Swaziland, Uganda, Kenya, Gabon and Senegal to review the options for these countries to improve access to HIV/AIDS care and treatment under the initiative. Country Action Plans have been developed by Swaziland, Uganda and Senegal. Swaziland is focusing on a broad, comprehensive approach to HIV care, including voluntary counselling and testing, and psycho-social support.

  On 23 October, the Government of Senegal announced that it had reached agreements with Boehringer Ingelheim, Bristol-Myers Squibb, Glaxo Wellcome and Merck which would enable it to increase eight-fold the number of patients able to receive triple combination anti-retroviral therapy by 2003. The Government will be able to offer a wide range of therapeutic choices to patients and their physicians at costs which are competitive with those offered elsewhere by generic manufacturers, while guaranteeing quality and reliable supply. A copy of the Government's announcement is enclosed[13].

  In addition, the Ugandan Minister of Health announced on 2 December that his Government had concluded agreements with a number of the companies participating in the Accelerating Access Initiative which will facilitate an immediate increase in access to anti-retroviral treatments.

  These developments are clearly encouraging and demonstrate the value of the initiative. Similar discussions are under way with a number of other developing countries, and further announcements are likely to be made over the coming months.

  Accelerating access to HIV care, support and treatment is a complex challenge requiring the involvement of many stakeholders from a variety of disciplines. UNAIDS has established a Contact Group in order to provide a forum for representatives of governments, people living with and affected by HIV/AIDS, non-governmental organisations and other interested parties, including the pharmaceutical industry, for consultation and to exchange information and views. The Contact Group also provides advice and guidance to the UNAIDS secretariat, WHO, UNICEF, UNFPA and World Bank on principles, policy and practice relating to the accelerating access endeavour. A first meeting of the Group took place on 29 September, and a second took place on 13 December.

  Our experience of the initiative over the past seven months confirms our view that partnership involving all the appropriate stakeholders represents the most effective response to the HIV/AIDS crisis in developing countries. Collaborations involving national governments, UN agencies, NGOs, local communities and industry are complex and demanding but, as the examples of Senegal and Uganda show, they can deliver real progress.

  The Independent article failed to mention the AAI, and it also gave a misleading impression of the situation in South Africa. The actual position there is as follows.

  The local pharmaceutical industry association, the PMA, has initiated legal proceedings challenging certain provisions of proposed South African legislation allowing the Minister of Health to abrogate patent protection for pharmaceuticals. The grounds of the litigation address the legislation's incompatibility with South African intellectual property law and with South Africa's obligations under TRIPS. We do, of course, recognise that such litigation is, in principle, undesirable, and that is why we have supported a series of attempts to reach a negotiated agreement with the Government. In September 1999, the PMA voluntarily suspended the litigation following the Health Minister's announcement that the legislation in question was to be amended. Unfortunately the Minister rejected the suspension and insisted that the litigation should either be withdrawn or pursued. In the absence of any assurances from the Government regarding the provisions threatening intellectual property protection, the PMA felt obliged to resume its legal action earlier this year.

  In our view, the litigation is a symptom, rather than the cause, of the lack of a constructive partnership between the South African Government and the pharmaceutical industry. The real impediment to dialogue lies in the belief of some close to the South African Government that the key to addressing South Africa's public health problems, and in particular its AIDS crisis, lies in compulsory licensing and parallel importation. A further illustration of the Government's thinking regarding its preferred sourcing structure has been given by the Health Minister's suggestion that the aim should be to secure supply from South African sources. Glaxo Wellcome believes that none of these ideas can create supply sources that compare with those available to the South African Government under the Accelerating Access Initiative, in terms of availability, cost, quality and reliability. The partnership approach being piloted in the initiative provides the best way forward on the critical issue of HIV/AIDS.

  The agreements struck with the Governments of Senegal and Uganda demonstrate that the Initiative is already working. South Africa faces many challenges in terms of putting in place effective systems of distribution and medical surveillance that are an essential complement to the supply of medicines, but it is better placed than most countries of sub-Saharan Africa. It is a great pity that, to date, the South African Government has declined to express to UNAIDS any interest in participating in the Accelerating Access Initiative, unlike many other African governments. Nevertheless Glaxo Wellcome is keen to work in partnership with the South African Government to improve access to treatments for HIV/AIDS.

  Please do not hesitate to let me know if you would like any further information on these important issues.

Mr James Cochrane,
Executive Director, Glaxo Wellcome plc
December 2000

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