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[Type text] Fall Pharmaceutical Access in Least Developed Countries: on-the-ground barriers and industry successes”. D. Wayne Taylor, Ph.D., F.CIM Executive Director 10 Table of contents Executive Summary ........................................................................................................................... 4 Findings of this Report……………………………………….………………………………………..7 Biases and Gaps in the Literature…………………………………………………………13 Perceived Problem, Bureaucratic Solution, and Unintended Consequences…...15 The Real ‘On-the-Ground’ Problems and Solutions……………………………………17 Conclusion…………………………………………………………………………………….20 An Annotated Catalogue of Public-Private Partnerships that Provide Access to Pharmaceuticals in Least Developed Countries……………………………………………….22 Major Global Initiatives in which Pharmaceuticals Played a Major Role……................143 List of Access to Pharmaceuticals Interventions…………………………………….............157 List of the 50 least developed countries………………………………………………………..177 The Cameron Institute……………………………………………………………………………..182 2 ! 2010 The Cameron Institute Limited Electronic Distribution Rights: This document and trademark(s) contained herein are protected by law. This electronic representation of The Cameron Institute’s (TCI) intellectual property is provided for non-commercial use only. Unauthorized posting of TCI PDFs to a non-TCI Web site is prohibited. TCI PDFs are protected under copyright law. Permission is required from The Cameron Institute to reproduce, or reuse in another form, any of our research documents for commercial use. For information on reprint and linking permissions, please contact The Cameron Institute. Disclaimer: This report provides a comprehensive overview of existing knowledge that existed in the public domain respective of access to medicines to the least developed countries as of the time of writing. The analysis and conclusions contained herein do not necessarily reflect the views of The Cameron Institute, its Board, or its funders. Any errors or omissions are the sole responsibility of the author and this project's research staff. Comments and suggestions are welcome. Please cite this paper as: "D. Wayne Taylor, Pharmaceutical Access in Least Developed Countries: on-the-ground barriers and industry successes”. 3 Pharmaceutical Access in Least Developed Countries: on-the-ground barriers and industry successes F10 Executive Summary The research-based pharmaceutical industry, in various public-private partnerships (PPPs), has been improving access to medicines in the least developed countries of the world since the 1950’s. 1 Summary data 140 Number of PublicPrivate Partnerships Industry success 120 100 80 60 40 Over the past two decades, the most significant gains have been made by the industry and its partners in improving both access to medicines and health outcomes in the poorest of the world’s nations. 2 0 1950 1960 1970 1980 1990 2000 2010 2020 Year On-the-ground barriers The greatest barriers to access and improved health are not drug prices or patents but “on the ground” barriers such as market failure, corruption, nonexistent health human resources and infrastructure, and the lack of both local and international political will. 20 Doha Declaration and licensing 3 To date there have been 150 public-private partnerships to improve access to medicines in the least developed countries; 90% have been industry-led; and one-half of those were created since the Doha Declaration of 2003 thus making compulsory licensing unnecessary. 4 Continued on page 5 Summary data as of 2010 for research-based pharmaceutical industry contributions to least developed countries USD 8,450,000,000 of product and investment 950,000,000 patients treated (Continued) A basic right in law is to retain possession of one’s own ideas and discoveries. Sustainable development is the way of the future for both North and South and, for there to be sustainable healthcare enterprise and optimal health outcomes in the least developed countries, there must also be the necessary infrastructure, health human resources, political stability, and professional administrative legal structures. Even though existing medicines for HIV/AIDS has reduced mortality rates in developed countries by 70%, adherence and compliance are two major obstacles, amongst many, to the successful deployment of these drugs in developing countries. 9,500,000,000 doses/treatments administered 350,000 doctors, nurses and other health personnel trained Research-based pharmaceutical companies contribute USD 8.5 billion and 9.5 billion doses/treatments to benefit 1 billion lives. Summary data re types of interventions by research-based pharmaceutical companies in the least developed countries Access to medicines (pricing) 31 Access to medicines (donations) 45 Access to medicines (voluntary licensing) 3 Research and development 15 Capacity building 66 Education 28 WHO’s list of essential medicines is comprised of over 95% off-patent products – the remainder being primarily second-line antiAIDS medicines. Patents pose no barrier to essential medicines being affordable and accessible throughout the world. If it wasn’t for patent protection none of those medicines would have been available in the first place, producing revenue from developed countries that now allows 100 medicines and vaccines to be in development to tackle malaria, multidrug resistant tuberculosis, dengue fever, and all the other scourges of the developing world. The real barriers to access are money, power, politics, and ideologies. Decades of market failure and corruption have denied least developed countries the rule of law, efficient infrastructure and roads by which to distribute and administer medicines, access to potable water, and trained health personnel. This report demonstrates beyond a reasonable doubt that, contrary to the opinion of many, intellectual property protection (IPP), in the form of patents or other devices, does not impede access to medicines in the least developed countries of the world; in fact, IPP fosters access. 5 Voluntary Licences (VLs) up to April 2010 Pharmaceutical company No. Of VLs issued Abbott 7 Boehringer Ingelheim 3 Bristol Myers Squibb 20 Gilead 5 GlaxoSmithKline (GSK) 7 Merck 13 Roche 4 Tibotec 2 ViiV ( a joint venture of GSK and Pfizer) 30 Total VLs 91 Up to 2007 31 2007-2010 60 Voluntary Licences Licensing of products and/or processes must be voluntary and mutually beneficial if it is to be sustained. Voluntary licensing is a win-win for pharmaceutical companies and the least developed countries. By voluntarily licensing medicines to be manufactured by third parties in developing countries, research-based pharmaceutical manufacturers do not have to incur distribution costs, while they retain their proprietary rights and help improve health outcomes among the most needy of the world’s inhabitants. In exchange, the lowerpriced pills are required to be sold in distinctly different shapes, sizes, and/or colours, dramatically lowering the possibility that they will be exported back into developed countries through black market channels to compete against full-price medicines. A collateral benefit to the developing country in which the production occurs is the addition of high-value employment, tax revenue, and wealth creation opportunities. The Cameron Institute – www.cameroninstitute.org 263 John Street South Hamilton, Ontario Canada L8N 2C9 6 [Type text] Findings of this Report There is a public health crisis in the least developed countries. It is a crisis made by humans and solvable only by humans. There is urgency for governments, businesses, NGOs and academia to collaborate in dealing with this most urgent of problems. However, actions taken today need to solve the problem and not exacerbate it or create another set of problems. The World Health Organization’s (WHO) Draft Global Plan and Strategy for Action focused its energies on “the growing burden of diseases and conditions that disproportionately affect developing countries, and particularly women and children”. Various discussions and papers have clarified that this burden of disease is largely attributable to communicable diseases within the developing world. The Cameron Institute is committed to improving patient care and outcomes, not just in Canada, but everywhere in the world. Based upon the findings of much earlier works1, as well as the findings of this report, The Cameron Institute endorses public-private partnerships (PPPs). As a policy research institute, The Cameron Institute does not support any attack on intellectual property (IP) – the cornerstone of affordable innovation and discovery so necessary for the solutions to world public health problems. Innovation is the hallmark of the pharmaceutical industry. Without innovation there would be no immunizations, medicines or biologics to save lives, improve quality of lives, and to save much needed healthcare dollars. Every dollar invested in new medicines relieves the healthcare system of seven dollars of expenditure elsewhere. New drugs increase life expectancy and life-time income by about 1.0% per year while also decreasing years of life lost. 2 Innovation through research and development sits astride a three-legged stool – each leg of which is integral to successful innovation: (i) sufficient capital and skilled researchers to create the critical mass needed to pursue the quest of discovery; (ii) an efficient means by which discovery can be developed into an efficacious and effective product for use; and, (iii) strong protection of intellectual property to motivate and reward the development of these innovations, and provide the capital for new and improved developments. However, innovation-based industry is also high-risk industry. What makes the pharmaceutical industry particularly vulnerable to patent infringement is that it is the most research-dependent industry in the world with individual firms reliant upon research for their very survival (see figure D. Wayne Taylor, Business and Government Relations: Partners for the 1990’s, Toronto, Gage, 1991. Frank R. Lichtenberg, “Are the benefits of newer drugs worth their cost?” Health Affairs, 20(5):241-251, 2001. 1 2 below) 3. Whether products are by prescription or over-the-counter, for human use or veterinary use, pharmaceuticals are developed, produced and sold to either prevent or cure illness, or to provide a better quality of life for those with illnesses for which there is no prevention or cure as of yet. The Biopharmaceutical Industry is the Most Research-Intense Source: Harvard Business Review, November 2008, 84. Over a 12 year period, 700,000 substances will be tested before 1,000 compounds can be isolated for advanced testing; from those 1,000 compounds only one will become an efficacious, effective, commercial drug available on the market for patients. With each new drug also comes the incremental depletion of long-established chemical possibilities which in turn raises the bar for further chemical discovery. It takes, today, over USD1.3 billion to bring a prescription drug to market, 90% of which never break-even to recoup all research and development costs thus requiring successful firms to rely upon a “portfolio” of products to realize their revenue needs (see figure below). Although we are perched on the brink of a new age of discovery – that of biotechnology where large molecule entities, rather than the traditional small molecule entities, will cure disease and improve outcomes – the art and science of discovery and innovation need to be nurtured and protected all the more for that reason. A basic right in law is to retain possession of one’s own ideas and discoveries. Sustainable development is the way of the future for both North and South. For there to be sustainable 3 Edwin Mansfield, “Intellectual Property Protection, Foreign Direct Investment and Technology Transfer”. International Finance Corporation Discussion Paper No. 19, 1994. 8 healthcare enterprise and optimal health outcomes in the least developed countries, there must also be the necessary infrastructure, health human resources, political stability, and professional administrative legal structures. Even though existing medicines for HIV/AIDS have reduced mortality rates in developed countries by 70%, adherence and compliance are two major obstacles, amongst many, to the successful deployment of these drugs in developing countries. New Pharmaceutical Product Development of 10-15 Years Versus Patent Life of 20 Years ~ 5,000 – 10,000 Preclinical Clinical Trials 250 FDA Review Scale-Up to Mfg. Post-Marketing Surveillance 5 COMPOUNDS 3 – 6 YEARS PHASE 1 PHASE 2 PHASE 3 NUMBER OF VOLUNTEERS 20–100 100–500 6 – 7 YEARS 1,000–5,000 NDA SUBMITTED ONE FDAAPPROVED DRUG IND SUBMITTED PRE-DISCOVERY Drug Discovery 0.5 – 2 YEARS INDEFINITE Source: Congressional Budget Office, 2006. Canada and the research-based pharmaceutical industry have been leaders and have played an active role in improving access to needed medicine around the world which in turn greatly improves health outcomes worldwide. In the last decade alone, Canadian researchbased pharmaceutical firms have discovered four generations of medicines to treat HIV/AIDS, the first treatment for Alzheimer Disease, and many cholesterol-lowering drugs that help prevent heart attacks. Canadian firms and their global affiliates have worked in partnership with more than 25 international aid programmes to build clinics, train health professionals, improve health – especially amongst women and children – and donate medicines and vaccines throughout the developing world. Today, Canada is focusing more and more of its energies on bilateral aid for countries that have demonstrated that they can use it effectively, and the results are positive. Therefore, the same approach needs to be taken when improving access to medicines in order to make sure that the drugs get to where they need to be, rather than detoured into black markets. By targeting their scare resources Canada, along with its partner companies, agencies and likeminded countries, has reduced the percentage of the world’s population living in extreme poverty from 33% to 19%; has increased enrollment in primary education 10%; and, has 9 reduced infant mortality by 20% in 11 West African countries, largely due to immunizations supplied by research-based pharmaceutical companies. Over the past decade there has been a twelve-fold increase in those receiving treatment for HIV/AIDS. Generic drugs have an important and acknowledged role to play in reducing healthcare costs after patents have expired on drugs. There is a clear time and place for generics to enter the market. WHO’s list of essential medicines is comprised of over 95% off-patent products – the remainder being primarily second-line anti-AIDS medicines. IP poses no barrier to essential medicines being affordable and accessible throughout the world. In fact, if it wasn’t for the protection of IP none of those medicines would have been available in the first place. Intellectual property protection (IPP) allows 100 medicines and vaccines to be in development to treat diseases of the developing world. Even Uganda’s President, Yoweri Museveni, who presided over the world’s largest reduction in HIV/AIDS prevalence, has declared that the whole essential medicines argument against patents is a red herring perpetrated by vested interests. IP is not a barrier to access. The real barriers to access are money, power, politics, and ideologies. The research-based pharmaceutical industry invests huge sums required for innovation and discovery as a direct result of the protection of IP and because of that they are able, and more than willing, to partner with governments and non-government organizations (NGOs) to make medicines affordable and available to all. The protection of intellectual property has enabled the pharmaceutical industry to develop more than 90% of all the medicines available worldwide today. As stated above, today it takes 10-12 years and USD1.3 billion to develop a new, innovative medicine for patients. Without innovation and related safeguards in place there will be no new vaccines or medicines to tackle malaria, multi-drug resistant tuberculosis, dengue fever, and all the other scourges of the developing world. This report demonstrates beyond a reasonable doubt that, contrary to the opinion of many, intellectual property protection (IPP), in the form of patents or other devices, does not impede access to medicines in the least developed countries of the world; in fact, IPP fosters access. Without the protection of IP no new medicines would be discovered and access would become a moot point. Since 2000, global research-based pharmaceutical companies have provided health interventions worth USD4.4 billion, enough to help up to 540 million people. Medicines have been shipped at preferential or no-profit prices. Many companies have fostered partnerships in developing countries. Some companies have even gone so far as to sponsor their own “give away” programmes. According to the Organization for Economic Cooperation and Development (OECD), pharmaceutical companies “punch way above their weight” in the field of international development assistance contributing over 10% of all monies donated (OECD 2008). Research and development (R&D) plus technology transfer have been improving in the developing world thanks to the work of many firms and partners and the enforcement of IP 10 rules and regulations 4. Research institutes have been established in Africa to focus on HIV/AIDS. Capacity-building to manage breast cancer in Ethiopia is underway. Sustained “at cost” pricing has been established for antiretrovirals for a decade. Neglected diseases such as lymphatic filariasis are being targeted. One partnership has seen 14 million individuals cured of leprosy. Current pipeline projects include 17 medicines and 2 vaccines for tuberculosis and 18 medicines and 2 vaccines for malaria. One research-based pharmaceutical company has invested USD20 million of capital and USD5 million operating funds per year in a research institute based in India employing more than 80 research scientists dedicated to finding a therapy to combat multi-drug resistant tuberculosis. Another firm has established a public-private partnership in search of the same therapy and promises to collaborate with others to accelerate the discovery phase. In Singapore, a public-private partnership employing over 100 scientists is focusing on developing treatments for dengue, malaria and tuberculosis which, once developed, will be offered at no profit to poor patients in developing countries. According to a 2009 Tufts University report, the pharmaceutical industry was the third highest funder of R&D related to neglected diseases that disproportionately afflict the least developed countries after the U.S. National Institutes of Health and the Bill & Melinda Gates Foundation.5 With respect to technology transfer, the licensing of products and/or processes has always been a recognized means by which firms can do business internationally. However licensing of products and/or processes must be voluntary and mutually beneficial if it is to be sustained. Voluntary licensing is a win-win for pharmaceutical companies and the least developed countries. By voluntarily licensing medicines to be manufactured by third parties in developing countries, research-based pharmaceutical manufacturers do not have to incur distribution costs, while they retain their proprietary rights and help improve health outcomes among the most needy of the world’s inhabitants. In exchange, the lower-priced pills are required to be sold in distinctly different shapes, sizes, and/or colours, dramatically lowering the possibility that they will be exported back into developed countries through black market channels to compete against full-price medicines. Collateral benefits to the developing country in which the production occurs is the addition of high-value employment, tax revenue, and wealth creation opportunities. This report identified there being 91 voluntary licences for brand-name medicines, two-thirds of which have been initiated within the past three years (see figure below). 4 Mark Dutz, Antara Dutta, and Jonathan Orszag, Intellectual Property and Innovation: New Evidence on the Relationship between Patent Protection, Technology Transfer and Innovation in Developing Countries, Compass Lexecon, October 2009. 5 Tufts Centre for the Study of Drug Development, Neglected Diseases in the Developing World: Progress, Current Challenges, and Promising Approaches, Boston MA: Tufts University, October 16, 2009. 11 Voluntary Licences (VLs) as of April 2010 Pharmaceutical company No. Of VLs issued Abbott 7 Boehringer Ingelheim 3 Bristol Myers Squibb 20 Gilead 5 GlaxoSmithKline (GSK) 7 Merck 13 Roche 4 Tibotec 2 ViiV ( a joint venture of GSK and Pfizer) 30 Total VLs 91 Up to 2007 31 2007-2010 60 On the other hand, compulsory licensing has proven to be ineffective and in some cases duplicitous and criminal6. Compulsory licensing exists to deal with public health crises; products produced under compulsory licence are not to be diverted from their intended beneficiaries in a specific country. Any work done to achieve health for all must be done in good faith and legally, and the short track record with compulsory licensing shows that this is not always the reality. In fact, all so-called “compulsory licences” other than the CanadaRwanda example have been simply political fiats unrestrained by law.7 Kristina M. Lybecker and Elizabeth Fowler, “Compulsory Licensing in Canada and Thailand: Comparing Regimes to Ensure Legitimate use of WTO Rules,” Journal of Law, Medicine and Ethics, Summer 2009, 222.239 (Lybecker is a Research Associate of The Cameron Institute and Fowler is a former staff associate of the Institute). 7 Richard A. Epstein and A. Scott Kieff, Questioning the Frequency and Wisdom of Compulsory Licensing for Pharmaceutical Patents, John M. Olin Law and Economics Working Paper No. 527, Chicago: University of Chicago, 2010, 5. 6 12 Pharmaceuticals, like most legal products, are sold globally using differential pricing – basically charging what each respective market can bear. This maximizes both the income for the firm and, in the case of the pharmaceutical industry, patient access to medicines around the world. Differential pricing is a win-win-win for risk-taking innovators, fiscally challenged payers, and patients in need of treatment. As Danzon and Furukawa concluded (2004), drug price differentials among countries roughly reflect income differences as do food prices and prices for consumer electronics. 8 Biases and Gaps in the Literature A recent review of the literature respective of access to medicines in least developed countries 9 identified a number of biases (or recurrent themes) and gaps that have probably tilted the debate in an erroneous direction either by design or coincidence. The review covered over 50 articles, published between 1992 and 2009, and other materials on barriers to access to medicines. A key finding of the literature review was “the paucity of illuminating research so far conducted on this topic”. What literature there is, is not robust or scientific. Most of the ‘access to medicines’ literature focused on only the cost of drugs. Half of the literature reviewed reflected anti-IP views, with a number of papers by a few well-known, biased, third parties claiming that these factors have damaged healthcare in the least developed countries. Almost all of these articles accepted a priori that IPP automatically translates into higher prices, which they interpreted as resulting in poor access to treatment with little or no evidence to support their claim. As will be explored below, the cost of treatment is only one variable in an extremely complex situation – maybe even the least important variable in the mix. Access to medicines is hindered in the majority of the least developed countries as a result of a wide range of issues, some of which are documented in the literature reviewed, including inadequate government administration, bare-bones healthcare systems, inadequate distribution capacity, and counterproductive regulation and taxation. While it is becoming much more widely understood that these other variables are far more important barriers to access than the cost of medicines (both innovative and generic), the literature does not yet reflect this and there was not one single article that investigated these variables scientifically. Regardless of the uneven distribution of thought in the literature some of the factual findings are worth noting. Patricia M. Danzon and Michael F. Furukawa, “International Prices and Availability of Pharmaceuticalsin 2005,” Health Affairs 27(22), 2008. 9 Phillip Stevens, Eman Al Saaed, David Taylor, Access to Medicines in Less Developed Countries: An Annotated Bibliography, London UK: International Policy Network and The School of Pharmacy, University of London, October 2009. 8 13 " " " " " " " one-third of the world’s population does not have access to “essential medicines” (even though almost all of these are off-patent and genericized) o in the poorest of countries, such as many of those in sub-Saharan Africa, this figure rises to 50% o the WHO’s “essential medicines list” is woefully outdated and overly bureaucratic to amend, to the extent that there are no lipid-lowering drugs on the list even though 80% of deaths resulting from the world’s number one killer, cardiovascular disease, occur in developing countries one-third of all medicines supplied in the least developed countries are counterfeit and/or sub-standard (the majority of which are manufactured in China, India and Thailand) more than 20% of medicines supplied to government-run facilities in the least developed countries are stolen and resold by staff thus explaining, in part, the chronic stock shortages in public health system dispensaries supply chain mark-ups from manufacturers’ supply prices to those found in private pharmacies and other retailers are typically 300-500% for generics and 10001500% leading brand name medicines patients are often ill advised and inadequately supported in medicine purchasing and use; there is a chronic shortage medical human resources where essential medicines are still on-patent, innovative manufacturers very rarely choose to enforce their intellectual property rights there was no scientific evidence that trade-related intellectual property agreements were causatively associated with worse health outcomes in least developed countries Many articles reviewed concluded that the least developed countries should issue compulsory licences as a means of driving down prices (an issue discussed at length later). Only one such licence has ever been issued with little effect on health outcomes. Again, there was no evidence presented, either theoretical or empirical, to support such a recommendation. Some articles still adhere to price controls as a means of lowering costs in the least developed countries ignoring the empirical reality that price controls only reduce supply, the exact opposite outcome that is desired, and fuel black markets that, in this case, would traffic in counterfeit, sub-standard products. According to this 2009 review, in a nutshell, the literature is not balanced, is largely overt political advocacy, and is dominated by a few ideologically-biased third parties that ignore the facts and cling to hypotheses that are out-dated and have no grounding in evidence. Unlike the authors that dominate the literature, The Cameron Institute is interested in the facts and present them later on in this report in an attempt to “balance” the argument.10 Interesting enough a review of the broader literature on intellectual property and developing countries was accurate in every respect except the section regarding access to medicines in which the authors uncritically accepted what was published as being factual when in fact it was not; see 10 14 Perceived Problem, Bureaucratic Solution, and Unintended Consequences Twenty-five years ago, during its Uruguay Round, the World Trade Organization (WTO) negotiated its Agreement on Trade-Related Aspects of Intellectual Property Rights (TRIPS). In essence, TRIPS attempted to globally harmonize rights-based protection of intellectual property and the enforcement thereof. This included patents. However, some countries found TRIPS to be too rigid because it stipulated that a compulsory licence could only be issued to service the domestic market so “flexibilities” were written into the agreement. This was of particular concern to developing countries that had neither the manufacturing capabilities nor the infrastructure to take advantage of the compulsory licensing provisions. Paragraph 6 of the November 2001 WTO Doha Declaration on TRIPS and Public Health addressed this perceived problem inherent in Article 31(f) of the TRIPS Agreement.11 Moreover, key transitional time periods in the TRIPS Agreement required worldwide protection for pharmaceutical products beginning in 2005 which challenged the practice of middle income countries reverse engineering medicines and then producing them for export. Consequently, it was agreed under Paragraph 6 that the Council for TRIPS would find an expeditious solution and report to the General Council by 2002. However, it was not until August 2003, shortly before the Cancun Ministerial Conference, that a consensus was reached. This was known as the Paragraph 6 Implementation Agreement. It granted rights to developing countries to waive the provisions under Article 31(f) and also allowed member countries to issue compulsory licences to export generic versions of patented pharmaceutical products to meet the needs of importing countries with insufficient or no pharmaceutical manufacturing capacity, subject to certain conditions. This Agreement created a waiver to Article 31 of TRIPS which was supposed to be temporary pending an amendment which was achieved on December 6, 2005. The new amendment approved changes to the TRIPS Agreement and made the waiver permanent. The Amendment comprises three parts; the first allows developing countries without a significant pharmaceutical capacity or sector, in the event of a public health crisis, to access alternative supplies of medicines. The annex of this amendment then goes on to spell out the specific circumstances in which a compulsory licence can be used and provides safeguards against parallel importing. Lastly the appendix deals with the criteria for accessing lack of manufacturing capacity in the importing country. Emmanuel Hassan, Ohid Yaqub and Stephanie Diepeveen, Intellectual Property and Developing Countries: A Review of the Literature, Cambridge UK: RAND Europe, 2010. 11 At the time of writing the Doha Declaration had still not been ratified by a majority of the member states of the WTO. 15 The Implementation Agreement makes compulsory licences easy to obtain for least developed countries by defining an eligible importing Member as “any least developed Member without any supplementary proof required from that Member”. The Paragraph 6 Implementation Agreement also introduces remuneration requirements which are not only difficult to calculate but are also paradoxically required even when the product is not produced for a country where medicine is not patented. Based on the “Chairman’s statement”, which accompanied the amending Agreement, middle income countries needing to import generics because of incapacity of their pharmaceutical sector must actually prove and defend such claims of need. Safety is, once again, a concern given that Good Manufacturing Practices and identified best practices are not always practised ideally in these circumstances. In effect, this “flexibility” in TRIPS allowed governments to issue a “compulsory licence” to a company, other than the innovator of the drug in question, to produce a patented drug, or use the patented process, under licence, provided that the legitimate interests of the patent holder were safeguarded. Numerous cases arose where compulsory licences were allegedly issued in middle income countries with total disregard for patent holders’ rights. Often drugs – still under patent - produced under these “compulsory licences” were not used for the public health of the producer’s domestic market but sold for a profit around the world. Most of these cases have been settled in favour of the innovator company. Compulsory licensing, when enacted illegally, is nothing short of piracy. 12 At its spring meetings, the World Trade Organization took stock of its trade liberalization initiatives which included Paragraph 6 of the Doha Declaration re compulsory licensing of pharmaceuticals. A month prior to that a small group of mostly middle income, socialist countries, including Brazil, China, Cuba, Ecuador, Egypt, India, Indonesia and Venezuela, claimed that Paragraph 6 was not working effectively. Others at that meeting, including Argentina, Canada, the European Union, Switzerland, and the United States, claimed that Paragraph 6 was not working because it was not needed. The findings of this report clearly show that Paragraph 6 is not needed to deliver much needed medicines to the least developed countries. Where possible, those drugs are being delivered Only one legal compulsory licence has ever been invoked, for a brief time by Rwanda to treat 21,000 AIDS patients. Canada, the exporting country, said that the shipments to Rwanda took longer than expected because the company seeking a compulsory licence needed time to find an interested importing country, as well as on account of Rwanda’s procurement tendering procedures. Regrettably nothing has changed “on the ground” in Rwanda to improve access to medicines. 