UNAIDS: The First 10 Years

Chapter 5Policy making: increasing access to treatment121The Drug Access Initiative had, in a limited way, proved that antiretroviral treatment could beprovided in places where health services were poorly resourced, and at much lower pricesfrom generic companies. Now there was a need to scale up.In 1998, WHO’s new Director-General, Gro Harlem Brundtland, had joined Piot in a seriousdialogue with the pharmaceutical companies to discuss the challenges of providing treatmentin the developing world: ‘Between 1998 and 2000, Brundtland and Piot partly pressured,partly enticed the company leaders towards a much wider use of differential pricing forantiretrovirals’ 15 .In January 2000, the Director-General of WHO had given her speech to the policy-makingExecutive Board. She stated, “… squarely put, the drugs are in the North and the diseaseis in the South. This kind of inequity cannot continue … I wish to invite the pharmaceuticalindustry to join us now in taking a fresh and constructive look at how we can considerablyincrease access to relevant drugs”.It is worth noting that there was divergence of opinion among the different pharmaceuticalcompanies on the issue of lowering drug prices. At an internal meeting, the Chief ExecutiveOfficer of Roche had said: “We have got to get off the subject of prices – they are not theissue” 16 . But Jeffrey Sturchio of Merck & Co, Inc, and Ben Plumley of GlaxoSmithKline feltthat the only way to turn perceptions around was to make something affirmative happen byslashing the prices of HIV medicines 17 .In February 2000, the Executive Director of UNAIDS and the Director-General of WHO hada meeting with Ray Gilmartin, CEO of Merck & Co, Inc, during the World Economic Forumat Davos.Gilmartin was not very positive. Piot recalls: “We said, ‘well this was a waste of our time;nothing happened … we’ll try again’”. But a few weeks later, Ken Weg from Bristol-MyersSquibb and then a representative from Merck & Co, Inc contacted them; now they did wantto talk about the price of drugs.After many months of meetings, the drug companies offered to cut prices and work on anew initiative. As Julia Cleves, Director of UNAIDS Executive Director’s office, explained, thisoffer was initially regarded with some scepticism by the UN. A period of intensive activityensued which came down to negotiating a joint statement of intent between the UN and thepharmaceutical companies.15Schwartländer B, Grubb I, Perriëns J (2007). ‘The 10-year struggle to provide antiretroviral treatment to peoplewith HIV in the developing world’. The Lancet, 368.16Gellman B (2000). ‘A turning point that left millions behind’. Washington Post, 28 December.17Ibid.