UNITAID actions and main achievements

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• UNITAID actions and main achievements
• A new innovative mechanism
• for scaling up access to medicines and
  diagnostics
• for HIV/AIDS, TB and malaria
• Why is Africa often out of stock
• Access to Health Care in Africa - changing the
  paradigm for access and quality
• Cape Town, South Africa, April 16 18, 2008
• L Llewellyn Witherspoon

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A global health state of emergency

• Medicines are in the North, patients in the
  South
• Least developed countries represent
• 84 of the world population
• Less than 11 of the global health expenditure
• More than 93 of the disease burden globally

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Global distribution of mortality in children
(each dot 5000 deaths)
Source Black et al., 2003 (apud UNICEF IPC
Meeting 14-15 Nov 2006)
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UNITAID mission and principles

• UNITAID mission is to reinforce access to
  treatments against HIV/AIDS, malaria and
  tuberculosis for the poorest populations in
  developing countries by reducing prices of
  quality medicines and diagnostics and by
  speeding up their availability
• General principles
• innovative and long term funding mostly based on
  a tax on air tickets (368 M budget),
• tool dedicated to impact the drugs / health
  products markets,
• complementarity with existing initiatives,
• solidarity and efficiency of the aid,
• adaptability,
• independence,
• transparency and accountability.

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From 5 to 27 member countries
Sept 2006 Launch of UNITAID at New York During
UN General Assembly5 founding countries
Now 27 member countries the Gates foundation
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Countries contributing to UNITAID
Countries that implemented the air tickets levy

• Tax adopted
• France
• Chile
• Cote dIvoire
• Congo
• Mali
• Madagascar
• Mauritius
• Niger
• Republic of Korea
• Norway (CO2 tax on kerosene)

• Budget contribution
• Spain
• United Kingdom

Countries committed to implement the tax Benin,
Brazil, Burkina Faso, Cameroon, Cyprus, Gabon,
Guinea, Liberia, Mali, Morocco, Namibia, Central
African Republic, Senegal, Sao Tome Principe,
Togo Countries committed to implement a budget
contribution South Africa
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UNITAID Governance

• Independent Executive Board
• Lean Secretariat
• Consultative Forum
• Hosted by WHO

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UNITAID added value

• UNITAID use of funds allows to
• 1/ Impact markets and reduce prices more drugs
  for same budget
• ex price reduction on pediatric (- 40) and
  2nd line ARVs (-25 to 50)
• 2/ Have manufactured medicines better adapted to
  patient needs ex first fixed dose
  combinations for pediatric ARVs in 2007
• 3/ Contribute to address quality issues
  (incentive for manufacturers to invest)
  ex support to WHO program for prequalification
  of products
• 4/ Deliver rapidly medicines in the countries in
  need (basic model - medicines instead of
  funds) ex treatments already provided in a
  number of countries for ARV, TB and ACT

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UNITAID business model
UNITAID uses of a wide range of tools to reduce
prices and speed up availability of drugs
COST plus pricing
Strategic buffer stocks
Predictable funding
Pool procurement
Volume price negotiation
Market dynamics forecast
Information sharing
Encouraging/attracting new manufacturers
Encouraging market competition
Prequalification
Encouraging technology sharing
Supporting local registration
Partnership pricing
Lowering barriers to entry on market
Patent pool ?
Reference price / price ceiling
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A unique partnership model
- UNITAID works with well-recognized partners.-
Money restricted exclusively to financing high
quality drugs, diagnostics and related
commodities.- Countries themselves cannot apply
directly for UNITAID funding. - UNITAID works
through its partners to provide drugs,
diagnostics and treatment to those in need.
For ex in 2007-2008 UNITAID allocated 52.5 M to
the Round 6 of the Global Fund to support
programmes relevant with UNITAID activities in
the 3 diseases
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UNITAID ongoing actions

• More than 80 countries already receive UNITAID
  support

HIV / AIDS 53 recipient countries
Malaria 22 recipient countries
Tuberculosis 58 recipient countries
- ACT
- First line TB - Pediatric TB - MDR-TB
- Pediatric ARV - Second line ARV - PMTCT
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UNITAID ongoing actions (M)
Paediatric ARV 35.5
GFATM Round 654.5
2nd line ARV 35.9
HIV
MDR-TB 20.8
Paediatric TB 5.7
TB
PMTCT20.9
1st line TB 18.3
ACTs Burundi Liberia1.3
ACT scale-up65.4
Malaria
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Ongoing UNITAID programs - HIV/AIDS
Pediatric ARV 100,000 new HIV-positive
childrenunder adapted ARV treatments in 2007 in
38 countries (40,000 previously treated only
when 660,000 needs it).
Partner Clinton Foundation
2nd line ARV price reduction for 7 products and
treatments pour 70,000 new patients in 27
countries in 2007.
Partner Clinton Foundation
Prevention of mother to child transmission
Improve care, reduce prices of diagnostics, 1.2
million pregnant women diagnosed and 340,000
under ARV treatment in 8 countries in 2007-2008.
Partners WHO and UNICEF
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Ongoing UNITAID programs - malaria
ACT program - Liberia Burundi 1.3 million
treatments provided in these 2 countries at risk
of stock out in 2007, before other donors take
over
Partners WHO / UNICEF
ACT scale up Supply of ACT treatments in 11
countriesuntil 2010, for 55 million treatments,
in order to impact prices, incentive
manufacturers, avoid stock out in countries
Partners Global Fund / UNICEF
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Ongoing UNITAID programs tuberculosis