12 16 through numerous public-private partnerships. Where they are not being delivered has little to do with price or patents but with on-the-ground barriers. The Real ‘On-the-Ground’ Problems and Solutions In the post-TRIPS world, enforcement of existing rules is almost non-existent world-wide. The Cameron Institute could find no evidence for supporting the application of flexibilities as provided for in Paragraph 6 of the DOHA Declaration under TRIPS. Where flexibilities have been invoked to date, desired results have not been achieved and wrongdoings have been identified. Compulsory licensing is being abused and should be discontinued for the welfare of all. Compulsory licensing was established as a humanitarian act and not as a vehicle to encourage privateering. In a TRIPS-compliant world, the patent owner of a product already in mass production will likely be the lowest cost producer since the cost of producing an incremental quantity of the product will be lower than the all-in costs for a start-up operation producing a limited amount of the product. As a result, compulsory licensing has done nothing to promote public health in least developed countries and has only reduced the incentive for investing in the innovation of new drugs (as illustrated in the figure below). The Patent Infringement-Innovation Loss Dynamic Intellectual Property Protection # Patents # Patent Infringement through Compulsory Licensing or other means # Economic Consequences # Social Consequences (Loss of profits and reduced (Concerns about drug safety and investment in innovation) unexpected, deleterious health outcomes) Instead of compulsory licences, various research-based pharmaceutical companies around the world have voluntarily entered into partnerships that permit their partners use of their compound libraries in R&D collaborations. However, the free and unrestricted opening of compound libraries owned by private entities undercuts the positive and constructive voluntary collaborations underway and the protection of IP. Furthermore, safety is always a 17 paramount concern in both the pharmaceutical R&D and manufacturing worlds. Unfettered access to compound libraries could potentially raise the safety risk significantly. Since September 11, 2001 we live in a different world. Any and all bilateral, multilateral or global initiatives must take into account the possibility of bioterrorism. Never before has the threat of bioterrorism been more real. Only because of the vigilance of the United States and its allies has a serious bioterrorist attack not occurred. Yet the potential for such an atrocity is high if chemical and biological compounds used in the manufacture of pharmaceuticals are not closely protected through a system of secure intellectual property rights and government enforcement of same. Intellectual property protection never played a greater role in global security than now. Opening compound libraries beyond voluntary arrangements such as exist today could very conceivably feed the capacity needs of bioterrorists. Innovative and complementary incentive schemes for R&D have also contributed to the success of many public-private partnerships. For example, advanced market commitments (AMCs), which provide a defined market through contractual agreement by governments, international agencies and/or NGOs to procure specified quantities of product, already exist in certain circumstances. Advanced market commitments have merit as both incentive and reward for innovation, as well as means to expedite the successful delivery of needed medicines to those most in need around the world. The real challenges facing access to medicines in the least developed countries are not ones of IP but ones of market failure, corruption, and lack of political will. These have been documented in the literature going back more than 20 years. 13 Most of the least developed countries do not have an efficient infrastructure by which to distribute and administer medicines. A real impediment to improving patient care and health outcomes in the least developed countries is the lack of roadways, potable water, basic education, transport and communications. Without infrastructure and capacity (both material and human) “drive-by” aid does little good.14 One-third of the world’s population lacks a safe water supply. The United Nations calculated that 25,000 people die unnecessarily from water-borne diseases every day, and that by 2025 two-thirds of the world’s population will live in countries with serious water shortage. It is not uncommon to have time-sensitive medical supplies off-loaded onto a dock only to sit there with no means of being transported to their destination. Developing countries must invest in rapidly evolving their own internal health delivery infrastructure to efficiently deliver For example see: P. Farmer, AIDS and Accusations: Haiti and the Geography of Blame, Berkeley CA: University of California Press, 1990; World Health Organization. The Rational Use of Drugs: Report of a conference of experts, Nairobi, 25-29 November 1985. 14 General Rick Hillier, A Soldier First: Bullets, Bureaucrats and the Politics of War, Toronto: HarperCollins Publishers Ltd., 2009:293. 13 18 pharmaceuticals to those most in need. Healthcare must become a priority in these countries if better health is to be achieved. For example, local tariffs (as high as 24% in some cases) and taxes on healthcare products should be removed. These tariffs and taxes are two of the real barriers to access to innovative medicines in developing countries 15. Canada, the United States, the United Kingdom and other nations, as always, must be willing to stand by and help those countries who are seen to be helping themselves. There is a serious shortage of healthcare professionals and those that do exist, exist mainly in the cities. Frontline, indigenous healthcare personnel are needed to assist in the very basic provision of immunizations, healthy baby and mother checks, and health promotion throughout the countryside of developing countries. Yet health human resources are in disarray and decline in most of the least developed countries. Even though Africa suffers 25% of the global burden of disease the continent only has 3% of the world’s supply of health workers. Africa needs 800,000 doctors and nurses. The healthcare infrastructure has totally collapsed in sub-Saharan Africa. The stigma of HIV/AIDS, the low status of women, and the absence of potable water make the effective use of medicines problematic. According to the International Development Research Centre (IDRC) of CIDA (the Canadian International Development Agency) the disparity between the financial commitments that are needed even for a minimal package of essential healthcare interventions and current levels of development assistance calls into serious question the likelihood of achieving health-related goals. Above all is the lack of political will to create stable, ethical, and law-abiding government administrations that will ensure products arrive where they are destined without delay, diversion, theft or unnecessary tariffs. When drugs are shipped to countries in need they often sit in warehouses until “fees” have been paid and sometimes the shipments are stolen, sold on the black market, or even re-exported for profit. Regrettably, global bodies continue to ignore the reality of delivering drugs in developing countries and, in particular, the least developed countries; they attack IP and ignore the onthe-ground realities16. In many countries adequate roads, transport facilities and equipment simply do not exist when and where needed. Tolls, fees, charges, and taxes all slow the delivery process. Theft of product and diversion into black markets is common. Lack of security, law enforcement, regulation and legitimate government presence all contribute to a very difficult delivery reality in much of the South that has gone totally unnoticed by world assemblies and their agencies. International Centre for Trade and Sustainable Development, “WTO, WHO and WIPO Vow Cooperation on Access to Medicines, but Challenges Remain,” Intellectual Property Programme, Vol. 14, No. 27, 21 July 2010. 16 For example see: Alec Irwin and Eva Ombaka, Background Paper of the Task Force on Major Diseases and Access to Medicines, Subgroup on Essential Medicines, United Nations Development Programme’s Millennium Project, April 18, 2003 15 19 Foreign aid for healthcare in African countries more than doubled from USD8 billion in 1995 to USD19 billion in 2006. Yet for every aid dollar sent to African governments for healthcare those same African governments divert USD1.14 of their own resources to other areas.17 At the African Union Summit in July 2010, it was reported by WHO that only six member countries had met their 2001 pledge to invest 15% of their national output in healthcare. Developing countries need to develop their own strategic plans to deal with major public health problems and invest in the determinants of health such as poverty, potable water, pollution, peace and the education of women. Much work needs to be done in formulating new economic models, trade frameworks and financing schemes by which the private sector can partner with governments and NGOs to not only deliver drugs to those in need but to create the sort of infrastructure, to develop the needed personnel, and to evolve the legal and administrative institutions required to improve patient care and health outcomes on a sustainable basis over the longer term. Only then will there be health for all in this world. Conclusion Based upon the evidence contained in this report, The Cameron Institute believes that both industrialized and developing countries must adopt, adhere to, comply with and respect existing IP laws, rules and regulations. Developing countries, with the assistance of developed countries, must create a parallel oversight capacity, where there is none today, to manage IP in their countries. A universal IP regime will be integral to any concerted effort to promote global health and healthcare through public-private partnerships or any other proven means – simply put, there is no effective substitute for patents. 18 Any attempts to undermine IPP will only pit the North against the South – and that would be just wrong. Statism and paternalism will only stifle the improvement of the health of those living in the least developed countries of the world; the evidence in this report strongly supports North-South, public-private partnerships as the preferred means by which to deliver health to all. Access to medicines and innovation are not and cannot be mutually exclusive; without access, innovation is meaningless; without innovation, there is nothing to access. The symmetry amongst innovation, free markets, protection of intellectual property, and democratic societies is no mistake. Patents and other forms of intellectual property protection are just simple, albeit very powerful, devices by which innovation is optimally incented in free societies. It is no accident that the lion’s share of the world’s innovativeness comes from democratic stalwarts like the United States, Canada and the United Kingdom. And the key to this success has been private property – in this case, patents and other protective devices. Alec Van Gelder, “How to Worsen Africa’s Health Crisis”, WSJ Europe, August 29, 2010. Richard A. Epstein and A. Scott Kieff, Questioning the Frequency and Wisdom of Compulsory Licensing for Pharmaceutical Patents, 14. 17 18 20 Public-private partnerships have been very successful in increasing access to needed medicines by the least developed countries of the world. The real barriers to access are not patents but on the ground. Based upon the evidence presented in this report it is concluded that Paragraph 6 of TRIPS is not required in today’s world. 21 An Annotated Catalogue of Public-Private Partnerships that Provide Access to Pharmaceuticals in Least Developed Countries 22 INITIATIVES TO IMPROVE HIV/AIDS ANTIRETROVIRAL (ARV) ACCESS 1. AAI - Accelerating Access Initiative Disease area(s): HIV/AIDS Company (ies): Abbott, Boehringer Ingelheim, Bristol-Myers Squibb, Gilead, GlaxoSmithKline, Merck & Co. Inc., Pfizer, Roche, Tibotec Partner(s): UNAIDS, UNFPA, UNICEF, WHO, World Bank Since 2000 Programme type(s): Access - Pricing Developing country(ies): Developing countries Established in 2000, the Accelerating Access Initiative (AAI) involves nine research-based pharmaceutical companies: Abbott, Boehringer Ingelheim, Bristol-Myers Squibb, Gilead Sciences, GlaxoSmithKline, Pfizer, Tibotec, Roche, and Merck & Co., Inc, and five United Nations partners: UNAIDS, the World Health Organization, World Bank, UNICEF, and the United Nations Population Fund (UNFPA). Data on patients receiving treatment with ARV medicines provided by the AAI companies: " The total number of patients receiving treatment from the AAI companies in 2008 increased by 77 percent from the previous year, with over 403, 000 people treated with ARVs supplied by the AAI companies during that time. " In Africa alone, over 446,000 patients are being treated with medicines supplied by the AAI companies. This increase of more than 116 percent from the previous year results in a 45-fold increase in the number of people being treated with ARVs supplied by the AAI companies in Africa since the establishment of the AAI in May 2000. " As of 30 September 2008, some 773,803 patients in developing countries were estimated to be taking one or more medicines supplied at preferential prices by an AAI company. AAI companies also recognize that expanded access to medications requires a collaborative approach with governments, NGOs, multilateral organizations, and other public and private bodies. Many AAI companies are involved in initiatives to strengthen healthcare systems, streamline product registrations, and conduct clinical studies in developing countries. AAI companies also continue to invest significantly in research and development of new medications - including paediatric formulations - and diagnostics, to help combat the global HIV/AIDS pandemic. 23 2. Abbott Programme for Expanding Access to Treatment Disease area(s): HIV/AIDS Company(ies): Abbott Partner(s): Various partners Since 2001 Programme type(s): Access - Pricing Developing country(ies): Africa, Least developed countries, low & lowermiddle income countries In 2002, Abbott made a commitment to sell its HIV medicines at USD 500 per patient per year in Africa and least developed countries (Least developed countries), as defined by the United Nations. In 2006, Abbott announced that the heat-stable lopinavir/ritonavir tablet would also cost USD 500 per patient per year in Africa and the least developed countries. In April 2007, Abbott announced a reduction in the mid-tier price to USD 1,000 per patient per year for middle income countries also. 24 3. Viramune® Donation Programme Disease area(s): HIV/AIDS Company(ies): Boehringer Ingelheim Partner(s): Governments in most recipient countries Since 2000 Programme type(s): Access - Donation & Pricing Developing country(ies): 59 developing countries As part of its policy to extend access to Viramune®, Boehringer Ingelheim offers its antiretroviral product Viramune® (nevirapine) for single-dose use in the prevention of motherto-child transmission (PMTCT) for free through the Viramune® Donation Programme. So far, around 1.7 million mother/child doses have been made available to 169 programmes in 59 countries. For chronic treatment, Boehringer Ingelheim charges a substantially reduced price for all countries as low income, all least developed countries and for all countries in sub-Saharan Africa - a total of 78 countries. In addition, all middle income countries qualify for a lowered price (63 countries). Since 2000, Boehringer Ingelheim has given free access to single-dose Viramune® (nevirapine), to be used alone or in combination with other drugs, to prevent mother-to-child transmission of HIV during birth. The company is currently donating the product to 59 countries in Africa, Asia, Latin America and Eastern Europe. In total more than 885, 000 mother and child doses were supplied free of charge so far. 25 4. Bristol-Myers Squibb Global Access Programme Disease area(s): HIV/AIDS Company(ies): Bristol-Myers Squibb (BMS) Partner(s): Various partners, including Health Ministries Since 2001 Programme type(s): Access - Pricing Developing country(ies): Africa & least developed countries In 2001, BMS announced that it would provide all of its HIV medicines at no-profit prices in subSaharan Africa, because of the extreme burden of disease there, combined with the region's limited ability to pay for HIV medicines. In July 2005, the company announced a further reduction in the price of paediatric formulations from no-profit to significantly below cost in an attempt to reduce all barriers hampering accelerated, broad access to treatment for the millions of children in sub-Saharan Africa who need these medicines most. BMS has also implemented a differential pricing policy globally, to enable collaboration with and support for government activities in regions with high incidence and low ability to pay for HIV medicines. 26 5. Gilead Access Programme Disease area(s): HIV/AIDS Company(ies): Gilead Partner(s): Various partners Since 2003 Programme type(s): Access - Pricing Developing country(ies): least-developed countries Gilead has developed a tiered pricing system for its HIV medicines, including Viread® (tenofovir disoproxil fumarate) and Truvada® (emtricitabine and tenofovir disoproxil fumarate), based on a country's economic status and HIV prevalence. It offers substantial price reductions through its Access Programme in 130 countries, representing two-thirds of the countries in the world, and the regions hardest hit by the AIDS epidemic. Highlights • More than 700,000 patients receiving HIV treatment • 130 countries in the Access Programme • Majority of patients on Gilead therapies live in developing countries • Partnerships with 14 Indian and South African generic manufacturers • Price of generic Viread® is USD 7.25/month The company has established an innovative access model that has significantly increased the number of developing world patients receiving the company’s HIV treatments – from just 100 people in 2003 to more than 700,000 in 2010. Today, the majority of people who benefit from Gilead’s HIV therapies live in developing countries. 27 6. GlaxoSmithKline Access to ARVs Disease area(s): HIV/AIDS Company(ies): GlaxoSmithKline (GSK) Partner(s): Various partners Since 1997 Programme type(s): Access - Pricing Developing country(ies): 37 developing countries GlaxoSmithKline has offered sustainable preferential pricing for certain antiretrovirals (ARVs) since 1997. All its ARVs are now available at no-profit prices to public sector customers and not-for-profit organizations in all least developed countries and all of sub-Saharan Africa - 64 countries in total. In addition, all private employers in sub-Saharan Africa who provide care and treatment to their uninsured staff can purchase its ARVs at no-profit prices. All CCM (country coordinated mechanism) projects fully funded by the Global Fund to fight AIDS, TB and malaria, and projects funded by the US President's Emergency Plan for AIDS Relief (PEPFAR), are also eligible. GSK's prices are sustainable - it does not make a profit on them, but it does cover its costs. This means that it can sustain supply of these high-quality products for as long as they are needed. In February 2008, GSK introduced significant new price reductions averaging 21% across the range of its ARVs. The most significant reduction, of almost 40%, was on Ziagen® oral solution (abacavir), which is recommended by the World Health Organization (WHO) for use in first-line and second-line regimens within resource-limited settings, particularly for children. Combivir® was reduced by 17% to USD 0.54 per day. During 2008, GSK supplied ARVs at no-profit prices to 37 countries, compared to 31 in 2007. GSK shipped 11.4 million tablets of no-profit Combivir® and 58.6 million tablets of no-profit Epivir® to the developing world in 2008 compared with 13 million and 72 million tablets respectively in 2007. In 2008, GSK licensees supplied more than 279 million tablets of their versions of Epivir® and Combivir® to Africa. The cost to the Indian economy is estimated to exceed USD 840m every year due to treatment costs, reduced working time and lost productivity. The Nashik facility will potentially save the Indian health system an estimated Rs. 1.38 billion (USD 30 million) in treatment costs and improve lives of 550 million people in India who live at risk of developing this debilitating condition. 28 7. Access to ARVs Disease area(s): HIV/AIDS Company(ies): Merck & Co. Inc. Partner(s): Various governments and NGOs Since 2001 Programme type(s): Access - Pricing Developing country(ies): Developing countries Since 2001, Merck & Co., Inc. has had a differential pricing policy whereby it provides its antiretroviral medicines (ARVs) at no-profit prices in least developed countries and those hardest hit by the AIDS pandemic. Merck's ARV pricing policy applies to all of the company's ARVs: Crixivan™, Stocrin™, Atripla™ and Isentress™. For each product, Merck offers its lowest price - a price at which Merck does not profit - to the world's least developed countries and those countries hardest hit by the HIV/AIDS pandemic, as measured by adult HIV prevalence. For the most economically-developed countries, Merck applies competitive, market-based principles in pricing its ARV products. As of July 2008, more than 777,000 patients in 125 countries and territories were being treated with regimens containing at least one of Merck's ARVs. Four out of five (81%) - or an estimated 631,000 patients - obtained these ARVs in the more-than-80 countries where they are sold at a price at which Merck does not profit. An additional 7% received Merck ARVs in countries where they are offered at significantly discounted prices. Nine out of ten patients using Merck ARVs live in developing countries in Africa, Asia, Latin America and the Caribbean where the pandemic is having its most devastating impact. Of those being treated with Merck ARVs, there are an estimated 96,600 children using paediatric formulations, representing 13% of all patients on Merck ARVs. 29 8. Access to ARVs Disease area(s): HIV/AIDS Company(ies): Roche Partner(s): Various partners Since 2002 Programme type(s): Access - Pricing Developing country(ies): All low and lower-middle income countries Roche supplies its HIV protease inhibitors, Invirase® and Viracept® (including paediatric powder), at no profit prices for people living in least developed countries (as defined by the United Nations and appended at the end of this report) and in sub-Saharan Africa. These prices are the lowest at which these medicines can be provided in a sustained, long-term manner, and have been shown to be similar or less than that of generic versions of the medicine. In addition, Roche established significantly reduced pricing for Invirase® and Viracept® for low and lower middle income countries (as defined by the World Bank), where there is need for access to HIV/AIDS treatments, and where local governments are able to play a greater role and make a more significant contribution towards the provision of public healthcare. The reduced prices apply to 88% of all people living with HIV/AIDS worldwide. The Cambodia Treatment Access Programme (CTAP) Launched in September 2003, the Cambodia Treatment Access Programme (CTAP) is a public-private partnership between the Cambodian Ministry of Health, the National Centre in HIV Epidemiology and Clinical Research at the University of New South Wales, Australia, and Roche. Cambodia is thought to have the highest rate of adult HIV infection in Asia. CTAP aims to increase access to essential treatments for HIV/AIDS and provide training for local healthcare professionals. As part of CTAP, a new outpatient treatment centre for patients with HIV/AIDS has been opened in Cambodia’s capital, Phnom Penh. The centre provides counseling, clinical care and HIV therapy, and supports HIV training and research. By 2006, CTAP had enrolled more than 1,200 people for free treatment thanks to Roche’s support. In September 2006, Roche funded a training event for 400 healthcare professionals from all over Cambodia to expand their knowledge and share experiences of treating HIV/AIDS. 30 9. Single Tablet per Day Disease area(s): HIV/AIDS Company(ies): Bristol-Myers Squibb, Gilead, Merck & Co. Inc. Partner(s): Ministries of Health Since 2003 Programme type(s): Access - Pricing Developing country(ies): Developing countries In August 2006, Gilead and Merck announced an agreement for the distribution of Atripla® in 106 developing countries around the world where convenient treatment options are critical to patient compliance and adherence to therapy. Gilead is manufacturing Atripla® using efavirenz supplied by Merck, and Merck is distributing Atripla® in these markets. In all of the developing countries, Atripla® is being sold at significantly discounted prices. As of April 1, 2008, 55 countries - including most in sub-Saharan Africa - had either granted regulatory approval for Atripla® or allowed the product to be imported. Tens of thousands of patients are already benefitting from this first-of-its-kind fixed dose combination ARV. 31 10. Technology Transfer & ARV Licensing in Developing Countries Disease area(s): HIV/AIDS Company(ies): Boehringer Ingelheim, Bristol-Myers GlaxoSmithKline, Merck & Co. Inc., Roche Partner(s): Various generic pharmaceutical manufacturers Squibb, Gilead, Since 2001 Programme type(s): Access - Licensing Developing country(ies): Kenya, India, South Africa Since 2001, Bristol-Myers Squibb has had a policy of not enforcing its patents for HIV products in sub-Saharan Africa and has immunity from suit agreements for stavudine and didanosine with five African generic companies. In February 2006, it concluded technology transfer agreements with generic companies Aspen PharmaCare (South Africa) and Emcure Pharmaceuticals (India), for its newest antiretroviral, atazanavir (sold as Reyataz® in the US). Bristol-Myers Squibb has transferred intellectual property and technical know-how related to the manufacturing, testing, packaging, storage and handling of the active pharmaceutical ingredient and finished dosage form. Gilead has partnered with Aspen Pharmacare, South Africa to manufacture and distribute branded and generic versions of Viread® and Truvada® in Africa. In 2006, Gilead also entered into non-exclusive licensing agreements with 10 Indian generic companies, allowing them to distribute generic versions of tenofovir in 95 developing countries, including Thailand. Matrix, India, has received tentative FDA approval for its generic tenofovir and tenofovir-lamivudine fixed-dose combination, and Aurobindo has received tentative FDA approval for its generic tenofovir. GSK's licensees supplied 279 million tablets of their versions of Epivir® and Combivir® to Africa in 2008. This represents more than 50% growth over 2007 and 130% more than in 2006. This trend is welcome as it gives customers in sub-Saharan Africa greater choice and contributes to better security of supply. Agreements have been signed with 10 companies in Bangladesh, Ethiopia, Kenya, South Africa, Tanzania and Zimbabwe. Expressions of interest have been received from 40 more companies in 17 eligible countries and assessment visits have been conducted with 38 of these potential partners. 32 11. AmpliCare Programme Disease area(s): HIV/AIDS Company(ies): Roche Partner(s): William J. Clinton Presidential Foundation Since 2002 Programme type(s): Capacity Building - Support & Training Developing country(ies): Sub-Saharan Africa, South America and the least developed countries The AmpliCare programme began in 2002 and supplies HIV viral load tests at the lowest possible price to sub-Saharan Africa, South America and the least developed countries as defined by the UN. AmpliCare also offers an education programme to keep local doctors and nurses fully informed about the latest advances in HIV/AIDS care. In 2008, in sub-Saharan Africa, 450,000 infants were tested for HIV and an estimated 560,000 patients had their HIV/AIDS treatment monitored. 12. CARE [The Cohort to evaluate Access to antiretroviral treatment and Education] Disease area(s): HIV/AIDS Company(ies): Roche Partner(s): PharmAccess Foundation Since 2001 Programme type(s): Capacity Building - Support & Training Developing country(ies): Africa and Asia Since 2001, the CARE programme has provided a forum for healthcare professionals across Africa, and more recently Asia, to meet and discuss their experiences of managing HIV/AIDS, with the aim of helping to improve the care and treatment offered in their own countries. Since the start of the CARE programme in 2001, the HIV/AIDS management exchange meetings have brought together more than 600 healthcare workers – including doctors, nurses, counselors, pharmacists and laboratory managers – from over 29 countries in Africa and Asia. 33 INITIATIVES FOR MOTHER AND CHILD PROGRAMMES 1. Abbott Fund Programme for Supporting Children Affected by AIDS Disease area(s): HIV/AIDS Company(ies): Abbott Partner(s): Baylor College of Medicine in USA, Catholic Medical Mission Board CMMB, Elizabeth Glaser Paediatric AIDS Foundation EGPAF, Academic Model for Prevention and Treatment of HIV/AIDS , Partners In Health, Family Heath International. Since 2000 Programme type(s): Capacity Building - Support & Training Developing country(ies): 10 developing countries on 3 continents The Abbott Fund is partnering with several organizations to expand access to healthcare for mothers and children affected by HIV/AIDS in developing countries. Since 2001, more than 1 million children and adults have received services in Burkina Faso, India, Kenya, Malawi, Romania, Tanzania and Uganda. Baylor and the Abbott Fund also partnered to establish the Baylor Children's Clinical Centres of Excellence Network to train health professionals who together treat 30,000 children - the largest number of children with HIV in any treatment programme worldwide. The Abbott Fund is working with the Catholic Medical Mission Board (CMMB) to help prevent mother-to-child HIV transmission in 100 health facilities in Kenya. Through the partnership, testing, care and treatment will be provided to pregnant women and exposed infants. The Abbott Fund-Elizabeth Glaser Paediatric AIDS Foundation (EGPAF) partnership in Tanzania and Uganda is working to accelerate enrollment of HIV-infected children into care and treatment programmes, and to train and support healthcare workers. The Abbott Fund and Family Health International (FHI) are partnering in Tanzania and Malawi to reduce mother-to-child HIV transmission and expand access to HIV care and treatment for children. The Abbott Fund works with AMPATH (also known as the Indiana University-Moi University, Kenya Partnership) in Kenya to prevent HIV infections through testing, counseling (primarily home-based), education and treatment. 34 2. Bristol-Myers Squibb’s Secure The Future® Children´s Clinics & Paediatric AIDS Corps Disease area(s): HIV/AIDS Company(ies): Bristol-Myers Squibb Partner(s): Baylor College of Medicine in USA Since 1999 Programme type(s): Capacity Building - Support & Training Developing country(ies): Botswana, Burkina Faso, Kenya, Lesotho, Malawi, Swaziland, Tanzania, Uganda. This centre now has more than 1,500 children under treatment. Additional children’s clinical centres have now been opened in Lesotho, Swaziland and Uganda. These centres add capacity to fight HIV/AIDS by providing modern facilities for testing, treating and monitoring children and their families, as well as training local healthcare professionals. To increase the number of trained paediatric specialists, Secure The Future® and Baylor College of Medicine created the Paediatric AIDS Corps, which will send 50 doctors a year over five years to Africa to treat some 100,000 children and train local healthcare professionals. The first class of 50 doctors arrived in Africa in August 2006. Additional Secure The Future® projects provide education, psychosocial care and support for orphans and vulnerable children, training, food security and income-generating projects for caregivers; and work to reduce stigma and encourage testing. Since 1999, Bristol-Myers Squibb and the Bristol-Myers Squibb Foundation have committed USD 150 million to develop and replicate innovative and sustainable solutions for vulnerable populations, including women and children, infected and affected by HIV/AIDS in subSaharan Africa. 