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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