Examination of Witnesses (Questions 700
- 707)
MONDAY 21 APRIL 2008
Dr Jorge Bermudez and Dr Philippe Duneton
Q700 Chairman:
Their argument would be that they have got to have sufficient
money to do the research, and the other side of the argument is
that it is too expensive to deliver the drugs even though you
have brought new money to it, if you like?
Dr Bermudez: We will have that discussion with
them at any stage that we are able to move.
Q701 Lord Avebury:
When we were talking a few minutes ago about the very high cost
of second-line drugs, I was looking at your written evidence where
you said that the cost of the second-line MDR-TB treatments could
be brought down by 20 per cent during the currency of the commitment
of the $20.8 million from 2007-11. Is that based on contractual
discussions with the manufacturers? Is there an advance market
commitment which you are discussing with them? Or would that be
a useful tool to help bring the price down?
Dr Bermudez: Those are initial discussions based
on the current manufacturers' price of the active principle ingredients
and the possibilities of working like we have done with ARVs,
for example, with the cost-plus methodology. All the costs need
to be known and some companies are open to that, but others are
not. Based on that assumption, we would have an estimate of what
the impact would be, but we have not discussed that thoroughly
with the manufacturers.
Q702 Lord Avebury:
Are you thinking about an advance market commitment?
Dr Bermudez: Not in the sense that it is being
used with vaccines currently. That is an open idea that we need
to follow very closely. It has been used in vaccines, but vaccines
and medicines are completely different models because of the time
of development of vaccines, the strains that are necessary, the
specificity of manufacturing. In pharmaceuticals you have a much
shorter cycle, a faster return to manufacturers and it is a completely
different approach. We understand an advance market commitment
as is being done for vaccines will not be discussed relating to
medicines now. It may be a possibility, but we will not say at
this stage we will do something like that.
Q703 Chairman:
You have enormous experience and it is clearly very focused on
what you are doing, but it must have given you a very good picture
of what is happening in the world of disease and treatment and
the international organisations. If you step back from your own
organisation, put that to one side for a moment, and if you were
looking at this whole area, WHO and all the many organisations,
and I asked you what are the problem areas that are not being
covered and what are the real pluses of it, what would your answer
be?
Dr Bermudez: One issue is that phrase that has
been raised several times here—medicines are in the north
and patients are in the south, the imbalance between what has
been manufactured between offer and demand, what has been manufactured,
delivered and what is the potential in years to come. We have
introduced a different view in some of the areas where we have
worked. We have seen the price of second-line ARVs being brought
down, so they are three times less than was initially thought.
We need to have an overall multi-stakeholder initiative that understands
that access to medicines are a part of health and have to be delivered.
Some countries are able to pay and some countries are not able
to pay. We are funding and our constitution is very clear, that
85 per cent of our resources has to go to low income countries
(and we think that is correct) and only 15 per cent to lower-middle
income countries or medium-middle income countries. Many of the
low income countries are not able to pay, so we need to know how
to expand the availability of resources to treat those diseases
as the global emergencies that they are.
Dr Duneton: I think it is obvious, and all the
organisations recognise the need to find a better way to strengthen
the capacity at country level. I will give an example. Of course
we want to be focused on the product; but, having said that, we
need to think what the product will be used for. We have certain
limitations because we do not want any overlap. In the case of
diagnostics, it is not only a question of devices and commodities,
it is a question that is more about the service. It is just an
idea for now, but we have discussed that with Partners and industry
and they have shown some interest, saying we could organise the
support. By the way, we are already doing that through the Clinton
Foundation for diagnostics for paediatrics, not only paying for
products but for the results. That is exactly the same way that
we consider this in the northern countries. We are not paying
for a PCR device or a part of this, because that does not work.
In fact, in a lot of countries in the south it does not work because
you can have the device but, if you do not have the human resource
to use that kind of device properly, you have nothing and you
have paid for nothing. I have tried to look from outside the organisation
but, in a way, it is a question not only for us but also for our
Partners. It is useful to think in that way of something a little
bit different and saying we have that impact on the product. But,
if we are paying for a service, it could be something for us to
think about again, not only us but with Partners and industry.
Q704 Chairman:
What sort of organisation would that be that would do that?
Dr Duneton: Just as an example, the Clinton
Foundation. With the experience of others we have started to think
about that, and that is the way it works now. We have had initial
discussions with UNICEF on that, with major industries like Roche
or Abbott, not trying to set something but to see the idea.
Q705 Chairman:
The shape in a way?
Dr Duneton: Exactly. It was a recommendation
issued by the assessment that we have paid for that, when we assess
the diagnostic part of TB, maybe there is a need to think in that
direction. It is something on how to move in the next three years
maybe.
Q706 Chairman:
If you get any more thoughts on that in the reasonably near future—we
have to report in July—please let us know, because it sounds
quite interesting. Any further questions? Is there anything you
have left out at all that you want to raise or you feel we have
missed? Is there anything at all you would like to say?
Dr Bermudez: No, thank you very much.
Q707 Chairman:
Thank you very much.
Dr Bermudez: We have to support more than 80
countries and I think we are moving forward in the right direction.
Chairman: That sounds very good. Thank
you.
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