35 3. Elizabeth Glaser Paediatric AIDS Foundation Disease area(s): HIV/AIDS Company(ies): Abbott, Boehringer Ingelheim, Johnson & Johnson (J&J) Partner(s): EGPAF Since 1988 Programme type(s): Access - Donation, Capacity Building - Training, Education Developing country(ies): 17 developing countries The Elizabeth Glaser Paediatric AIDS Foundation (EGPAF) was set up in 1988 to prevent paediatric HIV infection and to eradicate paediatric AIDS through research, advocacy, prevention and treatment programmes. It works in two broad programme areas: HIV/AIDS Research and Training Programmes, and International Family AIDS Initiatives. The Abbott Fund, Boehringer Ingelheim and Johnson & Johnson are major supporters of EGPAF and its work. EGPAF collaborates with host governments, international healthcare facilities, non- governmental organizations and community-based organizations to plan, implement and/or expand programmes. It also provides technical assistance and support for community mobilization and training of healthcare workers, HIV counseling and testing, mother-to-child prevention regimes and infant feeding education. As of September 2008, EGPAF had reached more than 6.3 million women with access to “preventing mother to child transmission” (PMTCT) services and almost 6.2 million have been counseled. Among these, more than 5.3 million individuals have been tested, 510,000 identified as HIV-positive, and ARV prophylaxis has been provided to over 480,000 women and over 280,000 infants. J&J has partnered with the EGPAF since 2003 and now has expanded to 770 sites in six countries. As of June 2007, the EGPAF-J&J PMTCT Partnership has directly contributed to reaching more than 860,000 women with counseling, providing nearly 760,000 women with HIV testing, and administering ARV prophylaxis to over 39,000 HIV-positive mothers. Total money spent in 2008 was close to USD 103 million, which represent 87% of total revenue. Administrative cost was just 10% of total revenue (USD 120 million dollars), which shows the high commitment and high efficiency with which the programme is being conducted. 36 4. Life Skills Community Support for Children Affected by HIV/AIDS Disease area(s): HIV/AIDS Company(ies): Johnson & Johnson Partner(s): Life Skills Development Foundation Since 2005 Programme type(s): Capacity Building - Training, Education Developing country(ies): Thailand There are some 150,000 AIDS orphans in the Upper Northern region of Thailand. From economic struggle and emotional hardship to social stigma and isolation, they face many problems. The Life Skills Development Foundation, a NGO that provides life skills education and training for children, youth, women and families, works in many districts to reach children affected by HIV/AIDS. With the help of Johnson & Johnson, the foundation provides assistance to these children and their caregivers through HIV/AIDS education, psychological and financial support, and community education. Out of total expenses of USD 22 million, only 10% was administration costs and the rest went into implementing the various aspects of the programme. 37 5. Abbott Rapid HIV Test Donation Programme Disease area(s): HIV/AIDS PMTCT Company(ies): Abbott Partner(s): Various partners Since 2002 Programme type(s): Access - Donation Developing country(ies): 39 countries - including all of Africa Each year, approximately 370,000 babies around the world become infected with HIV during their mothers' pregnancy, during birth or through breastfeeding. Enabling pregnant women to know their HIV status before they give birth is the first step in preventing mother-to-child transmission (PMTCT) of HIV. To facilitate access to rapid HIV testing, Abbott has made a commitment to donate a rapid (15 minute) HIV test to PMTCT programmes in 69 countries, including all of Africa and the least developed countries, as defined by the United Nations. Abbott also has extended its PMTCT donations to include testing of spouses and children of pregnant women who are found to be HIV positive through the programme. To date, Abbott has donated more than 11 million rapid HIV tests in 39 countries: Angola, Benin, Botswana, Burkina Faso, Burundi, Cambodia, Cameroon, Central African Republic, Chad, Côte d'Ivoire, Djibouti, Democratic Republic of Congo, Ethiopia, Gabon, Ghana, Guinea Bissau, Guinea, Haiti, Kenya, Laos, Lesotho, Liberia, Madagascar, Malawi, Mali, Mozambique, Namibia, Niger, Nigeria, Rwanda, Senegal, Sierra Leone, South Africa, Swaziland, Tanzania, Togo, Uganda, Zambia and Zimbabwe. 38 6. Viramune® Donation Programme Disease area(s): HIV/AIDS PMTCT Company(ies): Boehringer Ingelheim Partner(s): EGPAF, Governments, Rotary International, UNICEF Since 2000 Programme type(s): Access - Donation, Capacity Building - Training Developing country(ies): 60 developing countries Boehringer Ingelheim's Viramune® Donation Programme was announced in July 2000 as a programme that offers the antiretroviral medicine Viramune® free-of-charge to developing countries and has been designed for prevention of mother-to-child transmission (PMTCT) of HIV-1. There are 114 countries eligible according to the World Bank list of developing and transient economies. Boehringer Ingelheim donates Viramune® in accordance with the WHO Guidelines for Medicine donations, free of charge, based on the expressed interest of governments, NGOs, charitable organizations or other healthcare providers with comprehensive mother-to-child transmission prevention programmes. As well as Viramune® tablets and suspension, the donation includes oral syringes for the paediatric dose and pouches in which filled oral syringes can be taken home by mothers. Partners: Elizabeth Glaser Paediatric AIDS Foundation (EGPAF), Rotary International, United Nations Children´s Fund (UNICEF), Angola Ministry of Health, Antigua and Barbuda Ministry of Health, Benin Ministry of Health, Botswana Ministry of Health, Burundi Ministry of Health, Burkina Faso Ministry of Health, Cameroon Ministry of Health, Central African Republic Ministry of Health, China Ministry of Health, Côte d'Ivoire Ministry of Health, Democratic Republic of Congo Ministry of Health, Dominican Republic Ministry of Health, Djibouti Ministry of Health, Ecuador Ministry of Health, Eritrea Ministry of Health, Ethiopia Ministry of Health, Gabon Ministry of Health, Gambia Ministry of Health, Ghana Ministry of Health, Guyana Ministry of Health, Honduras Ministry of Health, Indonesia Ministry of Health, Jamaica Ministry of Health, Laos Ministry of Health, Lesotho Ministry of Health, Liberia Ministry of Health, Kenya Ministry of Health, Malawi Ministry of Health, Mali Ministry of Health, Mozambique Ministry of Health, Madagascar 39 Ministry of Health, Namibia Ministry of Health, Niger Ministry of Health, Nigeria Ministry of Health, Papua New Guinea Ministry of Health, Peru Ministry of Health, Russia Ministry of Health, Rwanda Ministry of Health, Senegal Ministry of Health, Sierra Leone Ministry of Health, South Africa Ministry of Health, Swaziland Ministry of Health, Tanzania Ministry of Health, Togo Ministry of Health, Ukraine Ministry of Health, Uganda Ministry of Health, Vietnam Ministry of Health, Zambia Ministry of Health, Zimbabwe Ministry of Health Countries: Angola, Antigua and Barbuda, Benin, Botswana, Burundi, Burkina Faso, Cambodia, Cameroon, Central African Republic, Chad, China, Côte d'Ivoire, Republic of Congo, Democratic Republic of Congo, Dominican Republic, Djibouti, Ecuador, Eritrea, Ethiopia, Gabon, Gambia, Georgia, Ghana, Guinea-Bissau, Guinea, Guyana, Haiti, Honduras, Indonesia, Jamaica, Laos, Lesotho, Liberia, Kazakhstan, Kenya, Malawi, Mali, Mozambique, Madagascar, Namibia, Niger, Nigeria, Papua New Guinea, Peru, Russia, Rwanda, St. Vincent and the Grenadines, Senegal, Sierra Leone, South Africa, Suriname, Swaziland, Tanzania, Togo, Ukraine, Uganda, Vietnam, Zambia, Zimbabwe 40 7. Abbott Fund Programme to Strengthen Tanzania's Healthcare System Disease area(s): HIV/AIDS Company(ies): Abbott Partner(s): Tanzania Ministry of Health Since 2003 Programme type(s): Access - Donation, Capacity Building - Support & Training Developing country(ies): Tanzania The Abbott Fund and the Government of Tanzania have formed a unique public-private partnership to modernize the country's healthcare system. In total, Abbott has invested more than USD 60 million in Tanzania. More than 15,000 healthcare workers have been trained or re-trained to date in Tanzania. At Muhimbili, 200 physicians now serve as trainers for other health staff. More than 250 staff has been trained in lab equipment operation, while 600 senior doctors and hospital directors have received management training. Facilities, systems and training have been upgraded at 90 sites throughout the country to improve voluntary counseling and testing (VCT) services. Due to these improvements, more than 300,000 people have received VCT services. The Abbott Fund also donated 1 million HIV tests to President Kikwete's National Testing campaign. The Abbott Fund is modernizing all 23 of the country's regional hospital laboratories; the project was launched in 2008 and is expected to be completed in 2010. The Abbott Fund is working with the Touch Foundation to support 105 lab technology students pursuing university degrees, and also is providing funds to upgrade the laboratory at Bugando Medical Centre, a referral hospital for a population of 13 million in the Lake Zone. 41 8. African Comprehensive HIV/AIDS Partnerships (ACHAP) Disease area(s): HIV/AIDS Company(ies): Merck & Co. Inc. Partner(s): Bill and Melinda Gates Foundation, Botswana Ministry of Health Since 2000 Programme type(s): Access - Donation, Capacity Building - Support & Training, Education Developing country(ies): Botswana The African Comprehensive HIV/AIDS Partnerships (ACHAP) was established in 2000 by the Government of Botswana, The Merck Company Foundation/Merck & Co., Inc. and the Bill & Melinda Gates Foundation, to support and enhance Botswana's response to the HIV/AIDS epidemic through a comprehensive approach to prevention, care, treatment and support. The two foundations have each committed USD 56.5 million to the partnership and Merck is donating its antiretroviral (ARV) medicines to Botswana's national ARV treatment programme, Masa (New Dawn), for the partnership's duration. As of April 2008, more than 100,000 people were receiving ARV treatment. The programme has strengthened local healthcare infrastructure, transferred technical skills, and supported the development of laboratory capacity, which has grown to enable more than 20,000 patients per year to be tested. The partnership has worked with Harvard University and the Botswana Ministry of Health to provide training for more than 5,500 of Botswana's healthcare workers, while more than 3,200 physicians, nurses and other healthcare professionals have received hands-on, clinic-based training through the partnership's preceptorship programme. In 2007, ACHAP expanded its support to target co-infection of HIV and tuberculosis (TB), as 6086% of TB patients in Botswana are HIV positive, and TB is the leading cause of death among adult AIDS patients. 42 9. GlaxoSmithKline's Positive Action on HIV/AIDS Disease area(s): HIV/AIDS Company(ies): GlaxoSmithKline Partner(s): AMREF, CRS, EGPAF, IHAA, NEPHAK Since 1992 Programme type(s): Capacity Building - Support & Training, Education Developing country(ies): 21 developing countries Positive Action is helping the Reach India project to make HIV/AIDS prevention, financial and business education available to millions of poor women in rural India. GSK is giving USD 595,000 over four years to develop the capacity of community organizations and self-help groups to reach 500,000 women and 2.5 million family members in rural areas. Reach India is a Freedom from Hunger project, supported by Catholic Relief Services (CRS) and Positive Action. In Kenya, GSK is giving USD 2.2 million over four years to integrate HIV/AIDS treatment and support services into 38 general healthcare clinics, to enable patients to avoid the stigma of visiting an HIV clinic. Fewer than 10% of Kenyans know their HIV status and fear of stigmatization is a significant barrier to seeking testing. Positive Action also helps to train healthcare professionals and create patient self-help groups, to increase awareness and adherence to treatment. Other partners include the African Medical and Research Foundation (AMREF), Elizabeth Glaser Paediatric AIDS Foundation (EGPAF) and the National Empowerment Network of People Living with HIV and AIDS in Kenya (NEPHAK). In Mexico, GSK is working on a four-year project with the International HIV/AIDS Alliance (IHAA) and its Mexican partner, Colectivo Sol, to improve quality of life for people with HIV/AIDS, reduce stigma and discrimination, and educate people about HIV/AIDS. Partners: African Medical and Research Foundation (AMREF), Catholic Relief Services (CRS), Colectivo Sol, Elizabeth Glaser Paediatric AIDS Foundation (EGPAF), International HIV/AIDS Alliance (IHAA), Foundation for AIDS Research (amfAR), National Empowerment Network of People Living with HIV and AIDS in Kenya (NEPHAK), Positive Action Countries: Belize, Botswana, Cambodia, China, India, Indonesia, Jamaica, Kenya, Mexico, Nigeria, Philippines, Romania, Russia, Rwanda, South Africa, Ukraine, Thailand, Vietnam 43 10. GSK - Other HIV/AIDS Capacity-Building Initiatives Disease area(s): HIV/AIDS Company(ies): GlaxoSmithKline Partner(s): AMREF & other partners Since 1998 Programme type(s): Capacity Building - Support & Training, Education Developing country(ies): 17 African countries Since 1998, the GSK France Foundation has supported 86 programmes to improve healthcare through prevention, education and training in 14 developing countries. During 2007, nine new programmes were implemented in five countries with grants of USD 1,091,461. The GSK Foundation Canada also supports community programmes in Africa, including AIDS Orphans Uganda, working with the African Medical Research Foundation (AMREF). GSK supports community programmes in Botswana, Cote d'Ivoire, Democratic Republic of Congo, Ethiopia, Ghana, Kenya, Malawi, Mozambique, Namibia, Nigeria, Senegal, South Africa, Swaziland, Tanzania, Uganda, Zambia and Zimbabwe. These provide treatment for HIV/AIDS patients, counseling and testing, home-based care, training for healthcare professionals and community volunteers, life skills training for orphans, hospice care, day care centres, feeding schemes, as well as support for basic primary healthcare and HIV/AIDS clinics. For example, GSK has supported the AIDS Care Treatment and Support (ACTS) initiative in Masoyi, South Africa, since 1999. GSK provided funds to buy land, build a dedicated HIV/AIDS primary healthcare clinic and training centre, and to cover all running costs for the first three years. The ACTS clinic opened in May 2001 and by the end of 2007 more than 20,000 patients had entered its doors. It is now a specialist HIV primary care clinic, complemented by a homebased care team and an eight-bed community hospice. There are currently 1,700 patients on ARVs, 100 of which are children under 12. Nearly 2,000 patients are seen each month. 44 In 2004, GSK's US Business launched a project called “Hope after HIV: Africa”. Through the Children's AIDS Fund, GSK has helped open six clinics in Uganda, Malawi, Zambia and South Africa that have treated more than 9,000 HIV/AIDS patients. The sponsored clinics offer testing, medicines, education, mother-to-child transmission care, counseling and follow-up. Patients are also supported by more than 1,500 volunteers who provide adherence counseling, disease education for family members and palliative care. GSK has also established the “Hope after HIV Fund”, a charitable programme that allows employees and others to donate funds to support life-enhancing, non-medical needs of patients receiving care at the clinics. The fund has been used to improve nutrition and generate income for patients and their families; provide bicycles, pumps and refrigerators; provide education for promising young HIV-positive people. 45 11. Merck & Co., Inc. HIV/AIDS Programmes - Africa Disease area(s): HIV/AIDS Company(ies): Merck & Co. Inc. Partner(s): Various partners - including universities and NGOs Since 1998 Programme type(s): Capacity Building - Training, Education Developing country(ies): 24 African countries Since 2006, Merck & Co., Inc. has supported the Health Economics and HIV/AIDS Research Division (HEARD) of the University of KwaZulu-Natal, South Africa in a study of factors influencing participation rates, voluntary counseling and testing services. Merck has supported the Regional AIDS Initiative of Southern Africa (RAISA), a project of Voluntary Services Overseas (VSO), since 2002 to strengthen the capacity of in-country partners to respond to the HIV and AIDS pandemic by providing the building blocks to develop programmes and coordinate efforts. In 2008, Merck helped RAISA launch the "Glove Campaign" aimed at protecting the women and girls who care for those who are living with HIV and AIDS. Since 2004, Merck has supported the UN Refugee Agency’s (UNCHR's) Strategic Plan for HIV, AIDS and Refugees. Support has focused on strengthening HIV and AIDS interventions in refugee operations in Angola, Botswana, Lesotho, Malawi, Mozambique, Namibia, South Africa, Swaziland, Zambia and Zimbabwe. Merck has supported the Community Health and Information Network’s (CHAIN's) efforts since 1998 to develop outreach programmes including treatment literacy and life skills programme for people living with HIV, orphans and vulnerable children. CHAIN is also working to inform uniformed forces personnel about HIV and AIDS Merck and DHL announced an agreement in 2004 to team up to expand access to critically needed HIV and AIDS medicines in countries throughout sub-Saharan Africa. Under this agreement, DHL is currently delivering Merck's HIV and AIDS medicines at cost by air express to designated treatment centres in 35 countries. Since 2005, Merck has supported the African Medical & Research Foundation (AMREF) in its efforts to improve health of young people living with HIV and AIDS in the Nakasangola District of Northern Uganda. In 2008, Merck provided support to AMREF to scale up the HIV and AIDS intervention in Uganda where HIV prevalence among young women in Kawempe Division is at 24%. 46 12. Merck & Co., Inc. HIV/AIDS Programmes - Asia-Pacific Disease area(s): HIV/AIDS Company(ies): Merck & Co. Inc. Partner(s): China Ministry of Health and other partners Since 2005 Programme type(s): Capacity Building - Training, Education Developing country(ies): China In 2005, Merck & Co., Inc. and China's Ministry of Health established the China-MSD HIV/AIDS Partnership (C-MAP), to address HIV and AIDS prevention, patient care, treatment and support. The Merck Company Foundation has committed USD 30 million to support this partnership. The Government of China, through the leadership of the Ministry of Health, is providing staff, facilities and equipment. C-MAP is led by two co-national directors and has project offices in Beijing, Sichuan Province and Liangshan Prefecture. 13. Merck & Co., Inc. HIV/AIDS Programmes - Caribbean Disease area(s): HIV/AIDS Company(ies): Merck & Co. Inc. Partner(s): USAID and other partners Since 2003 Programme type(s): Capacity Building - Training, Education Developing country(ies): Jamaica, Mexico, Venezuela In 2007, Merck and The Merck Company Foundation granted USD 36,500 to the Caribbean Coalition of National AIDS Programme Coordinators (CCNAPC), a peer-based organization working to improve national AIDS Programmes in 35 Caribbean countries. The grant was to support efforts to increase prevention and awareness. Also in 2007, Merck sponsored an exchange between Caribbean and Botswana business leaders to promote understanding of the private sector role in fighting HIV/AIDS. 47 14. Pfizer - Infectious Diseases Institute Disease area(s): HIV/AIDS Company(ies): Pfizer, Gilead Partner(s): Various partners, including universities Since 2002 Programme type(s): Capacity Building - Support & Training Developing country(ies): Uganda Pfizer, the Academic Alliance, Accordia Global Health Foundation, Makerere University, the Infectious Diseases Society of America, Pangaea Global AIDS Foundation and others partnered to establish the Infectious Diseases Institute (IDI) in Uganda in 2004. The IDI, a major medical training and research centre headquartered within Uganda's Makerere University, aims to improve health in Africa by training medical professionals in the treatment and prevention of HIV/AIDS and related infectious diseases and providing them with skills and resources to use in their communities. It provides care and treatment to almost 9,000 patients each year. IDI has trained more than 3,500 healthcare workers from 27 African countries since 2004, 98% of whom are providing antiretroviral therapy and other care for patients with HIV/AIDS. IDItrained workers indicate they have trained, on average, 20 additional healthcare workers per month 48 15. Diflucan Partnership Disease area(s): HIV/AIDS Company(ies): Pfizer Partner(s): Axios International, International Dispensary Association (IDA), IMA World Health, governments and NGOs Since 2000 Programme type(s): Capacity Building - Support & Training Developing country(ies): Developing countries The aim of the partnership is to provide treatment for AIDS-related fungal infections in developing countries where HIV/AIDS is endemic. Pfizer's has committed to provide Diflucan® (fluconazole), an antifungal to treat two fungal opportunistic infections associated with AIDS, free of charge to government and nongovernment organizations in developing countries with a greater that 1% prevalence of HIV/AIDS. More than USD 840 million in medicine has been donated to more than 2000 sites in 60 countries in Africa, Asia, the Caribbean and Latin America More than 20,000 health professionals have been trained in the diagnosis and treatment of fungal opportunistic infections 49 16. Tibotec Cost Recovery Distribution Programme Disease area(s): HIV/AIDS Company(ies): Johnson & Johnson Partner(s): CCBRT in Tanzania Since 2003 Programme type(s): Access - Pricing, Capacity Building - Support Developing country(ies): Sub-Saharan Africa Johnson & Johnson's Tibotec subsidiary makes Tibozole$ Miconazole MAT (micMAT), a mucoadhesive buccal tablet that can treat oral thrush in AIDS patients. To date, Tibotec has sold at cost or donated over two million patient treatments of Miconazole nitrate 10 mg MAT for use in sub-Saharan Africa. Of these, more than 1,300,000 treatment units have been sold to international procurement agencies for distribution in resource poor settings, through Tibotec's cost recovery distribution programme. Tibotec collaborates with major not-for-profit suppliers to the developing world, such as IDA and MSF, to maximize access and ensure sustainable product supply. Pilot collaborations with voluntary organizations have led to an increase in donations of patient treatments in a number of sub-Saharan African countries. 50 17. PEPFAR Partnership for Paediatric AIDS Treatment Disease area(s): HIV/AIDS Company(ies): Abbott, Bristol-Myers Squibb, Gilead, GlaxoSmithKline, Merck & Co. Inc. Partner(s): PEPFAR, UNAIDS, UNICEF, WHO Since 2006 Programme type(s): Access - Pricing, R&D Developing country(ies): 15 developing countries The US President's Emergency Plan for AIDS Relief (PEPFAR) Partnership for Paediatric AIDS Treatment was launched in 2006. This public-private partnership includes innovator and generic pharmaceutical companies and multilateral organizations such as UNAIDS, WHO and UNICEF. The initiative will identify scientific obstacles to treatment for children, take practical steps to address key barriers, share best practices and develop systems for clinical and technical support. Abbott is working with PEPFAR to advance treatment for children with HIV in developing countries by actively participating in the PEPFAR Partnership for Paediatric AIDS Treatment, In addition to making medicines available at preferential prices to PEPFAR. Bristol-Myers Squibb is an active partner in the PEPFAR Partnership for Paediatric AIDS Treatment, working to find solutions to issues concerning paediatric HIV treatment, formulations and access. In 2004, Bristol-Myers Squibb agreed to allow the FDA to make right of reference to its confidential dossiers and product registration files to facilitate approval of generic combination products under the PEPFAR programme. Gilead is an active member of the Accelerating Access Initiative and several United Nations´ agency working groups, as well as the PEPFAR Partnership for Paediatric AIDS Treatment. GlaxoSmithKline is a major supplier of ARVs to PEPFAR at no-profit prices and has also participated in the State Department's programme to expand the number of paediatric formulations for HIV medicines that are appropriate for PEPFAR and other child access programmes in the developing world. Merck & Co., Inc. is an active member of the PEPFAR Partnership for Paediatric AIDS Treatment, working to identify scientific and technical solutions to improving access to antiretroviral treatment for children living with HIV/AIDS in resource-limited settings. 51 18. Improving Neonatal Survival in Kosovo Disease area(s): Maternal Care Company(ies): Abbott Fund Partner(s): Dartmouth Medical School and the United Church of Christ (UCC) Since 2007 Programme type(s): Access - Pricing, R&D Developing country(ies): Kosovo To help improve neonatal survival, the Abbott Fund has partnered with neonatal specialists from Dartmouth Medical School and the UCC to support installation of a new oxygen system in the Neonatal Intensive Care Unit (NICU) in Kosovo’s main hospital. In 2007, the Abbott Fund, in partnership with AmeriCares and a grant of USD 86,800, helped purchase advanced ventilators, 15 CPAP machines, incubators, pulse oximeters and gas analyzers to equip four patient units within the NICU. The grant also supported training on respiratory care intervention and on how to administer Survanta, Abbott's surfactant replacement therapy, used to prevent or treat respiratory distress syndrome in premature infants. 52 19. Operation Smile Disease area(s): Facial Deformation Company(ies): Abbott Fund Partner(s): Operation Smile Since 1993 Programme type(s): Access - Pricing, R&D Developing country(ies): Worldwide For more than 16 years, Abbott has supported the work of Operation Smile, a global organization dedicated to improving the health and lives of children and young adults suffering from facial deformities. The organization's volunteer medical professionals travel the globe to help strengthen healthcare systems for both children and families. Since Operation Smile's inception in 1982, volunteers have provided free reconstructive surgery to more than 140,000 children and young adults around the world. Since 1993, Abbott has donated more than USD 5.4 million in grants and products. In 2002, Operation Smile elected to use sevoflurane, Abbott’s leading anesthesia product, for all of their missions, and since that time, donations of the product have helped treat thousands of patients in more than 30 countries. In 2007, in celebration of Operation Smile's 25th anniversary, Abbott donated product valued at almost USD 500,000 that was used to treat more than 3,000 children during a two-week, 25country event. In 2005, the Abbott Fund expanded its partnership with Operation Smile by supporting the Paediatric Advanced Life Support and Advanced Cardiovascular Life Support training programme, conducted in nine developing countries. Over the course of four years, the programme has expanded to 30 countries. The goal of the programme is to help strengthen the expertise of medical professionals in the developing world and provide quality services for children and adults requiring emergency critical care. To date, Operation Smile has been able to train more than 11,700 medical professionals in critical lifesaving techniques and purchase related training equipment. 53 20. Care and Prevention of Mother-to-Child Transmission of HIV/AIDS in Zambia Disease area(s): PMTCT Company(ies): Bristol-Myers Squibb Partner(s): Adventist Development and Relief Agency Since ---Programme type(s): Access - pricing, R&D Developing country(ies): Zambia A USD 433,000 Bristol-Myers Squibb grant to the Adventist Development and Relief Agency for two districts in Zambia will promote programmes for the prevention of mother-to-child HIV transmission. 21. mothers2mothers Disease area(s): PMTCT Company(ies): Merck Partner(s): mothers2mothers Since 2008 Programme type(s): Access Developing country(ies): Africa Merck is a sponsor of mothers2mothers (m2m) and has provided grants to the organization since 2008. m2m Milestones " In 2009, "mentor mothers" employed by m2m to provide counselling and support received salaries totalling more than USD 5 million (USD). Nearly every penny goes directly into local economies to purchase necessities including food, schooling and secure housing for their families. " m2m currently offers services in almost 644 sites in South Africa, Lesotho, Zambia, Kenya, Rwanda, Swaziland and Malawi, employs about 1,625 HIV-positive mothers, and currently reaches approximately 300,000 HIV-positive pregnant women and new mothers in one year. 54 INITIATIVES AGAINST TUBERCULOSIS 1. AstraZeneca & Red Cross: Fight against TB in Africa Disease area(s): Tuberculosis Company(ies): AstraZeneca (AZ) Partner(s): British Red Cross Since 2006 Programme type(s): Capacity Building - Training, Education Developing country(ies): Lesotho, Liberia, South Africa To help the British Red Cross broaden its approach to TB and TB/HIV co-infection, AstraZeneca further expanded its partnership in 2006 to support the charity in its work to help local communities combat the threat in South Africa and Lesotho. Following a TB training programme for 500 Red Cross volunteers, over 1,800 people affected by TB or TB/HIV have now successfully completed their treatment, with default rates averaging between 3 and 4%. This is being achieved through daily one-to-one contact with patients by trained volunteers who, when required, also collect treatment from clinics and oversee the patient’s compliance. Volunteers also distribute TB prevention information. Between June and August 2008 alone, volunteers made over 7,500 home TB education visits - including providing information tailored to orphans and vulnerable children. During 2008, the partnership’s geographic coverage was expanded with a new project in Liberia, where TB incidence rates have almost tripled since 1990 (from 113 to 310 per 100,000). Project development began in April 2008 and field implementation began in December 2008. In Central Asia The company joined forces against TB in 2002. Work initially targeted Kyrgyzstan and Turkmenistan - countries with widespread poverty and seriously high levels of TB incidence. 55 Progress up to 2009 includes: " Over 10,000 people living with TB or TB/HIV successfully completing their TB treatment. " TB treatment completion rates reaching 89% and 92% in Turkmenistan and Kyrgyzstan respectively. " A significant increase in community awareness following media campaigns and health education sessions in schools and public places that have reached nearly 2 million people. " Between January and September 2009, over 800 consultations, 68 group discussion and 73 home visits took place and some 1,800 food parcels were distributed. " Treatment completion rates increased to 73% from 54% in 2008. In Sub-Saharan Africa With the support of AZ, the South African Red Cross Society (SARCS) is helping to deliver improved care and support to people living with TB or TB/HIV in 10 areas, including the provinces of KwaZulu Natal, Western Cape, Eastern Cape, Limpopo, Gauteng and Free State. To date, some 2,500 people affected by TB or TB/HIV have successfully completed their treatment and over 6,000 suspected cases of TB identified and sent for screening. 56 2. Lilly MDR-TB Partnership Disease area(s): Tuberculosis Company(ies): Lilly Partner(s): WHO and other partners Since 2003 Programme type(s): Access - Pricing & Licensing, Capacity Building - Support & Training, Education Developing country(ies): Partnership activities in over 60 countries The Lilly MDR-TB Partnership was created to help address the challenge of multi-drug resistant tuberculosis (MDR-TB). The public-private partnership mobilizes 18 global partners on five continents. Eli Lilly and Company is contributing USD 120 million in cash, medicines and technology and has also donated USD 15 million to the Lilly TB Drug Discovery Initiative to accelerate TB drug discovery. The World Health Organization (WHO) provides technical assistance to MDR-TB countries and its Green Light Committee has enrolled 50,000 patients in over 60 countries. Several thousand health workers have been trained in MDR-TB diagnosis, treatment and prevention. Partners: Advocacy Partnership, Aspen Pharmacare, Harvard Medical School in USA, Hisun Pharmaceutical, International Council of Nurses (ICN), International Federation of Red Cross & Red Crescent Societies (IFRC), International Hospital Federation (IHF), Partners In Health, Purdue University in USA, Results Educational Fund, Shasun Chemicals and Drugs, SIA International/Biocom, Stop TB Partnership, TB Alert, Tuberculosis Survival Project, US Centres for Disease Control and Prevention (CDC), World Economic Forum (WEF), World Health Organization (WHO), World Medical Association (WMA). 57 3. Novartis TB DOTS Donation Disease area(s): Tuberculosis Company(ies): Novartis Partner(s): WHO Since 2003 Programme type(s): Access - Donation Developing country(ies): Tanzania In 2003, the Novartis Foundation for Sustainable Development signed a Memorandum of Understanding (MOU) with the World Health Organization (WHO) committing itself to donate the WHO-recommended tuberculosis treatment for 500,000 patients over 5 years. Novartis donates rifampicin-based fixed-dose combination tablets for the intensive and maintenance phases of treatment. The medicines are given to the Global Drug Facility (GDF)of the Stop TB Partnership for use in programmes supported by the Global Fund to fight against AIDS, Tuberculosis and Malaria. Novartis also funds logistics and independent quality control, in addition to its own quality control. A needs assessment found that knowledge of tuberculosis was extremely poor, leading to false beliefs, improper treatment and rejection of TB patients by the population. A pilot corrective social marketing campaign was conducted, which led to a significant increase in demand for treatment. Sixty percent of interviewees identified the campaign as their primary source of information on TB. The Global Plan to Stop TB The Stop TB Partnership has built an effective network to promote and coordinate the contributions of a wide and increasing range of stakeholders. A thriving partnership, its global membership grew to over 400 organizations in 2005, regional and national. 