UNAIDS: The First 10 Years

Chapter 3“UNAIDS did seem to be able to believe beyond the possible, even though it could be apain in the neck for everyone else”, said Cleves. Indeed, UNAIDS was responsible for thefirst pilot projects on antiretroviral treatment in Africa and in the campaign for reducingdrug prices.69The UNAIDS HIV Drug Access Initiative, launched in November 1997, was a collaborationbetween UNAIDS and brand-name pharmaceutical companies to develop strategies forincreasing access to antiretroviral drugs in middle- and low-income countries.As a pilot project, it involved only four countries: Chile, Côte d’Ivoire, Uganda and Viet Nam.Pharmaceutical companies were invited to supply the drugs at subsidized prices, usuallyat around 40% below the developed world price of US$ 10 000 to US$ 12 000 per personper year, while UNAIDS tried to adapt the health infrastructure in these countries in orderto ensure effective distribution of HIV-related drugs. If the pilot proved to be successful,UNAIDS would expand the Programme to other countries.At the launch press conference, the initiative’s coordinator, Joseph Saba, a Clinical ResearchSpecialist at UNAIDS, explained: “This programme will provide the information we need todetermine whether HIV/AIDS-related drugs can be obtained and distributed effectively indeveloping countries. Armed with this information, countries will then be able to mobilize thenecessary resources to treat infected individuals, and to help control the global epidemic”.Although they agreed to sign up to the Drug Access Initiative, the pharmaceuticalcompanies were dubious about the feasibility of treatment in resource-constrained environments.Sturchio from Merck & Co, Inc, recalled: “They came to talk to us in about 1997 aboutwhether we would provide Crixivan at a discount for use in Uganda. We were sceptical.Our argument about the Drug Access Initiative at the time was that, even if we made ourmedicine available for free, the infrastructure wasn’t there, so people wouldn’t be able to usethe medicines effectively”.In the course of this initiative, UNAIDS conducted elaborate discussions with the countriesto make sure that the concerns of the pharmaceutical companies were addressed and thatthe medicines would reach those who needed them. First, there could not be any diversionof discounted products to developed country markets. Second, the companies wanted guaranteesthat the drugs would be used in a rational manner, that the treatment programmeswould be structured in such a way that their products would be used for maximum benefitand not lead to waste. Third, UNAIDS had to structure the availability of these products sothat any intermediaries in the supply chain could not use the price discounts given by theoriginator companies to enrich themselves. Last but not least, the companies and the UNagencies agreed on the importance of protecting intellectual property interests, to ensurecontinued investment in research and development for new HIV medicines.