MDR - TB Support to the purchase of 4,700
treatments in 2007 for 17 countries, with an
objective to reduce prices by over 20
Partners Global Drug Facility / Global Fund
Pediatric TB provide adapted treatments for
children to treat 180,000 children in 2007.
Reduce prices by over 25 in 2010
Partner Global Drug Facility
1st line TB Support the provisional provision of
740,000 treatments in 2007-2008 for 18 countries
and establish a strategic stockpile to prevent
stock outs
Partner Global Drug Facility
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More prequalified products on the market

• Support from UNITAID to the Prequalification
  Program (6 M in 2007)
• Speed up the access to quality medicines for the
  three diseases in 2007, 20 new prequalified
  drugs on the 3 diseases
• Current focus on medicines for HIV/AIDS
  (paediatric and second line), TB (first line and
  MDR TB) and malaria (ACTs)
• Control the quality of medicines purchased with
  UNITAID funds and develop local capacity (4
  countries to initiate sampling for laboratory
  tests, also involving NDRA)

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Treatments delivered by UNITAID in 2007and
planned for 2008
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First significant price reductions
30 November 2006 on antiretroviral for HIV
positive children (with the Clinton foundation)
8 May 2007 on second-line antiretroviral (with
the Clinton foundation)
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More friendly-users medicines

• With UNITAID funding, new treatments put on the
  market against HIV/AIDS are more adapted
• Dosages well adapted for use by children
• Medicines to be taken in the form of tablets
  (fixed dose combinations)
• Heat stable products no refrigeration needed
  anymore
• No need to dilute them in water (problem of
  access to drinkable water in some countries).
• One FDC / Cipla FDA tentative approval / WHO
  PREQUAL August 2007

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Better products at lower price
Now Fixed dose combination3 tablets a day 60
per patient per year
Before Single dose syrups16 bottles of syrup
monthly 200 per patient per year
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New actions from 2008 (April)

• Multi-Drug Resistant (MDR)-TB Scale-up and
  Acceleration of Access 2008-2011.
• Partner Global Drug Facility
  Amount US
  33.7million
• Expanding and accelerating access to MDR-TB
  diagnostics within appropriate laboratory
  services within selected countries between
  2008-2011.
• Partners Global Laboratory Initiative (GLI),
  Amount US 26.2
  million
• Global Drug Facility (GDF),
• Foundation for Innovative New
  Diagnostics (FIND)
• Support for Quality Assurance of Medicines for
  the prequalification of UNITAID-funded medicines
  and the field sampling and quality testing of
  products supplied to users and capacity building
  at country level, between 2008-2012.
• Partner WHO Prequalification Program
  Amount US 40million
• Acceleration of Nutritional Care of Pregnant and
  Lactating Women and Children linked to PMTCT
  address nutritional problems that impact
  negatively on PMTCT outcomes, 2008-2010.
• Partners UNICEF, WHO
  Amount US
  4.8million

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UNITAID in the Health agenda

• Address by M. Chan, WHO DG (21 Jan 2008, 122nd
  EB)
• For me, one of the most encouraging trends in
  public health today is the power of commitment to
  unleash the best of human ingenuity. Let me just
  give one example, UNITAID, which draws funds
  primarily from a levy on airline tickets, began
  operating in 2006 as a facility for purchasing
  drugs and diagnostics for AIDS, TB and malaria.
  ... This is the kind of hard-nose pragmatism
  that gets result in public health. ... We must
  keep such approaches in mind as we consider broad
  ways to improve access to essential medicines.

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Out of Stock? Africa?

• Yes No
• ..and this holds true, mainly for low- and
  low-middle income countries around the
  world....

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Why stock-outs?

• The major issues surrounding stock-outs..
• Financial
• Forecasting / Quantification
• Lack of forecasting demand
• Procurement planning model
• Less than ideal drug (supply chain) management
• Rational use issues
• Limited use of diagnostics, dependence on
  sub-optimal drugs

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Quality or Quantity?

• Plausible reason for stock-outs
• NDRAs are "tightening the noose"
• Multilateral partners are stepping in with
  technical support
• WHO, BILL MELINDA GATES FOUNDATION, UNITAID,
  UNICEF, etc
• Global financing mechanisms providing funding for
  testing, training and outfitting
• UNITAID support through WHO Prequalification
  Program field sampling and quality testing of
  products supplied to users and capacity building
  at country level, between 2008-2012 US40mn
• Bill Melinda Gates Foundation
• SHORT TERM PAIN FOR LONG TERM GAIN

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www.unitaid.eu
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 UNITAID is hosted and administered by the World
Health Organization