58 Stop TB partnerships are now being formed to support long-term expansion of DOTS at country level. The Global Drug Facility, established by the partnership, has provided treatment for more than 4.5 million patients, at the same time as catalyzing a worldwide improvement in the quality of TB drugs, and a reduction in their cost. In addition, the Green Light Committee (GLC) promotes access to, and rational use of, second-line drugs with activity against multi-drug resistant TB. It has secured price reductions of 95% for some second-line drugs. To help prevent misuse of these drugs, the GFATM selected the GLC as its mechanism for procurement of second-line drugs and monitoring of approved projects. The GDF and the GLC are merging in a phased programme. Implementation of the plan will save some 14 million lives over the next 10 years, using only existing tools. But it will also be the precursor for future gains. Because TB dynamics are slow, implementation activities from 2006 to 2015 will yield benefits later as well as those shown here as occurring within the period of the plan. Even more dramatically, the investment in new drugs, new diagnostic tests and new vaccines will begin to pay rich dividends beyond 2015. The real prize will be the elimination of TB. The total cost of the Global Plan for 2006–2015 is estimated as USD 56.1 billion. • 80% (USD 44.3 billion) is for country-level activities, especially in Africa. • A large part of the cost (USD US28.9 billion) is for DOTS programmes. • DOTS-Plus and TB/HIV activities will cost about USD 5.8 and USD 6.7 billion respectively. • Research and development of new tools requires USD 9 billion. • USD 25.3 billion is currently estimated as available, leaving a funding gap of USD 30.8 billion. 59 4. Sanofi-Aventis : TB Free & Other Initiatives Disease area(s): Tuberculosis Company(ies): Sanofi-Aventis Partner(s): Nelson Mandela Foundation and other partners Since 2002 Programme type(s): Capacity Building - Support & Training, Education Developing country(ies): India, Kenya, South Africa In March 2002, Sanofi-Aventis and the Nelson Mandela Foundation established the TB Free programme, a EUR 15 million effort to increase detection and treatment rates for tuberculosis in South Africa. Initially planned to finish in 2007, it has now been extended to 2010. The partnership trains volunteers to encourage patient compliance during the 6-month treatment, using the WHO-recommended DOTS (Directly Observed Therapy Short-Course) strategy. The actions would help to increase the TB cure rate by as much as 80% through improved compliance to TB treatment. In each of the country's nine provinces, a TB Free Centre has been established, which works closely with the Ministry of Health. By 2008, nine training centres had been opened, in which 20,000 “DOTS supporters” have been trained and 500,000 patients treated since 2005. In Kenya, Sanofi-Aventis works with the Kenya Association for the Prevention of Tuberculosis and Lung Diseases to train health-care workers in 200 targeted treatment centres. SanofiAventis also supports the Kenya's World TB day awareness activities. In India, Sanofi-Aventis formed a partnership with the Association Père Ceyrac in 2007 to fight tuberculosis and support TB-affected families living in the slums of Mumbai, Navi-Mumbai and Pune. Sanofi-Aventis supports the Inter-Aide NGO through local partners by means of 51 DOTS centres, 11 centres for collecting samples, and 4 testing laboratories located in the heart of the slums, which manage to treat almost 4,000 patients a year. 60 5. Stop TB Partnership Disease area(s): Tuberculosis Company(ies): AstraZeneca, GlaxoSmithKline, Lilly, Novartis Partner(s): International Federation of Red Cross & Red Crescent Societies IFRC, Médecins sans Frontières MSF, Stop TB Partnership Since 2000 Programme type(s): Access - Donation & Pricing, R&D Developing country(ies): Endemic countries and vulnerable populations The Stop TB Partnership was established in 2000 to realize the goal of eliminating tuberculosis (TB) as a public health problem. It comprises a network of more than 500 international, government, non-government and private sector organizations and individuals with an interest in working together to achieve this goal. The Partnership is a global movement to accelerate social and political action to stop the spread of TB around the world. A number of member companies of the International Federation of Pharmaceutical Manufacturers and Associations (IFPMA), including AstraZeneca, GlaxoSmithKline, Lilly, Novartis, Pfizer, and IFPMA itself are currently partners of the Stop TB Partnership, and actively contribute to its aims and programmes. The targets set by the Stop Partnership are: " By 2005: 70% of people with infectious TB will be diagnosed and 85% of them cured; " By 2015: the global burden of TB disease will be reduced by 50% relative to 1990 levels (Millennium Development Goal); " By 2050: The global incidence of TB disease will be less than 1 per million population (Elimination of TB as a global public health problem). The Global Drug Facility, run by the Stop TB Partnership, is expanding access to medicines for DOTS scale up; in just 5 years it has committed over 7 million TB treatments. Projects managing MDR-TB can apply through the Green Light Committee (GLC) for access to quality MDR-TB medicines at reduced prices - in some cases by as much as 99%. The Committee is operated by WHO and the Stop TB Partnership. Lilly has a programme to make two critical medicines for 61 treatment of drug-resistant strains available in developing countries and will supply 1.4 million vials of capreomycin at concessionary prices to the GLC in 2009. Novartis is donating 500,000 fixed dose combinations to the Global Drug Facility during 2005-2009. Partners: International Federation of Red Cross & Red Crescent Societies IFRC, Médecins sans Frontières MSF, Stop TB Partnership. 6. Lilly TB Drug Discovery Initiative Disease area(s): Tuberculosis Company(ies): Lilly, Jubilant Biosystems, Summit plc Partner(s): IDRI, NIAID & other partners Since 2007 Programme type(s): R&D Developing country(ies): India Created in June 2007, the Lilly TB Drug Discovery Initiative is a not-for-profit public-private partnership to accelerate the research and development of new treatments for TB, including drug-resistant strains. The primary partners are Eli Lilly and Company, the Infectious Disease Research Institute (IDRI), and the National Institute of Allergy and Infectious Diseases (NIAID), which is part of the U.S. National Institutes of Health (NIH). Lilly has given USD 15 million to establish the Initiative, including USD 9 million in-kind, including fully equipped high throughput screening and chemistry laboratories, research tools, databases, and scientific and technical expertise, plus USD 6 million in cash over five years to seed the organization. Lilly is also providing access to its library of 500,000 compounds and is making available its expertise in drug discovery and chemistry. Partners: Infectious Disease Research Institute (IDRI), National Institute of Allergy and Infectious Diseases (NIAID), Seattle Biomedical Research Institute (SBRI), Microbial Chemistry Research Foundation, University of Washington in the USA, YourEncore 62 7. Novartis Institute for Tropical Diseases (NITD) Disease area(s): Tuberculosis Company(ies): Novartis Partner(s): Global Alliance for TB Drug Development and other partners Since 2003 Programme type(s): R&D Developing country(ies): Indonesia and research in Singapore The USD 122 million Novartis Institute for Tropical Diseases (NITD) research centre in Singapore is a public-private partnership between Novartis and the Singapore Economic Development Board (SEDB) and focuses exclusively on the discovery of innovative medicines for the treatment of diseases that are endemic to developing countries. With more than 100 scientists employed, and activities that range from target discovery, screen development and compound optimization to preparation for clinical testing, NITD also offers teaching and training in the field of tropical diseases. The goal of NITD's Tuberculosis Unit is to apply new genomic and bioinformatic technologies to develop novel treatments for multi-drug resistant TB. In 2006, NITD and ten other collaborators led by the Imperial College received a grant from the Grand Challenges for Global Health Initiative to discover new targets for latent and persistent TB infection. A recent Collaboration and Licence Option Agreement between NITD and the Global Alliance for TB Drug Development aims at accelerating development of potential costeffective new drugs towards clinical use. To secure direct access to hospitals and patients in a real-life context, in 2007 NITD also teamed up with the Hasanuddin University and Eijkman Institute in Indonesia to form NEHCRI a clinical research initiative that aims to strengthen translational research in tuberculosis, but also malaria and dengue fever, two other diseases NITD is working on. 63 INITIATIVES AGAINST MALARIA 1. GSK & Access to Malaria Care Disease area(s): Malaria Company(ies): GlaxoSmithKline Partner(s): Various partners Since 2003 Programme type(s): Access - Pricing, Capacity Building - Support, Education Developing country(ies): 13 developing countries GlaxoSmithKline offers its anti-malarials at not-for-profit prices to public sector customers and not-for-profit organizations in 64 countries - all the least developed countries and all of subSaharan Africa. All Country Co-ordinating Mechanism (CCM) projects fully funded by the Global Fund to fight AIDS, TB and Malaria are also eligible. GSK does not make a profit at these prices, but it does cover its costs, so it can sustain supply of these high-quality products for as long as they are needed. These prices apply to orders of any size and include insurance and freight costs. GSK's African Malaria Partnership was set up in 2003 to support education programmes in eight African countries, through partnerships with Freedom from Hunger, AMREF and Plan International. These focused on prevention and prompt treatment, particularly among children and pregnant women. GSK funding for these initiatives has now ended, but the investment will have a long-term positive impact. The scale of the malaria problem requires a significantly bigger response, so in 2005, GSK gave a USD 1.5 million three-year grant to a new partner, the Malaria Consortium, to launch the Mobilizing for Malaria initiative. The aims are to increase awareness and generate political commitment and sustained funding to combat the disease. It will increase the number of NGOs engaged in tackling malaria, and give more African communities the knowledge and tools they need to prevent transmission of malaria. Partners: Freedom from Hunger, African Medical and Research Foundation (AMREF), Plan International Countries: Benin, Burkina Faso, Cameroon, Democratic Republic of Congo, Ethiopia, Ghana, Mali, Mozambique, Nigeria, Senegal, Sudan, Tanzania, Togo. 64 2. Millennium Villages Project Disease area(s): Malaria Company(ies): Novartis Partner(s): Ilolangulu Village Since 2007 Programme type(s): Access - Donation, Capacity Building - Support Developing country(ies): Tanzania As three out of eight Millennium Development Goals (MDGs) are health-related, the Novartis Foundation for Sustainable Development agreed in 2007 to support the Millennium Villages Project (MVP) in health-related research. The MVP was founded with the goal of helping impoverished communities in rural Africa achieve the MDGs formulated and agreed to by all member countries of the United Nations. The MVP is active at twelve sites in ten African countries. In 2007, the Novartis Foundation started financing one of the six Millennium Villages in Tanzania, the Ilolangulu Village. For a five-year-period, the Novartis Foundation will invest in the village's transition from subsistence farming to self-sustaining commercial activity. Challenges facing Ilolangulu Village included inadequate water supply, extreme hunger, failed crops and a high prevalence of malaria. After one year, positive results have been seen. The project has distributed more than 20,000 bed nets to prevent malaria and free malaria treatment (Coartem®). Two new schools were built and the project has launched a school feeding programme for more than 7,000 children, using community crop surpluses. The villagers restored water points and built new ones. Despite many challenges, the Tanzanian MVP villages increased their crop yield by 500%. About 8,000 to 9,000 patients are treated per month in their clinics and mobile clinics. In addition, other services such as immunization, birth deliveries, pre- and post-natal care and growth monitoring cover 1,500 additional people. 65 3. Novartis Coartem® Disease area(s): Malaria Company(ies): Novartis Partner(s): WHO and MMV Since 2001 Programme type(s): Access - Pricing, Capacity Building - Training, Education Developing country(ies): 34 developing countries Coartem® is fast-acting and cures over 97% of patients after a 3-day treatment course. Since 2001, Novartis has provided more than 200 million treatment courses - without profit - for public sector use in Africa. These treatments have helped save an estimated 550,000 lives. In early 2009, Novartis and Medicines for Malaria Venture introduced Coartem® Dispersible, the first artemisinin-based combination therapy (ACT) developed especially for children with malaria, to address specific treatment needs of millions of children with malaria. Coartem® Dispersible contains the same amounts of artemether and lumefantrine as Coartem® tablets (20mg/120mg) and delivers the same high cure rates. 4. Roll Back Malaria Partnership Disease area(s): Malaria Company(ies): GlaxoSmithKline, Novartis, Sanofi-Aventis Partner(s): Roll Back Malaria RBM, United Nations Children's Fund UNICEF, United Nations Development Programme UNDP, World Bank, (WHO). Since 1998 Programme type(s): Access - Pricing, Capacity Building - Support Developing country(ies): 35 developing countries The Partnership promotes high-level political commitment and keeps malaria high on the global agenda by enabling, harmonizing and amplifying partner-driven advocacy initiatives. Founded by UNICEF, WHO, the World Bank and UNDP and strengthened by the expertise, resources and commitment of more than 500 Partner organizations. The Partnership secures policy guidance and financial and technical support for control efforts in countries and monitors progress towards universal goals. 66 5. Sanofi-Aventis : Impact Malaria Disease area(s): Malaria Company(ies): Sanofi-Aventis Partner(s): Various national and international partners, including universities Since 2001 Programme type(s): Access - Pricing, Capacity Building - Training, Education, R&D Developing country(ies): Benin, Madagascar, Republic of Congo, Tanzania Sanofi-Aventis seeks to improve access to its anti-malarials, by making them available at a “no profit, no loss” prices to needy populations. In 2008, 6 million artemisinin-based combination treatments were sold at preferential prices to over 20 malaria-endemic countries. Sanofi-Aventis and Drugs for Neglected Diseases initiative (DNDi) launched a new artesunateamodiaquine combination treatment in early 2007. The company has relinquished its patents and will supply drugs at prices scaled to income. In the poorest countries, this is less than USD 1 for an adult treatment and a less than USD 0.5 for a paediatric treatment. Tablets are soluble, facilitating their use with children. In 2008, Sanofi-Aventis provided 20 African health professionals with high-level malaria training. In addition, information, education and communication tools have been developed with national malaria control programmes and NGOs, while the www.impact-malaria.com website provides disease, prevention and treatment information, plus educational tools and an online library. Partners: Actions de Solidarité Internationales, Agence de Médecine Préventive, Caritas, CFAO, Drugs for Neglected Diseases initiative (DNDi), Epicentre, Lille University in France, Jeremi, Médecins sans Frontières (MSF), Medicines for Malaria Venture (MMV), Montpellier University in France, Palumed, PlanetFinance, Total, World Health Organization (WHO). 67 6. Mobilize Against Malaria Disease area(s): Malaria Company(ies): Pfizer Partner(s): Clinton Global Initiative and others Since 2007 Programme type(s): Access - Pricing, Capacity Building - Training, Education, R&D Developing country(ies): Ghana, Kenya, Senegal At the 2006 Clinton Global Initiative, Pfizer announced a five-year programme (2007-2012), Mobilize Against Malaria, focused on improving access to prompt and effective treatment, and preventing infection and the spread of malaria by improving symptom recognition, treatment, and referral through local grassroots training, education and awareness. In April 2009, Pfizer and Medicines for Malaria Venture (MMV) signed an agreement which gives MMV access to Pfizer's vast chemical compound library in order to test approximately 200,000 compounds for activity against P. falciparum. Partners: London School of Hygiene and Tropical Medicine, KEMRI-Wellcome Trust, Population Services International (PSI), Health Partners Ghana, Family Health International/Ghana Social Marketing Foundation (GSMF), Intrahealth International 68 INITIATIVES AGAINST TROPICAL DISEASES 1. Bayer HealthCare & African Sleeping Sickness Disease area(s): Sleeping sickness Company(ies): Bayer HealthCare Partner(s): WHO Since 2002 Programme type(s): Access - Donation Developing country(ies): Democratic Republic of Congo, India, Kenya, Malawi, Mozambique, Sudan, Tanzania, Uganda In 2002, Bayer HealthCare agreed to supply - at no cost and for an initial five-year period - as much of the sleeping sickness medicine Germanin® (suramin) as the World Health Organization (WHO) determines is needed to eliminate the disease. The initial donation comprised 50,000 ampoules. Bayer is also in favor of supporting an “Integrated Sleeping Sickness Initiative” fostered by a broad base of institutions and covering all aspects of the disease from infection, diagnosis and therapy to prevention. The agreement was renewed in 2008, whereby Bayer will provide, free-of-charge, 50,000 ampoules of Germanin® to the WHO, over a five-year period. 69 2. Bayer HealthCare: Fight Against Chagas Disease Disease area(s): Chagas disease Company(ies): Bayer HealthCare Partner(s): WHO Since 2004 Programme type(s): Access - Donation Developing country(ies): Argentina, El Salvador, Honduras, Nicaragua, Chile, Guatemala, Uruguay In April 2007, Bayer signed a new agreement to provide WHO with 2.5 million Lampit® tablets and additional funding for the distribution of the drug. The latest agreement assures the supply of Lampit® until 2012. To widen access of patients to affordable medicines, Bayer HealthCare signed agreements with WHO in 2004 and 2005 for donations of its medicine Lampit® (nifurtimox) to combat Chagas disease, the form of sleeping sickness found in Latin America. A total of 500,000 tablets was given to WHO, which informs the governments of disease endemic countries of the availability of the free supplies, including the procedure to be followed for obtaining such supplies, and decides about its distribution. The goal of the WHO is to distribute Lampit® in all 21 endemic countries in Latin America. Currently, the medicine is approved in Argentina, El Salvador, Honduras, Nicaragua, Chile, Guatemala and Uruguay. Lampit® will also be provided in small quantities, as needed, in some non-endemic countries, like Canada, France, Japan, Spain, UK and the USA. 70 3. Gilead - AmBisome for Leishmaniasis Disease area(s): Leishmaniasis Company(ies): Gilead Partner(s): WHO Since ----Programme type(s): Access - Pricing, R&D Developing country(ies): Endemic countries Gilead's therapeutic AmBisome (amphotericin B) liposome for injection has shown potent antiparasitic and fungicidal activity against multiple pathogens, including mucosal and visceral leishmaniasis in clinical studies. Gilead's goal is to expand access to AmBisome for the treatment of leishmaniasis in settings where the disease has the largest impact. Gilead works closely with the World Health Organization and NGOs to provide AmBisome at a preferential price for the treatment of leishmaniasis in resource-limited settings. Gilead also actively supports multiple clinical research studies aimed at elucidating the best treatment course for visceral leishmaniasis. 71 4. Global Alliance to Eliminate Lymphatic Filariasis (GAELF) Disease area(s): Lymphatic filariasis Company(ies): GlaxoSmithKline, Merck & Co. Inc. Partner(s): Global Alliance to Eliminate Lymphatic Filariasis (GAELF), World Health Organization (WHO) Since 1998 Programme type(s): Access - Donation, Capacity Building - Support & Training Developing country(ies): 47 out of 80 endemic countries The Global Alliance to Eliminate Lymphatic Filariasis (GAELF) was created to eliminate one of the world's leading causes of disability and disfigurement as a public health problem by the year 2020. An estimated 120 million people in at least 80 countries of the world suffer from the disease, and one billion (20% of the world's population) are at risk of infection. Initiated by the World Health Organization (WHO) and GlaxoSmithKline in 1998, the Global Alliance has evolved into a global partnership between international organizations in the public and private sectors, academia and non-government organizations working in partnership with ministries of health in tropical countries where lymphatic filariasis (LF) is endemic. Merck & Co., Inc. joined the elimination effort in 1998, when it widened the scope of its Mectizan® Donation Programme to include LF in African countries where river blindness and LF co-exist. The WHO recommends that lymphatic filariasis be prevented with a combination of albendazole (donated by GSK) with either DEC or Mectizan® (donated by Merck). Drug administration for people living in endemic areas is recommended by WHO once a year for at least five years to break the cycle of transmission. In 2008, GSK donated 266 million treatments of albendazole to prevent transmission in 30 countries. To date, GSK has donated over one billion treatments to 48 countries. Over the 20 year life of the programme, GSK expects to donate up to 6 billion preventative albendazole treatments across the 80 endemic countries that are accepted into the programme by the WHO. Merck approved 88 million treatments of Mectizan® to LF elimination programmes in 14 African countries and Yemen in 2008, bringing the cumulative total to 303 million. Merck and 72 GSK have also provided financial grants to support partners in research programmes, coalition building, workshops and communications. WHO estimates that over 100 million people - 30 million of whom are children - have begun to be protected from LF. In the twelve years since its initiation, the GAELF has become the most rapidly scaled-up medicine administration programme in public health history. The WHO reported that during 2007, over 546 million people were treated worldwide. In a study published in October 2008 in PLoS Neglected Tropical Diseases, researchers found that the LF elimination effort has prevented 6.6 million children from acquiring the disease. Countries: American Samoa, Bangladesh, Benin, Burkina Faso, Cambodia, Cameroon, Comoros, Cook Islands, Côte d'Ivoire, Dominican Republic, Egypt, Fiji, French Polynesia, Ghana, Guinea Bissau, Haiti, India, Indonesia, Kenya, Kiribati, Laos, Madagascar, Malawi, Malaysia, Maldives, Mali, Myanmar, Nepal, Niger, Nigeria, Niue, Papua New Guinea, Philippines, Samoa, Senegal, Sierra Leone, Sri Lanka, Tanzania, Thailand, Timor Leste, Togo, Tonga, Tuvalu, Uganda, Vanuatu, Vietnam, Yemen 73 5. Guinea Worm Eradication Programme (GWEP) Disease area(s): Dracunculiasis (Guinea worm) Company(ies): Johnson & Johnson Partner(s): Carter Centre, World Health Organization (WHO), United Nations Children's Fund (UNICEF), US Centres for Disease Control and Prevention (CDC), World Bank Since 1986 Programme type(s): Access - Donation, Capacity Building - Support, Education Developing country(ies): 9 African countries Established in 1986 and operating under the auspices of the Carter Centre's Global 2000 Programme, the Guinea Worm Eradication Programme (GWEP) aimed to rid future generations of Guinea worm by the year 2005. This multilateral partnership brings together organizations like the WHO, UNICEF, the CDC and the World Bank, as well as national governments and the pharmaceutical industry in a programme combining eradication efforts, training and research. To accelerate the eradication of Guinea worm disease, the partners target specific interventions (provision of safe water, health education, community mobilization, filter distribution, and treatment of selected water sources) like: " Maintain global and national dracunculiasis databases; " Monitor the epidemiological situation and map all endemic villages; " Conduct advocacy for eradication of the disease; " Certify dracunculiasis eradication country-by-country worldwide. Today, through the joint efforts of many partners, the incidence of this disease has been reduced worldwide by 99%, from an estimated 3.5 million cases in 1986 to less than 35,000 reported cases in 2003. Today, the last 1% of the disease is being fought. Johnson & Johnson has donated enough medical supplies, such as Tylenol®, forceps and gauze, to treat more than 3,000 villages in the endemic countries. In 2007, J&J donated medical supplies to the GWEP, for use in Sudan, the country most affected by Guinea worm. The donation included Tylenol® painkiller, to make the excruciating process of removing the worms from victims more bearable; Neosporin® and Savlon® antiseptics for disinfecting the wounds; and scissors, gloves, tape, gauze and sterile bandages for wrapping the wounds. 74 6. International Trachoma Initiative (ITI) Disease area(s): Trachoma Company(ies): Pfizer Partner(s): Edna McConnell Clark Foundation and other partners Since 1998 Programme type(s): Access - Donation, Capacity Building - Support & Training, Education Developing country(ies): 15 developing countries The International Trachoma Initiative (ITI) was founded in 1998 by Pfizer and the Edna McConnell Clark Foundation to treat and prevent blinding trachoma, the world's leading cause of preventable blindness. In March 2009, ITI and the Task Force for Child Survival and Development announced that they will join forces to scale up efforts to eliminate trachoma. ITI supports the implementation of the WHO-recommended SAFE strategy, a comprehensive public health approach that combines treatment with prevention, involving sight-saving surgery, mass treatment with the Pfizer-donated antibiotic Zithromax®, facial cleanliness, and environmental improvement to increase access to clean water and improved sanitation. ITI supports the WHO's Alliance for Global Elimination of Trachoma by 2020 (GET 2020) as well as Vision 2020: The Right to Sight. Other ITI partners include AmeriCares, the Carter Centre, Helen Keller International, Lions Club, the United Nations Children's Fund (UNICEF), WaterAid, and World Vision. The International Trachoma Initiative involves the following activities: " Providing patients in developing countries with antibiotics and surgery to treat advanced cases of trachoma; " Educating communities about trachoma prevention and training healthcare workers to conduct surgeries for advanced trachoma cases; " Providing training and technical assistance to support national trachoma control campaigns; " Advocating for increased funding for trachoma control and catalyzing partnerships to work towards trachoma elimination. 75 Since 1998, Pfizer has provided over 145 million treatments of Zithromax® for treatment and prevention of the disease in 18 countries. With Pfizer's support, ITI has trained thousands of healthcare workers who have performed more than 416,000 surgeries to treat advanced cases of trachoma. With the support of the ITI, Morocco became the first country to complete the campaign for trachoma control in 2006, and is now working toward WHO certification to signify that blinding trachoma has been eliminated as a public health problem. Partners: AmeriCares, Carter Centre, Edna McConnell Clark Foundation, Helen Keller International, Lions Club, Task Force for Child Survival and Development, United Nations Children´s Fund (UNICEF), WaterAid, World Health Organization (WHO), World Vision Countries: Burkina Faso, Eritrea, Ethiopia, Gambia, Ghana, Guinea-Bissau, Kenya, Mali, Mauritania, Morocco, Nepal, Niger, Nigeria, Senegal, Sudan, Tanzania, Vietnam, Uganda 76 7. Leprosy Elimination Disease area(s): Leprosy Company(ies): Novartis Partner(s): WHO Since 2000 Programme type(s): Access - Donation, Capacity Building - Support Developing country(ies): 66 developing countries Recommended by the World Health Organization, multi-drug therapy (MDT) cures patients, interrupts the transmission of leprosy and prevents disabilities. Novartis developed two of the three medicines in MDT and has provided MDT, free of charge, for all patients in the world through the WHO since 2000. This is a core element in the WHO Elimination Strategy of creating awareness of the early signs, improving patients' access to free diagnosis and treatment, and close monitoring. The Novartis-WHO collaboration has led to the cure of more than 4.5 million people to date. The prevalence rate has dropped by over 90% since 1985, from 21 per 10,000 inhabitants to less than 1 per 10,000 inhabitants worldwide, the threshold of elimination as a public health issue. All but three countries in the world have successfully eliminated leprosy at a national level. Detection of new leprosy cases has decreased by 20% per year over the past three years. Novartis and the Novartis Foundation for Sustainable Development also cover the costs of freight, insurance and independent quality control, in addition to that carried out by Novartis. The value of the first donation, 2000-2005, was USD 40 million. In 2005, Novartis and WHO signed a new MOU to ensure the continued uninterrupted supply of high quality MDT, free-of-charge for all patients in the world, until the end of 2010. Novartis has expressed its willingness to help anyone affected by this disease until leprosy is eradicated. The small remaining number of patients has changed the challenge of fighting leprosy. New approaches have to be developed to move towards a world free of leprosy. The Novartis 77 Foundation has started a new world-wide study to shed light on what is needed to further improve the control of leprosy, with special emphasis on improving early detection. Partners: World Health Organization (WHO) Countries: Afghanistan, Angola, Argentina, Bangladesh, Bhutan, Brazil, Burkina Faso, Burundi, Cape Verde, Cambodia, Cameroon, Central African Republic, China, Colombia, Costa Rica, Cuba, Democratic Republic of Congo, Dominican Republic, Egypt, El Salvador, Eritrea, Ethiopia, Gambia, Gabon, Ghana, Guatemala, Haiti, Honduras, India, Indonesia, Iran, Kenya, Laos, Liberia, Madagascar, Malawi, Mali, Marshall Islands, Mexico, Micronesia, Mozambique, Myanmar, Nepal, Nicaragua, Nigeria, Pakistan, Panama, Papua New Guinea, Paraguay, Peru, Philippines, Republic of Congo, Rwanda, Senegal, Sierra Leone, Somalia, Sri Lanka, Sudan, Timor Leste, Togo, Uganda, Venezuela, Vietnam, Yemen, Zambia, Zimbabwe 78 8. Merck Mectizan® Donation Programme Disease area(s): Lymphatic filariasis, onchocerciasis Company(ies): Merck & Co. Inc. Partner(s): WHO, World Bank and other partners Since 1987 Programme type(s): Access - Donation, Capacity Building - Support & Training Developing country(ies): 33 endemic countries in Africa, Latin America, and the Middle East Onchocerciasis, or river blindness, is a leading cause of infectious blindness in the developing world. The Merck Mectizan® Donation Programme (MDP) was launched in 1987, when Merck & Co., Inc. announced that it would donate as much Mectizan® (ivermectin), for the treatment of onchocerciasis to all who needed it for as long as necessary. A multi-sectoral partnership was established with governments in countries where onchocerciasis is endemic, their ministries of health and other national and international stakeholders, including the World Health Organization, to ensure appropriate infrastructure, distribution and support. Since the inception of the programme, Merck has donated more than 2.5 billion tablets of Mectizan® for river blindness, with nearly 700 million treatments approved since 1987. The programme currently reaches more than 100 million people annually through river blindness programmes in Africa, Latin America and Yemen. In 2007, Merck re-affirmed its pledge to donate as much Mectizan® as necessary for the elimination of river blindness globally. With this renewed pledge, Merck's donation of Mectizan® for river blindness is estimated to reach 100 million treatments annually by 2010. Also in 2007, Merck announced a donation of USD 25 million over eight years as part of an initiative with the World Bank to raise approximately USD 50 million in support of river blindness elimination in Africa. The MDP has made a substantial impact in the fight against onchocerciasis: 79 " In 2007, public health officials announced that transmission of river blindness had been halted in Colombia: the first time that the disease has been eliminated as a public health problem on a country-wide basis anywhere in the world. " Health officials also announced that river blindness transmission has been halted in certain endemic areas in Ecuador and Guatemala, and new cases of eye disease caused by river blindness have been eliminated in 9 of the 13 foci in the Americas. " The success of the programme in Latin America means that 74,476 people in 190 communities are now free of the threat of river blindness. While much progress has been made in the treatment and progress toward elimination, a number of additional challenges remain that Merck and its partners are actively addressing. Partners: United Nations Children's Fund (UNICEF), World Health Organization (WHO), World Bank Countries: Angola, Benin, Brazil, Burkina Faso, Burundi, Cameroon, Central African Republic, Chad, Côte d'Ivoire, Democratic Republic of Congo, Ecuador, Equatorial Guinea, Ethiopia, Ghana, Guatemala, Guinea, Guinea-Bissau, Liberia, Malawi, Mali, Mexico, Niger, Nigeria, Republic of Congo, Senegal, Sierra Leone, Sudan, Tanzania, Togo, Uganda, Venezuela, Yemen 80 9. Merck Praziquantel Donation Programme Disease area(s): Schistosomiasis Company(ies): Merck KGaA Partner(s): WHO Since 2007 Programme type(s): Access - Donation Developing country(ies): 6 African priority control countries According to the World Health Organization (WHO), up to 300 million people suffer from schistosomiasis, a worm disease caused by schistosomes, parasitic worms that multiply as swimming eggs in certain fresh water snails. Human infection occurs when the skin comes into contact with schistosome parasites released into the water by infected snails. The parasites migrate to the liver, mature into adult worms and reproduce, with their eggs being ejected from the body in the feces. Schistosomiasis causes anemia, stunted growth and learning disabilities. It is the second-most common tropical disease in Africa after malaria and is also prevalent in Asia, Africa, the Caribbean, the Middle East and South America. Some 600 million people are at risk and around 200,000 people die of this disease every year. In April 2007, Merck KGaA signed a partnership agreement with the WHO to supply 200 million tablets of Cesol® 600 (praziquantel) for the treatment and prevention of schistosomiasis over a 10 year period. Some 27 million African school children will benefit from the Merck donation, with an estimated value of approximately USD 80 million, which is focused on Sub-Saharan African countries. Angola, Benin, Cameroon, Central African Republic, Madagascar, Nigeria, Senegal and Yemen have been designated by WHO/AFRO for priority control of neglected tropical diseases (NTDs). Partners: World Health Organization (WHO) Countries: Angola, Benin, Cameroon, Central African Republic, Madagascar, Senegal, Nigeria, Yemen 81 10. Sanofi-Aventis “Most Neglected Diseases” Programme Disease area(s): Buruli ulcer, Chagas disease, leishmaniasis Company(ies): Sanofi-Aventis Partner(s): WHO and other partners Since 2006 Programme type(s): Access - Pricing, Capacity Building - Support Developing country(ies): Brazil, Chad, Ethiopia, Panama, Sudan, Togo, MiddleEast countries As part of its 5-year agreement with the World Health Organization (WHO) in 2006 to extend its partnership in sleeping sickness (see separate entry), Sanofi-Aventis also supported a collaborative programme with WHO to improve treatment for some “most neglected diseases”, namely leishmaniasis, Chagas disease and Buruli ulcer. Sanofi-Aventis is providing USD 6.4 million to WHO over 5 years for development of training, diagnostics and optimization of treatment for leishmaniasis. It will transfer the worldwide production of its leishmaniasis medicine Glucantime® to its Brazilian subsidiary, to optimize product price. Sanofi-Aventis will also provide Glucantime® at a tiered-price of USD 1.2 per ampoule in all developing countries. In 2008, Sanofi-Aventis also helped the WHO with import licences in some critical endemic countries. Sanofi-Aventis’s Humanitarian Partnership Department is developing a joint leishmaniasis control programme with the Aggeu Magalhaes Research Centre and the Oswaldo Cruz Foundation to set up a screening, care and follow-up programme for 4,000 poor families in Pernambuco, to fight leishmaniasis and other endemic diseases in the region, such as tuberculosis and dengue. Other programmes on leishmaniasis are also being developed with the governments of Panama and Bolivia. Sanofi-Aventis is also giving WHO USD 2 million for new programmes to intensify disease management of Buruli ulcer and Chagas disease and USD 4 million to support field activities of its Innovative and Intensified Disease Management programme. 82 In addition to the above-mentioned agreement with WHO, Sanofi-Aventis has partnered in 2007 with Handicap International to set up a five-year national campaign in Togo to reduce the death rate and the serious post-disease effects caused by Buruli ulcer. In 2008, 98 health professional were trained, and 194 patients treated under this programme. Partners: Aggeu Magalhaes Research Centre in Brazil, Oswaldo Cruz Foundation in Brazil, Handicap International, World Health Organization (WHO) Countries: Brazil, Chad, Ethiopia, Panama, Sudan, Togo 83 11. Sanofi-Aventis Sleeping Sickness Programme Disease area(s): Sleeping sickness Company(ies): Sanofi-Aventis Partner(s): WHO and other partners Since 2001 Programme type(s): Access - Donation, Capacity Building - Support, R&D Developing country(ies): Sub-Saharan African countries Sleeping sickness has re-emerged in Africa as a major health threat. In 2001, Sanofi-Aventis committed USD 25 million over the years 2001-2006 to help the World Health Organization implement a strategy of adequate medicine supplies, disease surveillance and management, plus R&D for new treatments. After five years, WHO and Sanofi-Aventis’ efforts were estimated to have saved 110,000 lives. In 2006, the company renewed its contract with WHO and expanded it to address several additional “most neglected diseases” (see separate entry). It has committed to provide a further USD 14 million over the years 2006-2011, with continued medicines being donated for sleeping sickness, and funding for training, control and diagnostic programmes. It is also working to make eflornithine a more “ready to use” and safer treatment. By the end of 2008, more than 1,250,000 vials of eflornithine, pentamidine and melarsoprol had been distributed and WHO estimates that the number of new patients identified per year, via the WHO-Sanofi-Aventis partnership, is 11,000. Sanofi-Aventis has delivered donated medicines to Médecins sans Frontières, which provides storage, distribution and sometimes administration of the medicines on behalf of WHO, for national control programmes and NGO use. Sanofi-Aventis also helped fund development of new therapies through the UNDP-World BankWHO Special Programme for Research and Training in Tropical Diseases (TDR). These included an oral form of eflornithine (stopped in 2007) and a combination of eflornithine and nifurtimox. Based on promising results from early clinical trials, the development of this combination has 84 been continued. Bayer HealthCare provides nifurtimox for free for the clinical trials, while Sanofi-Aventis is providing free eflornithine. Bristol-Myers Squibb funded the supply of the active ingredient for eflornithine during the first year of the donation and, in 2002, provided a complementary USD 400,000 cash donation to the WHO. Partners: Médecins sans Frontières MSF, UNICEF-UNDP-World Bank-WHO Special Programme for Research and Training in Tropical Diseases (TDR), United Nations Development Programme (UNDP), World Bank, World Health Organization (WHO) Countries: Angola, Central African Republic, Chad, Democratic Republic of Congo, Republic of Congo, Sudan, Tanzania, Uganda 85 12. Soil-Transmitted Helminthiasis Disease area(s): Soil-transmitted helminthiasis Company(ies): Johnson & Johnson Partner(s): Task Force for Child Survival and Development Since 2007 Programme type(s): Access - Donation Developing country(ies): Bangladesh, Cameroon, Cape Nicaragua, Uganda, Zambia Verde, Laos, Globally, up to 400 million children suffer from Soil-Transmitted Helminthiasis (STH), an infection of intestinal worms, but fewer than 20% of at-risk children were reached with de-worming treatment in 2005, falling far short of the World Health Assembly's target to treat 75% of at-risk children by 2010. STH is especially dire for children because it causes malnutrition, increases susceptibility to other serious infections, and stunts growth during a critical development period. STH has been identified by the WHO and the US Centres for Disease Control and Prevention as a “target of opportunity”, meaning that with existing diagnostic tools and treatments and greater support, it can be prevented, treated and controlled. In 2007, Johnson & Johnson partnered with the Task Force for Child Survival and Development to develop and launch a programme to donate up to 50 million doses of mebendazole in 2007 to treat children with or at high risk for STH. Mebendazole is one of a class of medicines known as antihelmintics that are used to treat numerous kinds of worm infections. The governments of Bangladesh, Cameroon, Uganda and Zambia received donations in 2007, and four additional countries - Cambodia, Cape Verde, Laos and Nicaragua - are receiving membedazole donations in 2008. This is the largest pharmaceutical donation, to date, to treat intestinal worms. 86 13. GSK - DNDi Collaboration Disease area(s): Chagas disease, leishmaniasis, sleeping sickness Company(ies): GlaxoSmithKline Partner(s): DNDi and other partners Since 2008 Programme type(s): R&D Developing country(ies): Pre-clinical research in Spain and the UK In March 2008, GlaxoSmithKline (GSK) and the Drugs for Neglected Diseases initiative (DNDi) announced a collaborative research effort targeting visceral leishmaniasis (kala azar), human African trypanosomiasis (sleeping sickness) and Chagas disease. The collaboration, which has been established for an initial period of two years, will focus on identifying and developing compounds from existing GSK programmes and will leverage the expertise of researchers at GSK's Tres Cantos facility and leading academic centres like the London School of Hygiene & Tropical Medicine (LSHTM). The collaboration has been formed to address unmet patient needs, as current treatments for these diseases have significant drawbacks, such as difficulty of administration, severe side effects, length of treatment, cost and emerging parasitic resistance. Partners: Drugs for Neglected Diseases initiative (DNDi), London School of Hygiene & Tropical Medicine (LSHTM) 87 14. Roche Foundation for Anaemia Research (RoFAR) Disease area(s): Anaemia Company(ies): Roche Partner(s): Independent research facility Since 2004 Programme type(s): R&D Developing country(ies): Worldwide RoFAR was founded in 2004 as an independent, scientist-led, international medical research charity. RoFAR has committed 20 million Swiss francs since the Foundation began. It has so far awarded around 15 million Swiss francs to 68 research projects around the world. RoFAR will conclude its last cycle of funding in 2011. 15. West Africa Hydrocele Surgical Training Programme (WAHSTP) Disease area(s): Hydrocele Company(ies): Johnson & Johnson Partner(s): Since 2005 Programme type(s): Training – capacity building Developing country(ies): Burkina Faso, Ghana, Mali, Niger, and Togo Since the programme began in 2005, nearly 100 surgeons and surgical nurses have been trained, and more than 2,100 men have benefited from the surgery. Johnson & Johnson provides financial support that helps WAHSTP operate in targeted countries. 88 INITIATIVES AGAINST PREVENTABLE DISEASES Immunization reaches over 80% of children worldwide and is one of the most successful and cost-effective public health interventions ever, eradicating smallpox, lowering the global incidence of polio by 99% since 1988, and achieving dramatic reductions in illness and death from diphtheria, tetanus and whooping cough. In 2008, measles partners announced that mortality due to measles decreased by 74% globally between 2000 and 2007. Between 2 and 3 million deaths from diphtheria, tetanus, pertussis (whooping cough), and measles are estimated to be prevented annually as a result of immunization. Hepatitis B vaccination prevents an additional 600 000 future deaths (from liver cirrhosis and liver cancer) annually. However, an estimated 26.3 million of children under one year of age remained in need of immunization in 2006. The cost of not immunizing is higher because people who are not vaccinated as infants remain vulnerable for the rest of their lives. In September 2005, the United Kingdom, France, Italy, Spain and Sweden committed nearly USD 4 billion to immunization in developing countries over the next decade, using an innovative new mechanism called the International Finance Facility for Immunization (IFFIm). IFFIm and innovative finance mechanisms such as Advance Market Commitments (AMCs) reflect a growing willingness on the part of developed countries to make significant financial resources available to meet important health needs in resource-poor countries. 1. Bristol-Myers Squibb Foundation: Delivering Hope Disease area(s): Hepatitis Company(ies): Bristol-Myers Squibb Partner(s): Various national and local foundations Since 2002 Programme type(s): Capacity Building - Support & Training, Education Developing country(ies): China and India Delivering Hope is a comprehensive effort to fight Hepatitis B and C in Asia, sponsored by the Bristol-Myers Squibb Foundation. Delivering Hope has drawn upon the proven models created by the Foundation's work on HIV/AIDS in Africa to address a major healthcare challenge in resource-constrained settings. Since 2002, Bristol-Myers Squibb and the Bristol-Myers Squibb Foundation have provided USD 3.1 million in grants in China, already benefiting more than 700,000 people directly, and USD 1.7 million in India. 89 2. GAVI Alliance Disease area(s): Childhood diseases Company(ies): Crucell, GlaxoSmithKline, Merck & Co. Inc., Sanofi-Aventis , Wyeth Partner(s): GAVI Alliance, WHO and other partners Since 2000 Programme type(s): Access - Donation & Pricing, Capacity Building - Support & Training Developing country(ies): Low-income countries The Alliance's partners include industrialized countries vaccine manufacturers (Crucell, GlaxoSmithKline, Merck & Co., Inc., Novartis, Sanofi Pasteur, the vaccines division of SanofiAventis , and Wyeth), developing countries vaccine industry, industrialized and developing country governments, UNICEF, the WHO, the World Bank, charitable foundations and NGOs. Industry partners invest in the development of new vaccines and in enhanced global vaccine manufacturing capacity, including facilities in developing countries. They also help to educate healthcare providers and develop technologies to facilitate vaccine distribution. Crucell’s support for GAVI includes supplying large quantities of the first internationally available thiomersal-free fully liquid pentavalent (5-in-1) vaccine Quinvaxem™ which protects children against 5 diseases (DTP-HepB-Hib) in one single shot. Country applications for Hibcontaining combinations grew to their historical high in 2008 and over half a billion doses of liquid pentavalent vaccine have been requested for 2009-2012. Of the 1.1 billion vaccine doses GSK supplied in 2008, almost 80% went to developing countries. GSK has actively supported GAVI since its inception and was its main pentavalent and tetravalent vaccine supplier during GAVI Phase I. GSK has also developed new pneumococcal, rotavirus and cervical cancer vaccines, which will be made available in developing countries with help from GAVI. GSK is developing new vaccines for diseases which are future GAVI targets, including dengue and malaria. As part of its support for the GAVI Alliance, the Merck Company Foundation funds the Merck Vaccine Network - Africa. Merck also provided 1 million doses of MMR II vaccine for mumps, measles and rubella to Honduras over a three-year period and donated hepatitis B vaccine in 90 support of GAVI. Merck is also providing rotavirus vaccination for all infants in Nicaragua for a three-year period. In 2008, Merck contributed USD 2 million to the GAVI-supported Measles Initiative of the UN Foundation, for disease surveillance activities in Africa. Since 2001, the Measles Initiative has supported the vaccination of more than 600 million children in more than 60 countries. Sanofi Pasteur supports GAVI's polio eradication efforts and has donated 120 million doses of oral polio vaccine (OPV) since 1997. It also supports the GAVI yellow fever vaccine initiative for Africa. In 2007, Sanofi Pasteur sponsored the first EPIVAC technical conference on yellow fever, which drew 150 participants from Benin, Burkina Faso, Cameroon, Côte d'Ivoire, Guinea, Mali, Senegal and Togo. In November 2006, the GAVI Board approved investment in pneumococcal and rotavirus vaccines. In February 2007, donor countries approved an Advance Market Commitment (AMC) pilot programme to encourage development of new pneumococcal vaccines. In 2007, WHO recommended inclusion of PCV7 pneumococcal vaccine in immunization programmes with priority for high-risk populations, mostly in the developing world. In November 2008, GAVI accepted Wyeth's proposal to donate more than 3 million doses of its Prevnar® pneumococcal vaccine to protect children in Rwanda and Gambia, countries with very high mortality from pneumococcal disease. Immunization should start in 2009 - the first time a pneumococcal conjugate vaccine will have been used into the developing world. GSK has become one of the first manufacturers to sign a unique agreement with the GAVI Alliance that has the potential to save millions of children from dying in the world’s poorest countries. GSK will supply up to 300 million doses of its vaccine Synflorix, for invasive pneumococcal disease, to GAVI over a ten year period. Over the ten year period of the agreement, GSK will supply up to 300 million doses of its pneumococcal vaccine, valued at approximately USD 1.3 billion. Partners: GAVI Alliance, World Health Organization (WHO), World Bank, United Nations Children's Fund (UNICEF) Countries: Benin, Burkina Faso, Cameroon, Côte d'Ivoire, Gambia, Guinea, Honduras, Mali, Nicaragua, Rwanda, Senegal, Togo 91 3. Global Polio Eradication Initiative Disease area(s): Polio Company(ies): Sanofi-Aventis Partner(s): WHO and other partners Since 1988 Programme type(s): Access - Donation, Capacity Building - Support Developing country(ies): Afghanistan, Egypt, India, Indonesia, Nigeria, Pakistan In January 2004, a new plan was unveiled to immunize 250 million children in the remaining polio-endemic countries to eradicate finally a disease that once paralyzed hundreds of thousands of children each year. Working in cooperation, the World Health Organization (WHO), Rotary International, the US Centres for Disease Control and Prevention (CDC) and the United Nations Children's Fund (UNICEF) agreed to accelerate efforts targeted at eradicating polio. In 2002, Sanofi Pasteur, the vaccines division of Sanofi-Aventis, announced that it would donate 30 million doses of the Oral Polio Vaccine (OPV) to the Global Polio Eradication Initiative through 2005. Sanofi Pasteur, the longest-standing corporate partner in the Initiative, has donated 120 million OPV doses since 1997. At the WHO's request, Sanofi Pasteur developed and licensed a new vaccine in record time in 2005 - Monovalent Oral Polio Vaccine 1 or MOPV1 - for use first in Egypt as a critical part of a new WHO strategy to end polio transmission. Sanofi Pasteur also provides bulk MOPV1 to a manufacturer in India, to fill and package for local use. In 2007, Sanofi Pasteur donated 270,000 doses of inactivated polio vaccine (IPV) to Indonesia for a WHO-sponsored study on IPV introduction in Lombok. Partners: World Health Organization (WHO), Rotary International, United Nations Children's Fund (UNICEF), US Centres for Disease Control and Prevention (CDC) Countries: Afghanistan, Egypt, India, Indonesia, Nigeria, Pakistan 92 4. HPV Vaccine & Cervical Cancer Disease area(s): Cervical cancer Company(ies): GlaxoSmithKline, Merck & Co. Inc. Partner(s): PATH Since 2005 Programme type(s): Access - Donation & Pricing Developing country(ies): India, Peru, Uganda, Vietnam Cervical cancer is the second most common cancer in women worldwide, with about 500,000 new cases and 250,000 deaths occurring each year. Almost 80% of cases occur in low-income countries, where cervical cancer is the number one cause of cancer in women. Virtually all cervical cancer cases (99%) are linked to genital infection with human papillomavirus (HPV), a family of virus types which also causes genital warts and other forms of cancer. PATH, the Programme for Appropriate Technology in Health, is an international, non-profit organization that creates sustainable, culturally relevant health solutions, and works to advance acceptable and affordable new technologies for low-resource settings. PATH is partnering with GlaxoSmithKline and Merck & Co., Inc., both of which have developed HPV vaccines, to conduct pilot HPV vaccination programmes in adolescent females, looking at acceptance and accessibility. The countries selected are India, Peru, Uganda and Vietnam. GSK expects its Cervarix™ HPV vaccine will secure WHO Pre-Qualification in 2009, allowing its purchase by UN agencies on behalf of poorer countries. GSK works with partners to help improve access to its vaccines and is committed to ensuring pricing is not a barrier-to-access in the developing world. For example, it has made Cervarix™ available in Indonesia, South Africa, the Philippines and Vietnam, with price reductions of up to 60%. GSK has long practiced tiered pricing for vaccines supplied to government-led programmes, charging lower prices in poorer countries. GSK is also supporting HPV pilot projects; for example, it donated 50,000 doses of Cervarix™ to a PATH-led project in Uganda. The GARDASIL® Access Programme plans to make available at least 3 million doses of GARDASIL® [Human Papillomavirus Quadrivalent (Types 6, 11, 16, 18) Vaccine, Recombinant], 93 to qualifying organizations and institutions in developing countries where approximately 80% of the world's cervical cancer cases occur. The GARDASIL® Access Programme enables organizations and institutions in eligible lowest income countries to gain operational experience in the design and implementation of human papillomavirus vaccination projects, with the goal of supporting the development of successful child and adolescent immunization models. The GARDASIL® Access Programme, which will run over a 5-year period, is made possible by a pledge from Merck & Co., Inc., and overseen by Axios Healthcare Development (AHD), a US non-profit organization. AHD administers the donation programme, reviews and approves applications, and ensures prompt delivery of the vaccine to the recipients, with the technical assistance of Axios International, a public health consultancy specializing in developing and emerging countries. Since the inception of the programme, organizations and institutions in Bhutan, Bolivia, Cambodia, Cameroon, Georgia, Ghana, Haiti, India, Kenya, Lesotho, Moldova, Nepal, Nicaragua, Papua New Guinea, Tanzania, Uganda and Uzbekistan have been approved to receive more than 496,000 doses of GARDASIL®. Partners: Programme for Appropriate Technology in Health (PATH) Countries: India, Peru, Uganda, Vietnam 94 5. Merck Vaccine Network - Africa (MVN-A) Disease area(s): Vaccine-preventable diseases Company(ies): Merck & Co. Inc. Partner(s): Various partners Since 2003 Programme type(s): Capacity Building - Training Developing country(ies): Kenya, Mali, Uganda, Zambia MVN-A training centre partners include: Indiana University School of Medicine and Moi University Faculty of Health Sciences (Kenya); Centre for Vaccine Development, University of Maryland School of Medicine and the Centre for Vaccine Development, Centre national d'appui à la lutte contre la maladie (Mali); Task Force for Child Survival and Development, Emory University and Makerere University School of Public Health (Uganda); and Brighton and Sussex University Hospitals NHS Trust and the University of Zambia School of Medicine (Zambia). To date, more than 350 health professionals in Kenya and Mali have completed MVN-A training on a wide range of topics. Trainees have returned to their home medical facilities to share their expertise and knowledge with fellow healthcare workers. In Kenya, MVN-A trainees in the Ministry of Health worked to coordinate health services support, including mass immunization campaigns to prevent outbreaks of measles and polio for large camps of internally displaced persons. In Mali, the Ministry of Health leveraged the MVN-A programme to help train immunization managers in preparation for the accelerated introduction of a new Hib pentavalent vaccine (DTP-HepB+Hib), funded by GAVI. Since its successful expedited introduction in 2005, more than 675,000 Malian children have received this new combination vaccine. Partners: Brighton and Sussex University Hospitals NHS Trust in UK, Emory University in USA, Indiana University in USA, Makerere University School of Public Health in Uganda, Moi University in Kenya, University of Maryland in USA, Centre national d'appui à la lutte contre la maladie in Mali, University of Zambia 95 6. Pandemic Influenza & Developing Countries Disease area(s): Pandemic influenza Company(ies): Biken, Gilead, GlaxoSmithKline, Roche, Sanofi-Aventis Partner(s): WHO and other partners Since 2006 Programme type(s): Access - Donation & Pricing Developing country(ies): China, India, South Africa GlaxoSmithKline (GSK) has invested over USD 2 billion in research and expanded production capacity for its antiviral medicine, Relenza®, and for its pre-pandemic and pandemic influenza vaccines. It has set a preferential price for Relenza® for least-developed countries (Least developed countries) and has granted Simcere, China, a voluntary licence to make zanamivir and sell it in China, Indonesia, Thailand, Vietnam and all Least developed countries. In 2007, GSK announced it would donate 50 million doses of H5N1 vaccine to a WHO stockpile and that it will also sell this vaccine at preferential prices to the WHO stockpile and poorer countries. In May 2008, GSK obtained the first EU licence for a pre-pandemic influenza vaccine, Prepandrix™, and has also been granted an EU licence for its mock-up pandemic vaccine, Pandemrix™. Roche has increased its capacity to make Tamiflu® (oseltamivir) antiviral medicine by 500% since 2002; by 2007, it could make 400 million treatment courses per year if required. It sells Tamiflu® at a reduced price for pandemic stockpiling and offers further price reductions to low income countries. Production can be increased if key inventories drop below target levels or the WHO declares a phase 4 pandemic (human-to-human transmission). Roche and Gilead (which developed Tamiflu®) hold no patents on it in least developed countries, whose governments are free to make generic versions. To further increase access to Tamiflu® for pandemic use, Roche has granted sublicences to Shanghai Pharmaceuticals, HEC Group, China, and Hetero Pharmaceuticals, India, to make oseltamivir, and has given Aspen Pharmaceuticals, South Africa, information to facilitate local manufacturing of Tamiflu® for pandemic stockpiling by African governments. 96 Roche has also donated over 5 million treatment courses of Tamiflu® to WHO in 2009. It has also donated 5 million doses in 2003, which were donated by WHO to needy countries. A WHO central stockpile of 3 million courses will be used to extinguish or slow a pandemic at its site of outbreak. The regional stockpiles, comprising 2 million courses, are being used to manage current outbreaks of avian influenza and will augment the WHO central stockpile in a pandemic containment effort. In 2008, Sanofi Pasteur, the vaccines division of Sanofi-Aventis, announced it intends to contribute 60 million doses of H5N1 vaccine over 3 years to the WHO emergency reserve stockpile. Sanofi Pasteur is also expanding its manufacturing capacity, including building new vaccine plants in China and Mexico, and is researching new approaches, such as adjuvants, to allow more people to be protected using current capacity. In March 2009, Sanofi Pasteur's H5N1 vaccine, Emerflu®, was granted a marketing authorization by the Australian Therapeutic Goods Administration (TGA). Other manufacturers are also increasing vaccine capacity in developing countries, building new plants or through local partnerships. These include Biken in Indonesia and GlaxoSmithKline in China. In December 2009, AZ signed an agreement with the World Health Organization (WHO) which committed at least 3 million doses of its live, attenuated intranasal vaccine for H1N1 to be distributed at WHO’s discretion as well as a cash donation to help support those distribution efforts. WHO has processes in place to allow for legal distribution and use of the product in countries where it is not currently approved for marketing. Partners: World Health Organization (WHO), Aspen Pharmacare in South Africa, Simcere in China, Shanghai Pharmaceuticals in China, HEC Group in China, Hetero Pharmaceuticals in India 97 7. Rotavirus Vaccine Programme Disease area(s): Rotavirus-induced gastroenteritis Company(ies): GlaxoSmithKline, Merck & Co. Inc. Partner(s): GAVI Alliance, WHO and other partners Since 2003 Programme type(s): Access - Donation & Pricing Developing country(ies): Brazil, El Salvador, Mexico, Nicaragua, Panama, Venezuela Rotavirus infection is the leading cause of severe diarrhoea and vomiting (gastroenteritis) in children under two and kills around 600,000 children each year, mostly in developing countries. With funding from the GAVI Alliance and the Vaccine Fund, the Programme for Appropriate Technology in Health (PATH) established the Rotavirus Vaccine Programme (RVP) in 2003. With its strategic partners, the World Health Organization (WHO) and the US Centres for Disease Control and Prevention (CDC), RVP is working to accelerate introduction of the two available vaccines. GlaxoSmithKline's vaccine, Rotarix™ is a two-dose oral vaccine targeting one rotavirus strain. Early in 2007, GSK obtained WHO pre-qualification for Rotarix™. GSK is helping Brazil to implement a universal mass vaccination programme for rotavirus. It will supply enough Rotarix™ to protect every baby in Brazil for the next five years and will transfer technology to allow Brazil's Fiocruz to produce Rotarix™ under licence for the domestic market and for export to other developing countries. The vaccination programme has already resulted in an 85% reduction in rotavirus related hospitalizations, according to the Brazilian Ministry of Health. In 2005, WHO moved to recommend rotavirus vaccination as one of the core list of childhood immunizations. In late 2006, the GAVI Alliance committed to provide funding for the introduction of rotavirus vaccines in eligible countries around the world. Partners: Brazil Ministry of Health, FioCruz, GAVI Alliance, Nicaragua Ministry of Health, Programme for Appropriate Technology in Health (PATH), US Centres for Disease Control and Prevention (CDC), Vaccine Fund, World Health Organization (WHO) 98 8. Sanofi-Aventis & EPIVAC Disease area(s): Vaccine-preventable diseases Company(ies): Sanofi-Aventis Partner(s): GAVI Alliance, UNICEF, WHO and other partners Since 2002 Programme type(s): Capacity Building - Training Developing country(ies): 11 African countries The programme is a Sanofi Pasteur, the vaccines division of Sanofi-Aventis , contribution to the GAVI Alliance. Implemented by the Agence de Médecine Préventive, the programme was developed in partnership with national governments of eligible countries and the participating universities, in collaboration with the WHO, UNICEF, the Vaccine Fund and other partners working in Africa. EPIVAC is coordinated with the GAVI subregional working group and complements other GAVI support to African countries. EPIVAC seeks to strengthen the GAVI process within each country in coordination with the Interagency Coordinating Committee (ICC). The EPIVAC programme monitors and evaluates the impact of training on immunization delivery and management in the district. Between 2002 and 2008, approximately 350 doctors have been enrolled in EPIVAC training. Doctors have been trained from Benin, Burkina Faso, Cameroon, Côte d'Ivoire, Central Africa, Guinea, Mali, Mauritania, Niger, Senegal and Togo. In 2008, Sanofi Pasteur also funded the launch of the EPIVAC Network (REI), which aims to bring together the graduates of the EPIVAC programme for best-practice sharing and continuous education in vaccination and logistics. Partners: Agence de Médecine Préventive, EPIVAC (EPIdemiology & VACcinology), GAVI Alliance, United Nations Children's Fund (UNICEF), Vaccine Fund, World Health Organization (WHO). Countries: Benin, Burkina Faso, Cameroon, Côte d'Ivoire, Central African Republic, Guinea, Mali, Mauritania, Niger, Senegal, Togo 99 9. Schering-Plough Vaccine Licence Agreement with WHO Disease area(s): Pandemic influenza Company(ies): Schering-Plough Partner(s): WHO Since 2009 Programme type(s): Access - Licensing Developing country(ies): Developing countries In February 2009, Schering-Plough announced a licence agreement between Nobilon, Schering-Plough's human vaccine business unit, and the World Health Organization (WHO) to provide access to pandemic influenza vaccine manufacturing technology to developing countries. Under the agreement, Nobilon has granted WHO a non-exclusive licence to develop, register, manufacture, use and sell seasonal and pandemic live, attenuated, influenza vaccines (LAIV), produced in embryonated chicken eggs. WHO will be permitted to grant a sub-licence to vaccine manufacturers in developing countries working within the framework of the WHO Global Vaccine Action Plan. Vaccine manufacturers to whom a sub-licence will be granted will be able to provide vaccines to the public sector of developing countries royalty-free. Egg-based LAIV technology is specifically considered attractive for this purpose because the manufacturing technology process is easier to transfer, capital investment is lower and yields are higher, as compared to inactivated influenza vaccines. The WHO Global Vaccine Action Plan seeks to expand influenza vaccine manufacturing capacity in developing countries and enhance the global supply for pandemic vaccines. 100 10. Sigma-Tau & AMREF: “Uganda Project” Disease area(s): Vaccine-preventable disease Company(ies): Sigma-Tau Partner(s): African Medical Research Foundation (AMREF) Since 2008 Programme type(s): Access - Donation, Capacity Building - Training Developing country(ies): Uganda Sigma-Tau supports the African Medical Research Foundation (AMREF) in implementing the “Uganda Project”, a vaccination and medical training programme in Northern Uganda, in the areas most affected by the civil war of the 1990s. The main aim of the project is to vaccinate more than 3,000 Ugandan children against the six most common childhood diseases (tuberculosis, diphtheria, tetanus, poliomyelitis, hepatitis B and measles). At the same time, it also aims to provide medical training for local health workers, thus furnishing both immediate and long-term support for health development. 101 11. Nicaragua Rotavirus Vaccine Programme Disease area(s): Gastroenteritis Company(ies): Merck Partner(s): Nicaraguan Ministry of Health, UNICEF and others Since 2006 Programme type(s): Access - Donation Developing country(ies): Nicaragua In 2006, Merck, the Nicaraguan Ministry of Health, UNICEF and leading health organizations established a three-year partnership to provide free vaccinations against rotavirus gastroenteritis to all eligible infants born in Nicaragua. Through the partnership – called the Nicaraguan Rotavirus Vaccination Programme – Merck expects to donate more than one million doses of ROTATEQ® (rotavirus vaccine, live, oral pentavalent) through the end of 2009, representing a USD 75 million commitment. Since the partnership was launched in October 2006, Merck has provided nearly 1 million free doses of ROTATEQ® (rotavirus vaccine, live, oral pentavalent) to Nicaragua. Starting in March 2007, an estimated 27,720 doses of ROTATEQ® have been administered every month through the national immunization programme; to date, more than 769,120 doses have been administered. The country has achieved rates of rotavirus vaccination that are among the highest in the world with the Ministry of Health reporting that approximately 81% of eligible infants in Nicaragua were vaccinated with ROTATEQ® in 2008. The aim is an 82-84 percent vaccination rate with ROTATEQ by the end of 2009. 102 INITIATIVES FOR CHILD & MATERNAL HEALTH 1. Abbott Fund Programme to Fight Malnutrition in Vietnam Disease area(s): Child & maternal health, malnutrition Company(ies): Abbott Partner(s): AmeriCares, Giao-Diem Humanitarian Foundation Since 2006 Programme type(s): Access - Donation, Capacity Building - Training Developing country(ies): Vietnam According to UNICEF, more than 25% of Vietnamese children under five are underweight and more than 10% of Vietnamese children suffer from vitamin A deficiency. To help improve the overall nutritional health of children in rural areas of Vietnam, the Abbott Fund is working with AmeriCares to support the Giao-Diem Humanitarian Foundation. Together, the Abbott Fund and its partners are improving the nutritional status of school age children in three rural provinces of Vietnam - Quang Tri, Hue, and Dong Thap - where childhood malnutrition rates are among the highest in the country. This successful initiative targets nutritional health early in life. During the flooding and raining season, Abbott also donates paediatric nutritional products. In 2008, the Abbott Fund initiative reached 65 schools and more than 1,700 children. For the second year in a row, the Quang Tri province has exceeded the national nutritional health target, reducing the rate of malnutrition for children under five from 25% to 17%. In association with the UN’s Millennium Development Goal 1 on extreme poverty and hunger, Vietnam aims to reduce the proportion of people living under the food poverty line by 75% by 2010. In association with the UN’s Goal 4 on child mortality, the partnership is helping Vietnam reduce the proportion of children under five who are malnourished down to 20% by 2010. This programme serves as a sustainable model for improving paediatric nutrition in rural Vietnam. Abbott is currently supporting efforts by other organizations to replicate this model programme at five additional locations. 103 2. Abbott Fund Programme to Improve Children's Health in Cambodia Disease area(s): Child & maternal health Company(ies): Abbott Partner(s): Angkor Hospital for Children in Cambodia, Direct Relief International (DRI) Since 2006 Programme type(s): Access - Donation, Capacity Building - Training Developing country(ies): Cambodia Malnutrition is a significant contributor of early morbidity and mortality among young children in Cambodia. According to UNICEF, the mortality rate for children under five increased from 115 per 1,000 live births in 1990 to 143 in 2005; nearly 45% of all children under five are underweight. Since 2006, Abbott and the Abbott Fund have partnered with DRI and Angkor Hospital for Children in Siem Reap in an effort to reverse these troubling trends. Abbott and the Abbott Fund have provided grants and products to support the work of Angkor Hospital for Children, a paediatric teaching hospital providing free comprehensive care for more than 180,000 children in Siem Reap and neighboring provinces. The Abbott Fund is focused on improving health professional and caregiver awareness, knowledge and ability to treat paediatric nutrition through formal training, local and regional educational workshops, cooking demonstrations and donations of essential products. With the Abbott Fund's support, in 2008 Angkor Hospital for Children also sent nurses to participate in college-level “train the trainer” courses to strengthen the overall clinical teaching skills of the hospital's nursing staff. In 2008, more than 113,000 children received nutritional assessments, more than 3,000 families participated in nutrition information workshops, and more than 120 health professionals were trained. Abbott has also donated products to improve maternal and child health, including rehydration solutions, antibiotics, multivitamins and nutritional supplements. Since the partnership began, more than 250,000 children have received nutritional assessments, more than 6,000 families have participated in nutrition information workshops, and more than 400 health professionals have received nutrition training. The programme's success has helped Angkor Hospital for Children serve as a role model for hospital nutrition programmes in Cambodia. 104 3. Abbott Fund Programme to Improve Maternal & Child Health in Afghanistan Disease area(s): Child & maternal health Company(ies): Abbott Partner(s): Afghan Institute of Learning, Direct Relief International Since 2005 Programme type(s): Access - Donation, Capacity Building - Training Developing country(ies): Afghanistan According to the World Health Organization, Afghanistan has the second highest maternal mortality rate in the world, with 1,900 deaths per 100,000 live births. In addition, one in four Afghan children will not live to see their fifth birthday. To improve the lives of women and children in Afghanistan, Abbott and the Abbott Fund are partnering with the Afghan Institute of Learning (AIL) and Direct Relief International to help reverse the country's high maternal mortality rate, and increase the survival and overall health of infants and children. The Abbott Fund has provided more than USD 400,000 in grants and assisted in coordinating USD 3.7 million in product donations from Abbott to support the work of AIL, founded by Nobel Prize nominee Sakena Yacoobi, a long-time advocate for women's rights in Afghanistan. Direct Relief International, a global humanitarian assistance organization, manages the distribution of Abbott's grants and product donations to AIL. With three clinics serving mostly rural areas in Afghanistan (two in Herat province, one in Kabul province), AIL is staffed and operated by Afghan women. Abbott Fund support is focused on empowering Afghan women through the training of female nurses, midwives and health educators to provide skilled assistance during labor and delivery, as well as care for infants and children. The Abbott Fund also is supporting 5-day women's health workshops that provide health education directly to Afghan women. In 2008, more than 129,000 women and children received services and more than 70,000 individuals received training on health education. Abbott has donated products to improve maternal and child health, including rehydration solutions, antibiotics, multivitamins and nutritional supplements. Since the partnership began in November 2005, more than 380,000 women and children have received services, and 46 nurses/midwives have been trained, with most now employed in clinics and hospitals. The Abbott Fund is supporting the training of 25 additional women in 2008-2009. 105 4. AstraZeneca - Promoting Safe Motherhood in India Disease area(s): Maternal health Company(ies): AstraZeneca Partner(s): Federation of Obstetric & Gynaecological Societies of India Since 2005 Programme type(s): Capacity Building - Training, Education Developing country(ies): India Every year some 600,000 women die of pregnancy-related causes and 99% of these deaths occur in developing countries. India alone accounts for 25% of these deaths and the country has the third highest maternal mortality rate. AstraZeneca India's partnership with the Federation of Obstetric and Gynaecological Societies of India (FOGSI) is focused on improving these statistics, through educational activities, including conferences for healthcare professionals and public awareness campaigns. Since the partnership began in 2005, activities have included a unique “walkathon” along the river Ganges, to spread Safe Motherhood and other healthcare messages among rural populations with high maternal mortality. A team of 27 doctors, accompanied by children from local villages, covered five states in 108 days and met over 200,000 people. Main achievements include: " Rubella vaccinations for over 1,000 teenage girls; " Distribution of medicines; " Educational films on anaemia, HIV/AIDS and female feticide shown to approximately 500 people almost every day; " Visits to over 100 schools covered around 80,000 children in rural areas; " One to one communication on education, marital age, gender bias, female feticide, HIV/AIDS, sanitation, environment and nutrition. 106 5. Bayer Schering Pharma & Family Planning Disease area(s): Family planning Company(ies): Bayer HealthCare Partner(s): Governments, multilateral organizations, private organizations Since 1961 Programme type(s): Access - Pricing, Capacity Building - Training, Education Developing country(ies): Worldwide For more than 46 years, Bayer Schering Pharma AG (part of Bayer HealthCare) has been supporting family planning programmes in over 130 countries with its high quality products in close co-operation with government organizations (BMZ - German Federal Ministry for Economic Cooperation and Development, KFW - German Development Bank, GTZ - German Association for Technical Co-operation, the UK's DFID and DANIDA), multilateral organizations (UNFPA, the World Bank, the WHO, and USAID), and private organizations (International Planned Parenthood Federation, Population Services International, Marie Stopes, IMRES and Missionpharma). In that time, more than 2.6 billion cycle packs of oral contraceptives have been provided to family planning organizations and users in the developing world. Bayer is committed to making universal access to fertility control means a reality by 2015, as recommended by the International Conference on Population and Development. Through its long-term commitment to family planning, Bayer is making a substantial contribution to the UN Millennium Development Goals, including empowering women, reducing child mortality and improving maternal health by 2015. Training programmes for family planning providers are also part of Bayer's commitment. Since sexual education is vital to contraception, Bayer supports programmes like the CELSAM project (Centro Latinoamericano Salud y Mujer), providing detailed information on sexual education in all Latin American countries by radio, educational programmes for schools and universities, telephone hotlines and information booths on the streets. In Asia, Bayer cooperates with APCOC (Asia Pacific Council on Contraception). Partners: Danish International Development Agency (DANIDA), German Association for Technical Co-operation (GTZ), German Development Bank (KFW), German Federal Ministry for Economic Cooperation and Development (BMZ), IMRES, International Planned Parenthood Federation, Marie Stopes International, Missionpharma, Population Services International, World Bank, WHO, UK Department for International Development (DFID), United Nations Population Fund (UNFPA), US Agency for International Development (USAID) 107 6. Bidan Delima Midwife Training Programme Disease area(s): Child & maternal health Company(ies): Johnson & Johnson Partner(s): Indonesian Midwives Association Since 2003 Programme type(s): Capacity Building - Training, Education Developing country(ies): Indonesia In Indonesia, 20,000 women die each year as a result of pregnancy or delivery, and 165,000 infants die before, during or directly after birth. Midwives are crucial to improving reproductive health services. Johnson & Johnson has supported this midwife training programme since its inception in 2003. This past year, the company provided funds to train 1,200 midwives in the national clinical standards of midwifery. These standards cover family planning services, infection prevention, contraceptive technology and safe delivery care. The Association was also able to produce an updated version of its national safe delivery training video, which is used to train 76,000 practicing midwives in Indonesia. 108 INITIATIVES AGAINST CHRONIC DISEASES Some 35 million deaths are attributable to chronic diseases each year; this is 60% of all deaths worldwide. Principal chronic diseases include cardiovascular disease (17 million deaths), cancer (7 million deaths), chronic respiratory disease (4 million deaths) and diabetes (1 million deaths). About 80% of chronic disease deaths occur in low and middle income countries and the number of people, families and communities affected is increasing. The impact of chronic diseases in these countries will increase as they progressively control infectious diseases. A significant proportion of chronic disease morbidity and mortality can be prevented if medications are made accessible and affordable, which is a challenge in countries with large populations of very poor people. The chronic disease threat can be largely managed using existing knowledge and medicines. Many solutions are effective – and highly cost-effective. Public-private partnerships have a crucial role to play in accelerating progress with regard to specific diseases. Nevertheless, access to medicines is not the only key to achieving success: inadequate access to good-quality health services, including diagnostic and clinical prevention services, is a significant cause of the social and economic inequalities in the burden of chronic diseases. Investment in chronic disease prevention programmes and the development of services and infrastructure are essential for many low and middle income countries. 109 1. Abbott Programme to Advance Diabetes Care in Bolivia Disease area(s): Diabetes Company(ies): Abbott Partner(s): Centro Vivir Con Diabetes, Direct Relief International Since 2006 Programme type(s): Access - Donation, Capacity Building - Training Developing country(ies): Bolivia Since 2006, Abbott and the Abbott Fund have partnered with Direct Relief International to support the education and outreach activities of Centro Vivir Con Diabetes, a nongovernmental organization dedicated to low-income adults and children living with both type I and type II diabetes in Cochabamba, Bolivia. The Abbott Fund has provided grants to support diabetes education, expand public outreach campaigns, train healthcare personnel in diabetes management, and establish and expand the number of core diabetes educators. Abbott also has donated glucose screening and monitoring equipment, and disease-specific nutritional products. In 2008, the partnership screened more than 19,000 people, successfully trained 300 healthcare personnel, and provided patient education workshops to more than 800 patients. Since the partnership began, more than 26,000 people have been screened for diabetes. 110 2. AstraZeneca Breast Cancer Programme in Ethiopia Disease area(s): Breast cancer Company(ies): AstraZeneca Partner(s): Axios, Ethiopian Cancer Association, Ethiopia Ministry of Health Since 2005 Programme type(s): Access - Donation, Capacity Building - Support & Training Developing country(ies): Ethiopia In Ethiopia, AstraZeneca has been working since 2005 to build local capability in managing breast cancer - the second most common cancer among young women in the country. The company's partner in this project is Axios, an organization that works with the private sector to advance healthcare in developing countries. The programme has focused on strengthening diagnosis and treatment capabilities at Tikur Anbessa University Hospital in Addis Ababa. In the last three years, with company help, the hospital has become a centre of reference for breast cancer treatment across Ethiopia. Activities have included developing treatment guidelines, strengthening the referral system, setting up an institutional-based cancer registry, raising awareness of the facilities amongst healthcare professionals and providing training for other physicians in Ethiopia. AstraZeneca is also donating its breast cancer medicines, tamoxifen and anastrazole. During the course of the programme: " 3,122 patients have been screened, diagnosed, or treated and followed up; " Guidelines developed and morphine infusion now available at Tikur Anbessa Hospital; " New mammography equipment installed and 13 staff trained; " Tamoxifen available free of charge from March 2006 - 1,706 patients benefited so far; " Anastrazole available for first time in Ethiopia July 2007 and provided free of charge 175 patients benefited so far. 111 3. Bayer HealthCare Nexavar® Access Programme Disease area(s): Diabetes Company(ies): Bayer HealthCare Partner(s): Various partners Since 2007 Programme type(s): Access - Donation Developing country(ies): Asia-Pacific region In 2007, Bayer HealthCare, in partnership with local authorities and charitable organizations, started the first patient access programme for Nexavar® (sorafenib) in Asia for the treatment of renal cell carcinoma and is planning further implementation in this region. Bayer HealthCare donates its medicine Nexavar® to facilitate access for patients who cannot afford the cost of a full course of therapy. In 2008, after the approval of Nexavar® for the treatment of hepatocellular carcinoma, Bayer HealthCare initiated another patient access programme for this indication. 4. Circle of Care: Mental Health in Malaysia Disease area(s): Mental health Company(ies): Johnson & Johnson Partner(s): Circle of Care Since 2004 Programme type(s): Education Developing country(ies): Malaysia Since its inception three years ago, Circle of Care has helped more than 1,000 families in Malaysia cope with mental illness. Individuals released from mental health institutions are often unable to reintegrate into society because of stigma. Circle of Care provides job placement support programmes in nine cities, while families educated about mental illness and are connected to local support groups through the Family Link programme. Johnson & Johnson supports Circle of Care's efforts to educate and support families through Family Link, assist patients in finding jobs and re-entering their communities. 112 5. Glivec® International Patient Assistance Programme (GIPAP™) Disease area(s): Leukaemia Company(ies): Novartis Partner(s): Axios International, Max Foundation Since 2002 Programme type(s): Access - Donation Developing country(ies): 80 developing countries GIPAP™ was initiated in 2002, and operates in about 80 developing countries in Africa, Asia, Eastern Europe, South America and the Caribbean that have no comprehensive reimbursement system or available generics. Patients must be properly diagnosed, not covered by local reimbursement or insurance, and have no other financial resources. Since the programme's launch, Novartis has provided Glivec® at no cost through GIPAP™ to more than 35,000 patients in more than 80 countries. In 2008, Novartis provided USD 751 million worth of Glivec® to more than 25,000 patients who otherwise would not have been able to afford treatment. GIPAP™ operates through a global network of almost 1,000 registered physicians and more than 300 qualified treatment centres, including the leading oncology treatment centres and medical opinion leaders in each country. Novartis' main partners in GIPAP™ are The Max Foundation (TMF) and Axios International. Novartis is responsible for programme development, drug donation and provision of medicine to treatment centres. TMF, a non-profit organization, is responsible for verifying and screening patients for eligibility, case management and providing emotional support and education in about 35 developing countries. 113 6. IDF BRIDGES Programme Disease area(s): Diabetes Company(ies): Lilly Partner(s): International Diabetes Federation Since 2007 Programme type(s): Education, R&D Developing country(ies): Worldwide Eli Lilly and Company has agreed to support the International Diabetes Federation's programme “Bringing Research In Diabetes to Global Environments and Systems” (BRIDGES) with USD 10 million funding over seven years. The BRIDGES grant research programme will provide the opportunity to “translate” lessons learned from clinical research to those who can benefit most: people with diabetes. 7. India Diabetes Educator Project Disease area(s): Diabetes Company(ies): Bayer HealthCare, Lilly Partner(s): Becton Dickinson BD, Project HOPE Since 2007 Programme type(s): Capacity Building - Training Developing country(ies): India In November 2007, Bayer HealthCare, Becton Dickinson (BD) and Eli Lilly and Company agreed to support Project HOPE's “India Diabetes Educator Project”. This four-year, multi-million dollar collaborative programme aims to help healthcare workers in India reduce morbidity and mortality related to diabetes and to combat the rapidly growing threat of diabetes. With an estimated 40.9 million people currently living with the condition, India leads the world in the prevalence of diabetes. The India Diabetes Educator Project offers a comprehensive and sustainable approach that will provide diabetes training to more than 5,000 healthcare professionals, including nurses, dieticians and nutritionists in India. The project includes mentoring support for newly trained Diabetes Educators and also addresses the role of the educator in empowering the patient to take responsibility for daily self-care and to help prevent the onset of diabetes among those at risk. 114 8. Novo Nordisk: Best Possible Pricing on Insulin Disease area(s): Diabetes Company(ies): Novo Nordisk Partner(s): Health Ministries Since 2001 Programme type(s): Access - Pricing Developing country(ies): 32 developing countries Novo Nordisk offers human insulin to the public health systems in least developed countries at prices which do not to exceed 20% of the average price in Europe, Japan and North America. In 2008, Novo Nordisk offered this pricing scheme to all 50 least developed countries, of which 32 used it to buy insulin at or below this price, compared to 36 in 2007. For reasons that are unclear, four least developed countries purchase insulin outside this pricing scheme. Overall, 99% of the units of insulin sold to Least developed countries by Novo Nordisk are sold under the Best Possible Pricing scheme. The amount of insulin supplied to these 32 countries (plus another four) was enough to treat between 150,000 and 390,000 patients, depending on the daily dose. Countries: Angola, Bangladesh, Benin, Burkina Faso, Burundi, Cape Verde, Central African Republic, Chad, Democratic Republic of Congo, Djibouti, Gambia, Guinea, Haiti, Kiribati, Lesotho, Liberia, Madagascar, Malawi, Mali, Mauritania, Mozambique, Myanmar, Niger, Rwanda, Senegal, Somalia, Sudan, Tanzania, Togo, Uganda, Yemen, Zambia 115 9. Novo Nordisk Haemophilia Foundation Disease area(s): Haemophilia Company(ies): Novo Nordisk Partner(s): Health Ministries, NGOs, healthcare professionals, organizations Since 2005 Programme type(s): Capacity Building - Support & Training, Education Developing country(ies): 23 developing countries patient The Novo Nordisk Hemophilia Foundation (NNHF) was created in 2005 to address the significant need for improving hemophilia care in the developing world, where hemophilia is currently not a healthcare priority and many hemophilia patients go undiagnosed or are inadequately treated. NNHF is an independent trust, located in Zurich, Switzerland, and funds programmes to improve hemophilia care, treatment and awareness in the developing world. NNHF cooperates with partners in these countries, such as health ministries and authorities, non-government and patient organizations, healthcare professionals, other foundations and trusts. Countries: Algeria, Brazil, Bulgaria, Chile, China, Cuba, India, Iraq, Jordan, Lebanon, Macedonia, Malaysia, Pakistan, Panama, Poland, Romania, South Africa, Thailand, Uruguay, Uzbekistan, Venezuela, Vietnam, West Bank, Gaza 116 10. Novo Nordisk: World Partner Project Disease area(s): Diabetes Company(ies): Novo Nordisk Partner(s): Health Ministries and local NGOs Since 2001 Programme type(s): Capacity Building - Training, Education Developing country(ies): Bangladesh, China, El Salvador, India, Indonesia, Malaysia, Mexico, Nigeria, Tanzania, Zambia The World Partner Project (WPP) was launched in 2001 to establish a foundation on which developing countries can build their own diabetes healthcare strategies and ultimately improve access to proper care. The WPP works with local partners, usually health ministries and/or patient organizations, and is funded by a grant from Novo Nordisk. WPP and its partners have driven 31 projects in seven focus countries (Bangladesh, China, El Salvador, India, Malaysia, Tanzania and Zambia), organizing clinics, providing distance learning for healthcare professionals, educating people with diabetes and raising diabetes awareness. It is estimated that WPP projects have trained 104,000 healthcare professionals, while 122,000 people with diabetes have been educated or treated. During 2008, Novo Nordisk assisted the partners in various projects in the focus countries to consolidate efforts in order to continue the projects. Also new activities were instigated in Indonesia, Mexico and Nigeria, focusing on partnership building, participation in national diabetes programmes, awareness building and education. WPP will continue to support established projects in the focus countries until it is satisfied that these projects can be self-sustaining. 117 11. Pfizer Global Health Partnerships Disease area(s): Oncology, tobacco control Company(ies): Pfizer Partner(s): Various partners Since 2006 Programme type(s): Capacity Building - Support & Training, Education Developing country(ies): 15 developing countries Pfizer and the Pfizer Foundation will provide more than USD 47 million over four years (20072010) to address emerging challenges in cancer and tobacco control in 46 countries across five continents. The programme collaborates with local experts to improve the diagnosis and treatment of cancer and reduce its incidence and burden. Technical assistance and evaluation support is provided by the Bloomberg School of Public Health at Johns Hopkins University. Partners: Action on Smoking and Health International (ASH), Akebono-Kai, Alianca de Controle do Tabagismo /Tobacco Control Alliance, American Cancer Society, China Tobacco Control Association, Cause Marketing Fundraisers of South Africa, Comprehensive Cancer Centre at the Freiburg University Medical Centre, European Organization for Research and Treatment of Cancer (EORTC), FCA/ASH International, George Washington University Cancer Institute, Give 2 Asia, Heart and Stroke Foundation of Ontario, Health Promotional Foundation, Hellenic Respiratory Society, Hungarian Academy of Teaching Family Physicians, International Union Against Cancer (UICC), Irish Cancer Society, Japan Dental-Medical Association for Tobacco Council, King Baudouin Foundation, Korean National Council of Women, Mexican Council on Tobacco, New Hope in Health Foundation, Philippine Business for Social Progress, QUIT UK/European Network of Quitlines, Ralph Lauren Centre for Cancer Care and Prevention, Resource Foundation, SAMBA, Shanghai Centre for Disease Control and Prevention, TCC Group, Veronesi Foundation, Bloomberg School of Public Health at Johns Hopkins University Countries: Algeria, Argentina, Brazil, Canada, Colombia, Costa Rica, Egypt, Germany, Greece, Hungary, Kuwait, Lebanon, Malaysia, Mexico, Morocco, Philippines, Poland, Saudi Arabia, Singapore, South Africa, Sweden, Thailand, Tunisia, Turkey, United Arab Emirates, United States, Venezuela 118 12. Sanofi-Aventis Diabetes Prevention Disease area(s): Diabetes Company(ies): Sanofi-Aventis Partner(s): Handicap International, Santé Diabète Mali Since 2006 Programme type(s): Capacity Building - Support Developing country(ies): Burundi, India, Kenya, Madagascar, Mali, Nicaragua, Philippines, Thailand In 2006, Sanofi-Aventis launched pilot programmes to help improve diabetes disease management in developing countries, in conjunction with the NGO Handicap International, Santé Diabète Mali and other local NGOs in Africa, Asia and Latin America. Several projects were set up in 2007 in Burundi, India, Kenya, Madagascar, Nicaragua, Philippines and Thailand. The programme aims to help local healthcare systems to manage the disease better, prevent the onset of complications and so avoid the subsequent need for surgical interventions such as amputation. Since the beginning of the programme, Handicap International has trained 600 health professionals, who in turn have treated 3,000 patients. 119 13. Sanofi-Aventis : Impact Epilepsy Programme for Developing Countries Disease area(s): Epilepsy Company(ies): Sanofi-Aventis Partner(s): Association des Médecins de Campagne, Kenya Association for the Welfare of People with Epilepsy, Santé Sud, French Institute of Tropical Medicine Since 2004 Programme type(s): Access - Pricing, Capacity Building - Training Developing country(ies): Cambodia, Kenya, Laos, Madagascar, Mali Sanofi-Aventis, one of the major actors in the fight against epilepsy in the developed world, is also committed to the treatment of epilepsy worldwide using its two major treatments, Gardenal® and, more importantly, Depakine® / valproate Winthrop. In Mali, Sanofi-Aventis is working with Santé Sud and the Association des Médecins de Campagne (AMC) which have created the Réseau Action Recherche contre l´Epilepsie (RARE). More than 2,000 patients have been diagnosed and treated, thanks to these NGOs' highly motivated general practioners. Two further programmes are underway: 1. Kenya (with the Kenya Association for the Welfare of People with Epilepsy): since the 2nd trimester of 2007 until end of 2008, 260 healthcare professionals have been trained thanks to the multi-partnership developed by the KAWE and 10,000 patients treated; 2. Cambodia: where support has been provided to create the first association in the country to combat epilepsy; three training sessions already have been developed. In all these programmes, medicines such as Depakine® / VPA are provided on a “no-profit, no-loss” basis. An agreement has been signed at the end of 2008 to develop a new programme in Laos with the IFMT (French Institute of Tropical Medicine). 120 14. Sanofi-Aventis : Mental Health Disorders (Schizophrenia) Disease area(s): Schizophrenia Company(ies): Sanofi-Aventis Partner(s): Mauretania Ministry of Health, Morocco Ministry of Health, Vietnam Ministry of Health Since 2008 Programme type(s): Access - Pricing Developing country(ies): Mauritania, Morocco, Vietnam Sanofi-Aventis, one of the major actors in the central nervous system therapeutic field in the developed world, is developing new programmes to help provide better care for schizophrenia - one of the most severe mental disorders - in developing countries There, patients not only suffer from the disabling and potentially life-threatening symptoms of their illness, but they are also victims of ignorance, discrimination and social stigma. Sanofi-Aventis , which has a broad portfolio of anti-psychotic medicines, is committed to help treat this disease with its Largactil®, Nozinan®, Piportil L4® and Solian® products. Two pilot programmes have been set up in Mauritania and Morocco in liaison with the national health ministries and universities, combining information, education and communication, training and medicines at preferential prices. The programme has also been endorsed by the World Association of Social Psychiatry (WASP). The first stage of a similar programme has been ongoing in Vietnam since the end of 2008. 121 15. Sanofi-Aventis : My Child Matters Disease area(s): Childhood cancers Company(ies): Sanofi-Aventis Partner(s): International Union Against Cancer UICC Since 2004 Programme type(s): Capacity Building - Training, Education Developing country(ies): 21 developing countries In 2004, Sanofi-Aventis and the International Union Against Cancer (UICC) launched a mobilization and awareness programme called “My Child Matters”, to fight against childhood cancers in emerging countries. The objective is to encourage institutions (hospitals, NGOs, etc.) to develop pragmatic approaches to improve awareness, early diagnosis, access to care and treatment, pain control and better management of the social and cultural aspects of the disease for both children and families. This programme has already been launched in 16 developing countries - Bangladesh, Bolivia, Egypt, Honduras, Indonesia, Kenya, Mali, Morocco, Peru, Philippines, Rumania, Senegal, Tanzania, Ukraine, Venezuela and Vietnam - via 26 paediatric oncology projects. In 2008, 8 new childhood cancer projects have been launched in Burkina Faso, Colombia, Côte d'Ivoire, Pakistan and Paraguay. In 2008, 12,875 children benefited from this programme and 2,849 health professionals were trained. Countries: Bangladesh, Bolivia, Egypt, Honduras, Indonesia, Kenya, Mali, Morocco, Peru, Philippines, Senegal, Tanzania, Ukraine, Venezuela, Vietnam, Burkina Faso, Colombia, Côte d'Ivoire, Pakistan, Paraguay, Romania 122 16. Schering-Plough & National Cancer Coalition Disease area(s): Brain cancer Company(ies): Schering-Plough Partner(s): National Cancer Coalition Since 2007 Programme type(s): Access - Donation Developing country(ies): Dominican Republic, Guatemala, Honduras, Nicaragua, Peru Ecuador, El Salvador, In 2007, Schering-Plough began a partnership with the NGO National Cancer Coalition to treat five brain cancer patients at Hospital Escuela, a public hospital in Tegucigalpa, Honduras. In 2008, the National Cancer Coalition's international medical assistance programme requested further pharmaceutical donations for those in need in developing countries. Schering-Plough responded by supplying enough of its brain cancer drug, Temodar®, to treat 115 patients in 13 hospitals in the following seven countries: Dominican Republic, Ecuador, El Salvador, Guatemala, Honduras, Nicaragua and Peru. 123 17. The World Diabetes Foundation (WDF) Disease area(s): Diabetes Company(ies): Novo Nordisk Partner(s): WHO and Health Ministries Since 2002 Programme type(s): Capacity Building - Support & Training Developing country(ies): 83 developing countries WDF was established by Novo Nordisk in 2002 through a grant of up to DKK 650 million to be spent over a 10-year period. In March 2008, the shareholders approved an additional endowment of up to DKK 575 million, for a total of up to DKK 1.2 billion (USD 227 million) in the period 2001-2017. The WDF has grown into a leading international funding agency, devoted solely to funding projects for diabetes care and prevention in the developing world. To date, WDF has funded 182 projects in 83 countries, focusing on diabetes awareness, education and capacity-building. At present, 156 projects are ongoing. A projection of the impact of the WDF's work shows that the projects it funds will positively impact 66 million people in the developing countries. WDF funding has a multiplier effect, as it helps to secure other sources of funding. This gives an estimated current project portfolio value of USD 191.4 million, of which WDF has donated USD 62.2 million. To date, at least 2,876,565 people have been screened for diabetes in 4,427 screening camps. More than 229,829 people have been treated at the 754 established clinics funded by the foundation. More than 32,090 cases of diabetic retinopathy have been detected, and 21,991 eyes and 18,232 feet saved, rescuing their owners from disability and their families from lifelong indebtedness. Training healthcare professionals in proper screening and care of diabetic foot and eye conditions is essential for preventing avoidable amputations and blindness. To date, the WDF has supported the training of 14,433 doctors, 12,835 nurses and 27,852 paramedics. Partners: World Health Organization (WHO), International Diabetes Federation, World Bank, Danish International Development Assistance Agency (DANIDA), Global Alliance for Women's Health, DanChurchAid, Insulin Foundation, Fundacion para la Diabetes 124 Countries: Afghanistan, Anguilla, Antigua and Barbuda, Bangladesh, Barbados, Belize, Bhutan, Bolivia, Brazil, Burundi, Cambodia, Cameroon, Chile, China, Colombia, Costa Rica, Cuba, Democratic People's Republic of Korea, Democratic Republic of Congo, Ecuador, Egypt, El Salvador, Eritrea, Fiji, Ghana, Grenada, Guatemala, Guinea, Guyana, Honduras, India, Indonesia, Iran, Jamaica, Jordan, Kenya, Mali, Mauritius, Mexico, Mozambique, Nepal, Nicaragua, Nigeria, Pakistan, Peru, Congo, Rwanda, Seychelles, South Africa, St. Kitts and Nevis, St. Lucia, St. Vincent and the Grenadines, Sudan, Suriname, Tanzania, Thailand, Togo, Tonga, Trinidad and Tobago, Uganda, Vanuatu, Venezuela, Vietnam, West Bank and Gaza, Yemen 18. 2009 Alliance to Reduce Disparities in Diabetes Disease area(s): Diabetes Company(ies): Merck Partner(s): The Merck Company Foundation Since 2009 Programme type(s): Access-Donation Developing country(ies): USA To address the growing problem of healthcare disparities in the context of type 2 diabetes in the United States among low-income and underserved adult populations, The Merck Company Foundation - the philanthropic arm of Merck & Co., Inc. - launched the Alliance to Reduce Disparities in Diabetes (Alliance) with a commitment of USD 15 million through 2013. 125 19. Alliance for a Healthy Border Disease area(s): Diabetes Company(ies): Pfizer Partner(s): Multiple Since 2006 Programme type(s): Access-Donation Developing country(ies): USA-Mexico Border During the 3 year duration of the programme (2006-2008), the goal was to improve care for and prevention of diabetes and cardiovascular disease (CVD) – two of the most common health challenges facing the Hispanic population Pfizer's Committed USD 4.5 million over three years to support 12 federally qualified community health centres in the U.S. as well as several nonprofit organizations in Mexico as they establish or expand prevention programmes designed to reduce the incidence of diabetes and cardiovascular disease among the Hispanic population. Successes: " More than 50,000 individuals have been reached with diabetes and CVD prevention messages. " The University of Texas – Pan American has evaluated a subset of programme participants and has reported increases in healthy eating habits and exercise resulting in weight loss and lower blood sugar levels. " A conference focused on strengthening the capacity of healthcare organizations to deliver effective diabetes and cardiovascular disease prevention programmes in the U.S.–Mexico border region involved the participation of more than 170 people representing 70 community health centres, government agencies and Latino organizations. Partners: National Association of Community Health Centres, University of Texas – Pan American and local partners in the following states: (Arizona) El Rio Community Health Centre in Tucson and Mariposa Community Health Centre in Nogales; (California) Clinicas de Salud 126 del Pueblo in Calexico, La Maestra Community Health Centre and Family Health Centres in San Diego and San Ysidro Health Centre in San Ysidro; (New Mexico) Ben Archer Health Centre in Columbus and La Clinica de Familia in Las Cruces; (Texas) Centro de Salud Familiar La Fe in El Paso, United Medical Centre in Eagle Pass, Gateway Community Health Centre in Laredo and Nuestra Clinica del Valle in Pharr 127 ADDITIONAL HEALTH INITIATIVES 1. Arogya Parivar Programme - A Rural Health Initiative Disease area(s): Multiple diseases Company(ies): Novartis Partner(s): Rural Connect Since 2006 Programme type(s): Access - Pricing, Education Developing country(ies): India In 2006, Novartis' Consumer Health and Sandoz divisions launched an initiative in India to address the neglected health needs of rural populations. The Arogya Parivar (healthy family) programme started with pilot sites in the states of Uttar Pradesh and Maharashtra In the pilot phase, products focused on tuberculosis, other respiratory infections, coughs, colds, allergies, skin and genital infections, malnutrition in mothers and children, diabetes, intestinal worms and digestive problems - all important health challenges in these communities. The intent is to collaborate with third parties to broaden the product portfolio to include medicines for additional therapeutic areas and items such as anti-malarial bed-nets. To be included, products need to be easy-to-use, relevant and have instructions in local languages. Packages are reduced in size so that weekly individual treatment costs are kept below USD 1.25. The initial phase of Arogya Parivar will address 120 of India's more than 600 districts, selected using criteria ranging from population and purchasing power to transportation infrastructure and density of private doctors. By the end of 2008, Arogya Parivar had increased the number of cells to cover a population of around 25 million villagers in seven states. Arogya Parivar health advisors speak to villagers about diseases and help them recognize symptoms. Periodic health camps bring in doctors to do examinations and make referrals to a treating doctor. A single health camp can attract from 200 to 2,000 people. 128 2. AstraZeneca Product Donations Disease area(s): Multiple diseases Company(ies): AstraZeneca Partner(s): Food for the Poor, Health Partners International Since 2000 Programme type(s): Access - Donation Developing country(ies): Developing countries AstraZeneca's product donation and patient assistance programmes make its medicines available to those who cannot afford them, either free-of-charge or at reduced prices. In 2008, AstraZeneca donated a total of USD 646 million in product. The total spend on charitable contributions was USD 72 million (this includes the figure for “employee commitment” which is defined as “total company spend to support employee working days committed to company endorsed community activities”; the employee commitment figure does not represent a value assigned to the employee time committed). AstraZeneca donated USD 1.3 million to Food for the Poor, an international organization that provides food, housing, healthcare, education, water projects and emergency relief to those in need. 129 3. Boehringer Ingelheim: Strengthening Healthcare Capacity Disease area(s): Multiple diseases Company(ies): Boehringer Ingelheim Partner(s): Botswana and Papua New Guinea Ministries of Health and other partners Since 2005 Programme type(s): Capacity Building - Support & Training Developing country(ies): Botswana, Papua New Guinea, South Africa, Venezuela The Boehringer Ingelheim Lung Institute at the University of Cape Town has been set up to support clinical trials in infectious and respiratory diseases. Through its Student Education Programme with the University of Cape Town, South Africa, Boehringer Ingelheim provides full financial support for medical students from disadvantaged backgrounds. In Uganda, the company helps the Community Health and Information Network (CHAIN) in HIV/AIDS prevention, as well as care and treatment seminars and training. This has helped to strengthen the advocacy strategies at national and community level. The aim is to broaden CHAIN's activities among vulnerable populations. In 2007, some 46,000 of Papua New Guinea's 5.3 million inhabitants were infected with HIV. With other pharmaceutical companies, the Catholic AIDS Office, the Australasian Society for HIV Medicine (ASHM) and the government of Papua New Guinea, Boehringer Ingelheim has implemented a project to train healthcare workers under the auspices of the Collaboration for Health in Papua New Guinea. In Venezuela, the company provides training to doctors at the respiratory care centres in the Chacao neighbourhood and the Pérez de León Hospital in Caracas. The hospital also receives free medicines and equipment. Boehringer Ingelheim has developed a database where all relevant activities executed by all operating units globally can be found. Partners: Australasian Society for HIV Medicine, Botswana Ministry of Health, Catholic AIDS Office, Papua New Guinea Ministry of Health, Rhodes University 130 4. Bristol-Myers Squibb Medical Product Donations Disease area(s): Multiple diseases Company(ies): Bristol-Myers Squibb Partner(s): 9 specialized NGO partners Since ---Programme type(s): Access - Donation Developing country(ies): Developing countries During the past five years, BMS has donated USD 243 million of medical products, valued at wholesale, to support programmes throughout the world. In 2008, BMS product donations totaled USD 33 million. There are three main areas where the company's product donations are used: 1. Medical Mission Boxes: In partnership with Direct Relief International, this programme supplies healthcare products in parcels that can be carried by individual physicians to remote locations to treat indigent local populations; 2. Healthcare Infrastructure Support: With nine major international non-profit organizations, this programme supports a wide range of community-based healthcare infrastructure initiatives in regions around the world; 3. Disaster Relief: Focused solely on supplying needed medicines following major disasters, either natural or man-made (see Emergency Relief Efforts). Partners: AmeriCares, Catholic Medical Mission Board (CMMB), Direct Relief International, Heart to Heart International, IMA World Health, International Aid, MAP International, Medical Teams International, Project HOPE 131 5. GSK & Leonard Cheshire Disability in Sri Lanka Disease area(s): Disability Company(ies): GlaxoSmithKline Partner(s): Leonard Cheshire Disability Since 2004 Programme type(s): Capacity Building - Support Developing country(ies): Sri Lanka GlaxoSmithKline supports Leonard Cheshire Disability (LCD) in Galle, southern Sri Lanka. Following the devastating tsunami in 2004, LCD set up the Disability Resource Centre, the first of its kind in the area to support disabled peoples access to health and rehabilitation services, inclusive education and livelihood opportunities. Help from GSK will enable Leonard Cheshire Disability to support 500 people with disabilities access crucial faculties and services. It will also increase awareness of these services to 1,000 family members of people with disabilities. It is further hoped that 200 young people with disabilities will take part in their “Young Voices Programmes”, a global initiative campaigning for the implementation of the United Nations Convention on the Rights of People with Disabilities. 6. GSK Nurse Training in Tamil Nadu Disease area(s): Nurse training Company(ies): GlaxoSmithKline Partner(s): Direct Relief International, Sri Ramakrishna Math Since 2007 Programme type(s): Capacity Building - Training Developing country(ies): India In the aftermath of the devastating Indian Ocean tsunami of 2004, GSK is providing USD 133,509 of funding from June 2007 to June 2009 to help Sri Ramakrishna Math, a local NGO in the Chennai region of Tamil Nadu, to enroll an additional 420 local girls in its Nursing Training Course. 132 7. Health Training at Egypt's National Training Institute Disease area(s): Multiple diseases Company(ies): Pfizer Partner(s): Egypt Ministry of Health, Project HOPE Since 2006 Programme type(s): Capacity Building - Training Developing country(ies): Egypt Pfizer works with the Egyptian Ministry of Health and Project HOPE to equip Egypt's National Training Institute (NTI) to provide state-of-the-art training for physicians, nurses and health professionals in Egypt and the Middle East in infection control, family medicine, ophthalmology, urology, general surgery, research methodology, and healthcare management. Pfizer also helped upgrade laboratories and training equipment. Nearly 15,000 physicians have been trained through 220 training courses and 21 symposia. Pfizer will also support the development of distance learning options for new and existing courses. Pfizer will also help introduce leadership and management training in the NTI training curriculum. In 2007, NTI established some revenue generating capacity but these efforts need to be expanded and so Pfizer will help to develop a sustainability strategy and plan for the NTI. 133 8. Healthy Communities, Healthy Ecosystems Disease area(s): Multiple diseases Company(ies): Johnson & Johnson Partner(s): Family Health International, Kenya Ministry of Health, World Wide Fund for Nature (WWF) Since 2003 Programme type(s): Education Developing country(ies): Democratic Republic of Congo, Kenya, Nepal Since 2003, J&J has supported the innovative “Healthy Communities, Healthy Ecosystems” projects run by the World Wide Fund for Nature (WWF) in East Africa, the Congo Basin and the Eastern Himalayas. Over the past year in the Congo, the WWF has conducted sex education and HIV/AIDS training in eight villages. It has also established five wildlife management committees as well as two primary schools reaching 400 students. Recent activities in Kenya include building a dispensary clinic for target communities, provision of safe drinking water and family planning education by newly trained healthcare workers from the Ministry of Health and Family Health International. Mobile clinics reach villages that have no access to quality healthcare, and people are receiving prenatal and postnatal care, immunizations, nutritional counseling and education about environmental health and conservation efforts. 134 9. Johnson & Johnson Burn Treatment Centre in Soweto Disease area(s): Multiple diseases Company(ies): Johnson & Johnson Partner(s): Chris Hani Baragwanath Hospital Since 1992 Programme type(s): Capacity Building - Support & Training Developing country(ies): South Africa In 1992, the J&J built the Johnson & Johnson Burn Treatment Centre at the Chris Hani Baragwanath Hospital in Soweto, South Africa. This state-of-the-art unit treats more than 1,500 patients annually for serious and complicated burns, and has succeeded in reducing the mortality rate among critically ill patients. J&J continues to support the facility with management support, essential equipment, quality products, and education for nursing and medical personnel. Less visible, but of equal importance, are the investments and expertise provided at the community level with the establishment of clinics and training of caregivers. 135 10. Merck Medical Outreach Programme Disease area(s): Multiple diseases Company(ies): Merck & Co. Inc. Partner(s): AmeriCares, Catholic Medical Mission Board, Direct International, IMA World Health, MAP International, Project HOPE Since 1958 Programme type(s): Access - Donation Developing country(ies): Developing countries Relief Founded in 1958, the Merck Medical Outreach Programme (MMOP) is the primary mechanism through which Merck donates its pharmaceuticals and vaccines for humanitarian assistance in the developing world and in support of disaster relief and emergency situations worldwide. Donations of Merck medicines (with the exception of Mecitzan® for which there is a separate and dedicated programme) are made primarily through AmeriCares, Catholic Medical Mission Board (CMMB), Direct Relief International, IMA World Health, MAP International and Project HOPE. In 2008, Merck donated USD 43.4 million in market value of medicines and vaccines through well-established partnerships to help patients throughout the developing world. These donations supported sustained chronic-care health programmes in Central Asia; enabled immunization programmes in Central and Southeast Asia, the Caribbean and Africa; provided disaster assistance in, Myanmar, India, Honduras and the U.S.; and reached many thousands more worldwide through the ongoing medical programmes of its partner private voluntary organizations (PVOs). In addition, Merck donated USD 549 million worth of Mectizan® (ivermectin) for the treatment of river blindness and the prevention of lymphatic filariasis through the Merck Mectizan® Donation Programme. The total value of medical donations through MMOP in 2008 was USD 592 million, a decrease of 2% from 2007. The decrease is due in part to a reduction in the amount of requests from Merck’s PVO partners, and availability of pharmaceuticals and vaccines for ongoing development projects and disaster relief efforts. 136 11. Nursing Training in East Africa Disease area(s): Multiple diseases Company(ies): Johnson & Johnson Partner(s): Aga Khan University Since -------Programme type(s): Capacity Building - Training Developing country(ies): Kenya, Tanzania, Uganda Johnson & Johnson supports the Advanced Nursing Studies (ANS) and the Enrolled Nurses to Registered Nurses (ER-RN) programmes at the Aga Khan University Health Sciences campus in Nairobi, Kenya. The programme provides quality education and greater standards of evidence-based care to nurses and midwives from Kenya, Tanzania and Uganda, to further develop their professional skills. The training, which includes some distance-learning approaches, prepares nurses to become registered nurses. About 200 nurses from 50 different hospitals have been trained so far. 12. Otsuka Welfare Clinic Disease area(s): Multiple diseases Company(ies): Otsuka Pharmaceutical Partner(s): Local partners Since 2003 Programme type(s): Capacity Building - Support Developing country(ies): Pakistan In June 2003, Otsuka Pharmaceutical set up the Otsuka Welfare Clinic to help serve the health needs of refugees in Peshawar, in Pakistan's Northwest Frontier District state. Medical doctors, pharmacists, nurses and other medical professionals provide free treatment each day to some 300 patients requiring medical assistance. 137 13. Phelophepa Healthcare Train Disease area(s): Multiple diseases Company(ies): Roche Partner(s): Colgate, Transnet Foundation Since 1994 Programme type(s): Capacity Building - Support Developing country(ies): South Africa The Phelophepa healthcare train provides basic healthcare services to poor patients in remote rural areas of South Africa. The train is now 16 cars long and provides a pharmacy, cancer screening and education, psychology and dental and eye clinics, as well as diabetes and smear tests. It serves more than 45,000 people a year and has reached nearly 13 million in total since its inception in 1994. The train is run by the government-owned Transnet group. The Transnet Foundation funds about two-thirds of the train's running costs and provides staff, rail access and rolling stock. Roche is the lead outside sponsor which includes other corporations such as Colgate. Phelophepa also improves rural health education through its Edu-Clinic. 138 14. Rabies Control in Tanzania Disease area(s): Rabies Company(ies): Schering-Plough Partner(s): The Alliance for Rabies Control Since 2004 Programme type(s): Access - Donation Developing country(ies): Tanzania In 2008 Schering Plough's animal health business continued its efforts to reduce the impact of rabies, a fatal neurological disease, which is widespread throughout Africa. In Africa, more than 25,000 people die from the disease each year. Bites from infected domestic dogs are the main source of infection. As in previous years Intervet/Schering-Plough Animal Health donated 200,000 doses of rabies vaccine to the Afya Serengeti (Health of Serengeti) project in Tanzania, run by The Alliance for Rabies Control. Afya Serengeti's vaccination programme has produced a significant reduction of households reporting animal rabies cases, with the percentage dropping from 27% in 2003 to 2% in 2006. Injuries from rabid dogs have also declined, from 10% of households reporting bite injuries in 2003 to less than 1% in 2006. These significantly reduced levels were maintained in 2008. 139 15. Schering-Plough Medicine Donations Disease area(s): Multiple diseases Company(ies): Schering-Plough Partner(s): MAP International and other NGO partners Since 1950s Programme type(s): Access - Donation, Capacity Building - Training Developing country(ies): Developing countries Schering-Plough has long helped to provide essential medicines in countries affected by natural disaster, disease, war and poverty. In 2008, Schering-Plough provided more than USD 500,000 in financial support and more than USD 14 million worth of antifungal creams, topical creams, allergy medicines, vitamin-enriched ointments and other medicines for use in portable boxes of medication called Travel Packs. In 2008, MAP shipped more than 2,900 Travel Packs, which contained an average of 700 treatments each, for a total impact of approximately 2,000,000 patient treatments. These Travel Packs were used by over 1,400 medical teams in 96 developing countries such as Uganda, Haiti, Romania, Nicaragua, Venezuela, the Philippines and Zimbabwe. ScheringPlough also donated an additional USD 14 million worth of pharmaceutical and over-thecounter products to other US-based NGOs in 2008, including AmeriCares, Catholic Medical Missions Board, Direct Relief International, International Aid, MAP International and Project HOPE. Medical Assistance Programme (MAP) International has created a “Global Health Promoter” programme, which trains volunteer healthcare workers to provide basic medical care and health education within their communities. Schering-Plough provided USD 75,000 to this programme to train a total of 300 healthcare workers in 2007 and 2008. These health promoters provide health services in six countries in Africa, Asia and Latin America, where more formal health services are often not available. Countries: Bangladesh, Cambodia, Cameroon, Côte d'Ivoire, Dominican Republic, Ecuador, El Salvador, Ethiopia, Gambia, Ghana, Guatemala, Haiti, Honduras, Kenya, Malawi, Mongolia, Mozambique, Nicaragua, Paraguay, Philippines, Romania, Rwanda, Sierra Leone, Tanzania, Uganda, Venezuela, Zimbabwe 140 16. Tanzanian Training Centre for International Health Disease area(s): Multiple diseases Company(ies): Novartis Partner(s): Swiss Tropical Institute, Tanzania Ministry of Health Since 2003 Programme type(s): Capacity Building - Support Developing country(ies): Tanzania The Tanzanian Training Centre for International Health (TTCIH) was founded as the Ifakara Health Training Centre in 1961. To strengthen human resource development in the Tanzanian health sector and beyond, the Novartis Foundation for Sustainable Development has helped to remodel the centre. Moreover, in order to increase its financial self-reliance, the TTCIH has developed additional courses of its own curriculum in various health fields and also offers its facilities and services to other organizations wishing to hold their courses in Ifakara. In 2008, the TTCIH generated revenue of USD 480,000, excluding grants from third parties. The improved quality of training as well as the enhanced facilities and support services will contribute to a better medical and public health expertise, which is needed to improve the overall health situation of the population, especially in rural areas. The ultimate goal is to develop the centre into one of the leading training centres in Tanzania and East Africa. 141 Other commitments by research-based pharmaceutical companies 1. GSK The company committed to reinvest 20 per cent of its profits from the sale of medicines in least developed countries back into projects that address priority healthcare challenges, provide support to governments to remove barriers that stop patients accessing quality healthcare, and strengthen basic healthcare infrastructure. 2. AstraZeneca In 2009, the company spent a total of USD 882 million (2008: USD 718 million) on community sponsorships and charitable donations worldwide, including product donation and patient assistance programmes which make its medicines available free of charge or at reduced prices. 3. Sanofi-Aventis In 2009, under various programmes, the retail value of products provided for free exceeded USD 200 million. 4. Novartis In 2009, their access-to-medicine programmes, valued at USD 1.5 billion, reached 79.5 million patients around the world. 5. Eli Lilly & Company In 2008, the total giving by the company was about USD 350 million. About 80 percent of that amount was in the form of product donations. In October 2008, Forbes ranked Lilly among America's five most generous companies, based on donations as a percentage of operating income. 142 Major Global Initiatives in which Pharmaceuticals Play a major Role 143 1. The Global Fund The Global Fund to Fight AIDS, tuberculosis and malaria was launched as a unique partnership to support improved access to life-saving medicines in developing countries. The past decade has also seen a dramatic turnaround in the fight against HIV/AIDS. Together, the U.S. President’s Emergency Plan for AIDS Relief, the Global Fund and the international community have helped expand access to antiretroviral treatments (ARTs) for people once deemed too poor to receive HIV treatment. " " " In 2002, approximately 300,000 people living in low- and middle-income countries were on ART. By end-2008, according to UNAIDS, more than 4 million people in these countries were on this life-saving treatment. This includes an increase of 36% in the most recent year and a tenfold increase over five years. The largest increase in access between 2007 and 2008 took place in sub-Saharan Africa, where approximately two-thirds of global HIV infections occur. During this period, an additional 800,000 people in the region received ART, boosting total access to 2.9 million people, a 39% increase in one year alone. HIV % % % % % At the end of December 2009, programmes financed by the Global Fund were providing antiretroviral therapy (ART) to 2.5 million people. Approved HIV proposals have totalled close to USD 10.8 billion covering 140 countries. The Global Fund is estimated to have contributed about one-fifth of all disbursements by bi- and multi-laterals for the HIV response in low- and middle-income countries in 2008. In addition to providing ART, programmes funded by the Global Fund have also distributed 1.8 billion male and female condoms; Provided 790,000 HIV-positive pregnant women with treatment to prevent mother-tochild transmission of HIV, as well as 4.5 million basic care and support services to orphans and other children made vulnerable by AIDS, and 105 million HIV counselling and testing sessions. There is a growing body of evidence showing that Global Fund financing - alongside that of other financiers - has resulted in declines in AIDS mortality in countries in which provision of ART has been scaled up rapidly, accompanied by other significant impacts, such as improved survival and productivity of key professionals and other workers, and system-wide improvements in healthcare delivery. 144 Tuberculosis % % % % Through 2009, programmes funded by the Global Fund have provided treatment to 6 million people who had active TB. The Global Fund provides 63% of the external financing for TB and multi-drug resistant TB (MDR-TB) control efforts in low- and middle-income countries. Approved TB proposals have totalled close to USD 3.2 billion covering 112 countries, contributing 48% of the projected coverage required to achieve the Stop TB Partnership targets for the detection and treatment of new smear-positive TB cases. TB programmes supported by the Global Fund have also provided 1.8 million TB/HIV services. In many countries in which the Global Fund supports programmes, TB prevalence is declining, as are TB mortality rates. Malaria % % % By the end of 2009, Global Fund-supported programmes had distributed 104 million insecticide-treated nets (ITNs) to prevent malaria. They also supported indoor residual spraying of insecticides in dwellings more than 19 million times and treated 108 million cases of malaria in accordance with national treatment guidelines. Approved malaria proposals have totalled USD 5.3 billion covering 83 countries. In 2008, the Global Fund contributed 57% of international disbursements for malaria control. Global Fund investments have played a critical role in introducing and expanding coverage of novel, effective malaria treatments in many countries where drug resistance to older treatments is high. In conjunction with re-energized national and international efforts to combat malaria, increased Global Fund financing is having a substantial impact on malaria morbidity and mortality worldwide, with an increasing number of countries reporting a reduction in malaria deaths of more than 50%. The coming years will see even more results, as half of the total disbursements by the Global Fund were delivered in 2008 and 2009. Much of the USD 5.4 billion of financing approved in Rounds 8 and 9 will reach countries in 2010 and 2011, and will continue to significantly boost health outcomes. 145 2. UNITAID Since its inception, 29 governments have joined France in contributing finances to UNITAID, which raises approximately USD 300 million every year. UNITAID, together with UNICEF, will provide 20 million bed nets for eight African countries in 2009 and 2010, leading to an estimated 20% increase in bed net coverage. UNITAID Action on HIV/AIDS – 2006-2009 Programme Partner Funding (USD m) Patients treated Paediatric HIV/AIDS Paediatric HIV/AIDS CHAI Global Fund 235.5 ---- 255,970 28,870 Second-line HIV/AIDS CHAI 241.1 175,270 Second-line HIV/AIDS Global Fund ---- 7,480 First-line tenofovir CHAI PMTCT UNICEF 49,835 72.0 ---- Women receiving treatment ---- 234,000 Opportunistic infections (OI) prophylaxis Total committed to treatments and testing ---548.7 205,280 1,424,295 Rational use of HIV-related inputs 15.9 ---- Total committed to HIV/AIDS projects USD 564,600,000 TB Projects Areas Funding support Number of patients targeted Paediatric TB treatments USD 11,603,952 750,175 First line TB Treatments USD 26,841,025 866,273 MDR-TB Diagnostics USD 26,129,897 74,000 MDR-TB treatments USD 81,652,000 25,286 Total amount committed USD 146,226,874 146 3. UK Department for International Development DFID's aid will increase to GBP 7.9 billion by 2010/11. It is helping to lift about three million people out of poverty permanently every year. The aid spending on Africa is set to more than double from GBP1.3 billion in 2004 to at least GBP 2.6 billion by 2010, meeting all the commitments to increase aid to Africa that were made at in 2005. The department is also on track to meet the commitment to increase aid spending to 0.7% of their national income by 2013. The UK has written off 100% of the debt owed by the world's most heavily indebted poor countries. Other examples of DFID successes include: Globally: The proportion of people in developing countries living in extreme poverty fell from 28% in 1990 to 22% ion 2010. Each year, DFID helps to reduce permanently the number of people living in poverty by 3 million. Uganda: Between 2003 and 2006, 1.4 million people have been lifted out of poverty in Uganda, building on earlier achievements; 31% of Ugandans now live below the poverty line compared to 39% in 2002/03 and 56% in 1992/93. Tanzania: Nine out of ten children are now enrolled in school; in 1999 it was less than six in ten. The DFID’s support to buy bed nets to protect people from malaria is helping to save 20,00040,000 lives per year. Kenya: HIV/AIDS prevalence has fallen from over 11% to 5.9% over the past eight years. UK has provided GBP 43 million towards the fight against HIV/AIDS, including support to a national strategy for access to prevention, treatment and care. Mozambique: Between 2000 and 2005, poverty was reduced from 70% to 55% and the number of children in school has doubled, with the help of GBP 274 million in aid. 147 Bangladesh: DFID action on maternal mortality includes a GBP100 million contribution to Bangladesh’s Health, Nutrition and Population Support Programme, in which maternal health is a key priority. Rwanda: Primary school enrolment is high at 92.5% with girls and boys enrolling in equal numbers. DFID has contributed to the recruitment of 2,600 new primary teachers and the purchase of school materials. Nepal: DFID is the leading donor to the national safe motherhood programme. The 2006 preliminary Demographic and Health Survey results show a 26% decline in under-5 mortality (to 65 per 1,000 live births). DFID played a key role in fight against AIDS, TB and malaria – including the commitment to spend GBP1.5 billion from 2005 to 2008 on AIDS and to contribute GBP 360 million to the Global Fund to fight AIDS, TB and malaria in the period from 2002 to 2008. 148 4. Bill and Melinda Gates Foundation The Approach A global health mission to help ensure that technology based health solutions are created and delivered to those who need them most with a focus on health problems in the developing world that cause great harm but receive too little attention. To date, it has committed nearly USD 10 billion in global health grants to: • Discover scientific insights to fight serious diseases affecting developing countries. • Develop effective and affordable vaccines, medicines, and other health interventions. • Deliver these solutions to the people who need them most. Areas of Focus Malaria The world is making progress against malaria, one of the world’s oldest and deadliest killers. Grantees are working to speed research and development on new prevention and treatment methods, and to expand access to bed nets and other existing tools. Grant examples include: " USD 202 million for the Medicines for Malaria Venture, which works with private industry to develop new treatments. " USD 79 million for the Malaria Control and Evaluation Partnership in Africa, which is working to expand effective malaria control programmes. HIV/AIDS Significant progress is being made in the prevention and treatment of HIV/AIDS. The Foundation’s focus is on supporting prevention research through grants including: " USD 258 million for Avahan, an initiative to expand access to effective HIV prevention programmes in India. " USD 151 million for research on microbicides to prevent HIV transmission. 149 " USD 50 million to support the African Comprehensive HIV/ AIDS Partnerships, a national HIV prevention and treatment initiative in Botswana. Tuberculosis Support for the development of new TB drugs, vaccines, and diagnostic tools, and work to strengthen TB control programmes. Grant examples include: " USD 309 million to the Aeras Global TB Vaccine Foundation for vaccine development. " USD 33 million to improve TB control strategies in China. " USD 86 million for the Foundation for Innovative New Diagnostics to develop low-cost methods of diagnosis. Vaccine-Preventable Diseases No public health tool has improved global public health more than vaccines. Grants to expand access to immunization include: " USD 1.5 billion to the GAVI Alliance, a public-private partnership that helps developing countries to purchase and deliver vaccines. Polio In the last 20 years, polio cases have declined by 99% and the disease has been eliminated from most of the globe. The Gates’ have a strong commitment to polio, working closely with partners in the Global Polio Eradication Initiative and advocating with governments to increase their efforts toward eradicating polio. Some recent grants include: " USD 355 million to Rotary International to support global polio eradication activities through the Rotary Foundation’s PolioPlus programme (USD 200 million to be matched by Rotary). " USD 150 million to UNICEF and WHO to support operations for polio campaigns, outbreak response activities, surveillance, and research to develop a safer, cheaper, and more effective inactivated polio vaccine. Pneumonia and Flu Common respiratory illnesses, including pneumonia and flu, can often be prevented with current vaccines and treatments. Grants to help fight these illnesses include: 150 " USD 41 million to PATH to develop new vaccines to address pandemic influenza. " USD 4 million for the University of Maryland to introduce a vaccine for Hib pneumonia in West Africa. Nutrition Good nutrition is critical for the healthy development of young children. The Foundation’s partners are working to develop and produce foods fortified with essential nutrients, and to develop staple crops with higher micronutrient levels. Examples include: " USD 109 million to GAIN (Global Alliance for Improved Nutrition) to fortify foods with essential vitamins and minerals. " USD 15 million to UNICEF to eliminate iodine deficiency through universal salt iodization. Diarrhoea Diarrhoea and diarrhoea-related dehydration can be prevented and treated. The Foundation has provided several grants to understand and address the underlying causes of diarrhoea, such as: " USD 7 million for the International Centre for Diarrhoeal Disease Research to implement a zinc treatment programme for children in Bangladesh and Ethiopia. " USD 50 million to PATH to develop vaccines against bacteria that causes diarrhoea. Maternal and Neonatal Health The Foundation works to improve the health of mothers and newborns by providing grants to reduce pregnancy-related illness and death, improve healthcare for newborns and young children, and increase access to contraceptives. Grant examples include: " USD 25 million to BRAC to demonstrate a model for improving maternal, newborn and child health in poor urban communities of developing countries. " USD 110 million for Save the Children to expand access to simple, low-cost tools to improve newborn health in developing countries. 151 Tobacco Tobacco-caused diseases have emerged as one of the greatest health challenges facing developing countries. Fortunately, a number of programmes and policies to reduce tobacco use have proven highly effective. Investments include: " USD 125 million over 5 years to fight the global tobacco epidemic, including a USD 24 million grant to the Bloomberg Initiative to reduce tobacco use. Bill and Melinda Gates Foundation Funding from 1994 to 2010 152 5. The US President's Emergency Plan for AIDS Relief (PEPFAR) By the end of September 2008, PEPFAR was supporting treatment for over 2.1 million people around the world, exceeding its target of 2 million. This includes 2,007,800 people in the programme’s 15 focus countries. Treatment figures in some countries, however, have fallen short of their intended targets. In Nigeria, for example, 211,500 people were receiving treatment by the end of September 2008 compared to the goal of 350,000. The number on treatment in Ethiopia fell short of the 210,000 target by over 90,000. The Leadership against HIV/AIDS Act of 2003 refers to funding relating to combating HIV/AIDS focusing on fourteen specific countries, now usually referred to as “focus” countries: Botswana, Cote d'Ivoire, Ethiopia, Guyana, Haiti, Kenya, Mozambique, Namibia, Nigeria, Rwanda, South Africa, Tanzania, Uganda and Zambia. When Congress appropriated the funding for fiscal year (FY) 2004, they required that a 15th focus country should be added, and that it should be outside of Africa and the Caribbean. Vietnam was added as an additional focus country in June 2004. In his State of the Union Address in January 2003, President George W. Bush made a commitment to substantially increase U.S. support for addressing HIV/AIDS worldwide: "I ask the Congress to commit USD 15 billion over the next five years, to turn the tide against AIDS in the most afflicted nations of Africa and the Caribbean". In May 2003, the US Congress approved, and President Bush signed into law, the United States Leadership against HIV/AIDS, Tuberculosis and Malaria Act of 2003. This legislation approved expenditure of up to USD 15 billion over 5 years and it provided the legal and policy framework for the expenditure. The first "new" money of USD 350 million was made available by Congress in January 2004. Full implementation of PEPFAR began in June 2004. 153 PEPFAR Funding 2004-2008 PEPFAR was re-authorized for a further five years when President Bush signed the “Tom Lantos and Henry J Hyde United States Global Leadership Against HIV/AIDS, Tuberculosis and Malaria Reauthorization Act of 2008”, in July 2008. The act authorized up to USD 48 billion for PEPFAR for FYs 2009-2013. It was named in honour of two late congressmen, one Republican and one Democrat, who authored the original 2003 act. Under the original 2003 act Congress required that PEPFAR money should be divided in the following way: " 55% for the treatment of individuals with HIV/AIDS; " 15% for the palliative care of individuals with HIV/AIDS; " 20% for HIV/AIDS prevention (of which at least 33% is to be spent on abstinence until marriage programmes); " 10% for helping orphans and vulnerable children. 154 # of Patients Receiving ARVs by Year 5,000,000 4,500,000 4,000,000 3,500,000 3,000,000 2,500,000 2,000,000 1,500,000 1,000,000 500,000 0 2004 2006 2009 PEPFAR Latest Programme Results, 2010 " Through its partnerships with more than 30 countries, as of September 30, 2009, PEPFAR directly supported life-saving antiretroviral treatment for over 2.4 million men, women and children. They represent more than half of the estimated four million individuals in low- and middle-income countries on treatment. " In addition, through September 30, 2009, PEPFAR partnerships have directly supported care for nearly 11 million people affected by HIV/AIDS, including 3.6 million orphans and vulnerable children. " In FY 2009, PEPFAR directly supported prevention of mother-to-child transmission programmes that allowed nearly 100,000 babies of HIV-positive mothers to be born HIVfree, adding to the nearly 240,000 babies born without HIV due to PEPFAR support during FYs 2004-2008. " In FY 2009, PEPFAR also directly supported HIV counseling and testing for nearly 29 million people, providing a critical entry point to prevention, treatment and care. 155 " From FY 2010 onward, PEPFAR will report on partner countries' national achievements in service delivery and health systems strengthening, as well as PEPFAR direct contributions to those achievements. The new national health systems indicators are being developed in collaboration with partner countries and multilateral organizations. Through September 30, 2009, the last point at which indirect results will be reported before this transition to national indicators, PEPFAR indirectly supported treatment for 539,700 people in the 15 original PEPFAR focus countries. The prime partners for PEPFAR in year 2007 were: 1. Partnership for Supply Chain Management 2. Family Health International 3. Catholic Relief Services 4. Columbia University 5. Government departments 6. US CDC 7. Elizabeth Glaser PAF 8. University of Maryland 9. Harvard University 10. USAID 156 List of Access to Pharmaceuticals Interventions 157 No. 1 2 3 4 5 6 7 8 Name of the programme Disease Company sponsoring Countries Medicines used/ Money spent/ Cost incurred Patients served or Doses supplied AAI Accelerating Access Initiative HIV/AIDS 9 companies developing countries ----- 773,803 patients undergoing treatment till Sept 2008. (446,000 in Africa) Expanding Access to Treatment HIV/AIDS Abbott Least developed countries Invested more than USD 40 million in Tanzania; providing Lopinavir/ ritonavir at USD 500 per patient per year. Since 2001, 500,000 families have been supported. Viramune® Donation Programme HIV/AIDS Boehringer Ingelheim 59 developing countries Viramune® 1.7 million doses free of cost in 2008. Global Access Programme HIV/AIDS Bristol-Myers Squibb Least developed countries HIV medicines At no profit Gilead Access Programme HIV/AIDS Gilead Least developed countries Viread® and Truvada® Generic Viread = USD 7.25 per month 700,000 people were treated in 2010 at low prices. Access to ARVs HIV/AIDS GSK 37 developing countries Abacavir and Combivir®; up to 40% reduction in cost 70 million tablets in 2008 at no profit Access to ARVs HIV/AIDS Merck & Co. Inc. developing countries Crixivan™, Stocrin™, Atripla™ and Isentress™ no profit Treated 777,000 patients in 2008 Roche - Access to ARVs HIV/AIDS Roche All low & lowermiddle income countries Provides Invirase and Viracept at no profit 88% of total AIDS patients. The Cambodia Treatment Access Programme (CTAP) HIV/AIDS Roche Cambodia New outpatient treatment centre was opened Enrolled 1200 patients Single Tablet per Day HIV/AIDS 9 10 Trained 400 healthcare professionals Bristol-Myers Squibb, Gilead, Merck & Co. developing countries Atripla® at no profit Tens of thousands of patients are benefiting 158 11 12 13 14 15 Technology Transfer & ARV Licensing HIV/AIDS Bristol-Myers Squibb Kenya, India, S. Africa Atazanavir ---- Technology Transfer & ARV Licensing HIV/AIDS Gilead SubSaharan Africa Viread® and Truvada® both generic and branded ----- Technology Transfer & ARV Licensing HIV/AIDS Gilead 95 countries Tenofovir allowed as Generic drug ----- Technology Transfer & ARV Licensing HIV/AIDS GSK Africa Epivir® and Combivir® 279 million tablets in 2008 Diflucan HIV/AIDS Pfizer developing countries Tibotec Cost Recovery Distribution Programme HIV/AIDS Johnson & Johnson SubSaharan Africa Miconazole MAT at low cost or free ----- Programme for Supporting Children Affected by AIDS Mother and Child care initiatives (HIV related) Abbott 10 developing countries on 3 continents ---- Since 2001 more than one million families supported; trained or retrained more than 13,000 healthcare professionals PMTCT: Abbott Rapid HIV Test Donation Programme Mother and Child care initiatives (HIV related) Abbott 39 countries, including all of Africa Shipped more than 15 million rapid HIV test units till 2009 By 2009, 11 million pregnant women tested for HIV; averted more than 125,300 potential infections of infants Elizabeth Glaser Paediatric AIDS Foundation Mother and Child care initiatives (HIV related) Abbott, Boehringer Ingelheim, Johnson & Johnson 17 developing countries USD 103 million spent in 2008 By march 2010, tested more than 8.5 million women for HIV, started more than 535,000 individuals on antiretroviral and provided services to more than 10 million women. Partnership 16 17 18 19 Diflucan® (fluconazole) Free of cost USD 840 million spent on medicines 20,000 health professionals trained 159 20 21 22 23 24 25 26 27 PEPFAR Partnership for Paediatric AIDS Treatment Mother and Child care initiatives (HIV related) Abbott, Bristol-Myers Squibb, Gilead, GSK, Merck & Co. Inc. 15 developing countries Over USD 26 billion dedicated to HIV/AIDS As of Sept, 2009, provided antiretroviral to more than 2.4 million people; directly supported over 11 million people; nearly 340,000 babies born without HIV. Programme for Supporting Children Affected by AIDS Mother and Child care initiatives (HIV related) Baylor and the Abbott Fund 10 developing countries on 3 continents Baylor Children's Clinical Centres of Excellence Network More than 30,000 children PMTCT: Viramune® Donation Programme Mother and Child care initiatives (HIV related) Boehringer Ingelheim 60 developing countries Providing Viramune® Free of cost; 1 million doses provided; ---- Secure The Future Mother and Child care initiatives (HIV related) Bristol-Myers Squibb’s 8 developing countries in Africa Children´s Clinics & Paediatric AIDS Corps was established; committed USD 150 million since 1999 1500 under treatment Life Skills: Community Support for Children Affected by HIV/AIDS Mother and Child care initiatives (HIV related) Johnson & Johnson Thailand USD 19.8 million spent in 2008 ----- Programme to Strengthen Tanzania's Healthcare System Improve Health Systems Abbott Tanzania Upgraded various facilities and laboratories More than 15,000 healthcare professionals trained African Comprehensive HIV/AIDS Partnerships (ACHAP) HIV/AIDS Merck & Co. Inc. Botswana Committed USD 56.5 million More than 100,000 patients receiving treatment; saved more than 50,000 lives. African Comprehensive HIV/AIDS Partnerships (ACHAP) Improve Health Systems Merck & Co. Inc. Botswana Developed a laboratory Annual capacity of testing 20,000 patients 160 28 29 30 31 32 33 34 35 36 37 Positive Action on HIV/AIDS Improve Health Systems GSK 21 developing countries Develop capacity of community organisations; USD 595,000 over four years in India Reaching 2.5 million people Positive Action on HIV/AIDS Improve health systems GSK 21 developing countries To integrate treatment and support services USD 2.2 million in Kenya; Other HIV/AIDS CapacityBuilding Initiatives Improve health systems GSK 17 African countries Various activities done; USD 1,091,461 in 2007; committed GBP 700,000 in new initiatives in 2009 for Africa; committed USD 280,000 in 2009 for Asia ---- HIV/AIDS Programmes Improve health systems Merck & Co., Inc. 24 African countries Supported various universities and research centres; awarded more than USD 10 million in various capacities since 1999. ---- HIV/AIDS Programmes Asia-Pacific Improve health systems Merck & Co., Inc. China USD 30 million donated ---- HIV/AIDS Programmes Caribbean Improve health systems Merck & Co., Inc. Jamaica, Mexico, Venezuela Supported Caribbean Coalition of National AIDS Programme Coordinators (CCNAPC); donated USD 36,500 ---- Infectious Diseases Institute Improve health systems Pfizer, Gilead Uganda Support to build a regional treatment and R&D institute in Kampala. Treatment to 90,000 patients annually Trained more than 3500 workers Fight against TB in Africa TB AstraZeneca Lesotho, Liberia, S. Africa ---- 1800 people completing their treatment Fight against TB in Africa TB AstraZeneca Central Asia ---- More than 10,000 treated Fight against TB in Africa TB AstraZeneca Sub Saharan Africa ---- 2500 patients treated and 6000 more identified ---- 161 38 MDR-TB Partnership TB Lilly over 60 countries USD 120 million in medicines and USD 65 million for TB research in 2007; total USD 135 million Enrolled over 50,000 patients The Global Plan to Stop TB TB Novartis Tanzania Total cost USD 56 billion for 10 years from 2006 Over 4.5 million treated till 2010 TB Free & Other Initiatives TB SanofiAventis Kenya, South Africa Euro 15 million By 2008, 500,000 patients treated and 20,000 workers trained TB Free & Other Initiatives TB SanofiAventis India ---- Facilities to treat 4000 patients annually Stop TB Partnership TB AstraZeneca, GSK, Lilly, Novartis Endemic countries & vulnerable populations TB Lilly, Jubilant Biosystems, Summit plc India opened access to its library of 500,000 compound; establishing labs and facilities ---- Novartis Institute for Tropical Diseases (NITD) TB Novartis Indonesia (research in Singapore) USD 122 million for the centre ---- GSK & Access to Malaria Care Malaria GSK 13 developing countries At no profit To increase awareness GSK & Access to Malaria Care Malaria GSK 13 developing countries USD 1.5 million to The Malaria Consortium To increase awareness Millennium Villages Project Malaria Novartis Tanzania Coartem® Distributed bed-nets and medicines Novartis Coartem Malaria Novartis 34 developing countries Coartem® Dispersible; provided 320 million treatments since 2001 saved 500,000 lives. Roll Back Malaria Partnership Malaria GSK, Novartis, SanofiAventis 35 developing countries USD 3 million by GSK ----- 39 40 41 42 43 44 45 46 47 48 49 Lilly TB Drug Discovery Initiative ---- Lilly donating 1.4 million vials; Novartis donating 500,000 doses 162 50 51 52 53 54 55 56 57 58 Impact Malaria Malaria SanofiAventis Benin, Madagascar, Republic of Congo, Tanzania In 2009, 23 million treatments were distributed; artemisinin-based combination Provided training to 20 health professionals in 2008. Bayer HealthCare & African Sleeping Sickness Sleeping sickness Bayer HealthCare 8 developing countries At no cost donated 50,000 ampoules of Germanin® ---- Fight Against Chagas Disease Chagas disease Bayer HealthCare Endemic countries in Latin America Assured supply of 2.5 million tablets of Lampit® till 2012 ---- AmBisome for Leishmaniasis Leishmaniasis Gilead Endemic countries Provides AmBisome at a preferential price ---- Global Alliance to Eliminate Lymphatic Filariasis (GAELF) Lymphatic filariasis GSK, Merck & Co. Inc. 47 out of 80 endemic countries In 2009, 425 million treatments of albendazole were provided; over 1.4 billion treatments have been provided Over 100 million people have been protected. Guinea Worm Eradication Programme (GWEP) Dracunculiasis (Guinea worm) Johnson & Johnson 9 African countries Donated enough medical supplies, such as Tylenol®, forceps and gauze, to treat more than 3,000 villages Today 99% of the disease has been fought International Trachoma Initiative (ITI) Trachoma Pfizer 15 developing countries Since 1998, donated over 145 million treatments; trained thousands of workers and performed more than 416,000 surgeries Morocco has become totally free from the disease. Leprosy Elimination Leprosy Novartis 66 developing countries 2 medicines free of cost; donation 2000-2005 was USD 40 million; uninterrupted supply of free medicine till 2010 Cured more than 5 million people. Prevalence rate has dropped by over 90%. Merck Mectizan® Donation Programme River Blindness Merck & Co. Inc. 33 endemic countries in Africa, Latin America, the Middle East Since 1987, 2.5 billion tablets of Mectizan®; 700 million treatments; Invested more than USD 35 million in direct financial support; donation will reach 100 million treatments. transmission of river blindness had been halted in Colombia and in certain areas of Ecuador and Guatemala 163 59 60 61 62 63 64 65 Merck Praziquantel Donation Programme Schistosomiasis Merck KGaA 6 African priority control countries Will supply 200 million tablets of Cesol® 600 between 2007 and 2017; approx cost USD 80 million Will help 27 million children “Most Neglected Diseases” Programme Buruli ulcer, Chagas disease, leishmaniasis SanofiAventis Brazil, Chad, Ethiopia, Panama, Sudan, Togo, MiddleEast countries Donating USD 6.4 million to WHO; providing Glucantime® at low price; donating USD 2 million for new programme and USD 4 million to support field activities. In 2008, 98 health professionals were trained and 194 patients treated. Sleeping Sickness Programme Sleeping Sickness SanofiAventis SubSaharan African countries Committed USD 25 million for 2001-06; provided further USD 14 million for 2006-2011; provided 171,000 vials of medicines in 2009 Saved 140,000 lives; by the end of 2009, 10,000 in 2009 only Sleeping Sickness Programme Sleeping Sickness Bristol-Myers Squibb SubSaharan African Provided active ingredient and donated USD 400,000 ---- Soil-Transmitted Helminthiasis Soil Transmitted Helminthiasis Johnson & Johnson Bangladesh, Cameroon, Cape Verde, Laos, Nicaragua, Uganda, Zambia From 2007 plan to donate up to 50 million doses of mebendazole ---- Neglected Diseases initiative (DNDi) Chagas disease, leishmaniasis sleeping sickness GSK Pre-clinical research in Spain & UK focus on identifying and developing compounds from existing GSK programmes ---- Delivering Hope Hepatitis Bristol-Myers Squibb China, India Since 2002, provided USD 3.1 million to China and USD 1.7 million to India. Benefitted more than 700,000 people directly. 164 66 67 68 69 70 72 73 74 GAVI Alliance Childhood diseases Crucell, GSK, Merck & Co. Inc., SanofiAventis, Wyeth Lowincome countries Crucell providing Quinvaxem™; in 2008 1.1 billion vaccine doses supplied; Merck donated USD 2 million for measles programme; Sanofi Pasteur donated 120 million doses of polio vaccine; in 2008, Wyeth provided 3 million doses of Prevnar® pneumococcal vaccine; GSK agreed to supply up to 300 million doses of its vaccine Synflorix, for invasive pneumococcal disease. Vaccinated more than 600 million children since 2001 Global Polio Eradication Initiative Polio SanofiAventis Afghanistan, Egypt, India, Indonesia, Nigeria, Pakistan Donated 120 million doses since 1997; 30 million more in 2002; in 2007, donated 270,000 doses to Indonesia. ---- HPV Vaccine & Cervical Cancer Cervical cancer GSK India, Peru, Uganda, Vietnam Donated 50,000 doses of Cervarix™; ---- Gardasil® Access Programme Cervical cancer Merck & Co. Inc. Eligible countries Donate at least 3 million doses of its recombinant Gardasil® Human Papillomavirus Quadrivalent ---- Merck Vaccine Network Africa (MVN-A) Vaccinepreventable diseases Merck & Co. Inc. Kenya, Mali, Uganda, Zambia To provide training; committed USD 4.4 million through 2011 More than 510 professionals have completed training; more than 675,000 Malian children benefited. Pandemic Influenza & Developing Countries Pandemic influenza GSK China, India, South Africa Invested USD 2 billion in research; to donate 50 million doses of vaccine to WHO Pandemic Influenza & Developing Countries Pandemic influenza SanofiAventis China, India, South Africa To donate 60 million doses to WHO ---- Pandemic Influenza & Developing Countries Pandemic influenza AstraZeneca China, India, South Africa In 2009, committed at least 3 million doses of vaccine ---- ---- 165 75 76 77 77 78 79 80 81 Rotavirus Vaccine Programme Rotavirusinduced gastroenteritis GSK Brazil, El Salvador, Mexico, Nicaragua, Panama, Venezuela GSK will supply enough Rotarix™ to protect every baby in Brazil for the next five years and will transfer technology to allow Brazil's Fiocruz to produce Rotarix™ under licence. Till 2009 more than 600,000 doses had been administered in Nicaragua. Sanofi-Aventis & EPIVAC Vaccinepreventable diseases SanofiAventis 11 African countries Between 2002 and 2008, approximately 350 doctors have been enrolled in EPIVAC training. ---- Pandemic Influenza & Developing Countries Pandemic influenza Biken, Gilead, Roche, China, India, South Africa Hold no patent in least developed countries; sell Tamiflu at reduced prices for stockpiling; donated 5 million doses to WHO ---- ScheringPlough Vaccine Licence Agreement with WHO Pandemic influenza ScheringPlough developing countries Provided a non-exclusive licence to WHO to develop and sell its influenza vaccine ---- Sigma-Tau & AMREF: “Uganda Project Vaccinepreventable disease Sigma-Tau Uganda Aim is to vaccinate more than 3000 children ---- Abbott Fund Programme to Fight Malnutrition in Vietnam Child & maternal health, malnutrition Abbott Vietnam Improving nutritional status of children; donate paediatric nutritional products during flooding and raining season For the second year in a row, the province has exceeded the national nutritional health target Abbott Fund Programme to Improve Children's Health in Cambodia Child & maternal health Abbott Cambodia Grants and products to support free comprehensive care; formal training to improve paediatric nutrition. In 2008, more than 113,000 children received nutritional assessment and 120 health professionals were trained; since 2001 the respective figures are 250,000 and 400. Abbott Fund Programme to Improve Maternal & Child Health in Afghanistan Child & maternal health Abbott Afghanistan Provided more than USD 400,000 in grants and USD 3.7 million in donations; focus of partnership is empowerment of women through improving health education. In 2008, more than 129,000 women and children received services and more than 70,000 individuals received training on health education; since 2005, more than 380,000 women and children have received services. 166 82 83 84 85 86 Promoting Safe Motherhood in India Maternal health AstraZeneca India Awareness campaigns; unique “walkathon” along the river Ganges, to spread Safe Motherhood and other healthcare messages among rural populations; distribution of medicines. Rubella vaccinations for over 1,000 teenage girls; educational films on anaemia, HIV/AIDS and female feticide shown to approximately 500 people almost every day; visits to over 100 schools covered around 80,000 children in rural areas; one to one communication on education, marital age, gender bias, female feticide, HIV/AIDS, sanitation, environment and nutrition to many beneficiaries. Bayer Schering Pharma & Family Planning Family planning Bayer HealthCare Worldwide Focusing on fertility control and family planning through distribution of contraceptives; training programmes for sexual education also conducted Since 1961, more than 2.6 billion cycle packs of oral contraceptives have been provided Bidan Delima Midwife Training Programme Child & maternal health Johnson & Johnson Indonesia Supporting midwife training programme; In 2008, 1,200 midwives were trained in national clinical standards of midwifery Abbott Programme to Advance Diabetes Care in Bolivia Diabetes Abbott Bolivia Grants to support diabetes education, expand public outreach campaigns, train healthcare personnel in diabetes management, and establish and expand the number of core diabetes educators; also donated glucose screening and monitoring equipment In 2008, the partnership screened more than 19,000 people, trained 300 healthcare personnel, and provided patient education workshops to more than 800 patients. Since the partnership began, more than 26,000 people have been screened for diabetes and there has been 260% annual increase in detection of diabetes. Breast Cancer Programme in Ethiopia Breast cancer AstraZeneca Ethiopia Focused on strengthening diagnosis and treatment capabilities; activities include developing treatment guidelines, strengthening the referral system, setting up an institutional-based cancer registry, raising awareness and providing training 3,122 patients have been screened, diagnosed, or treated and followed up; new mammography equipment installed and 13 staff trained; Tamoxifen available free of charge 1,706 patients benefited so far; Anastrazole available for first time in Ethiopia (Oct 2009)and provided free of charge 167 87 88 89 90 91 92 93 94 Bayer HealthCare Nexavar® Access Programme Diabetes Bayer HealthCare AsiaPacific region Donates medicine Nexavar® to facilitate access for patients who cannot afford the cost of a full course of therapy ---- Circle of Care Mental health Johnson & Johnson Malaysia Provides job placement support programmes; disseminates education about mental illness; connects to local support groups. Has helped more than 1,000 families in Malaysia cope with mental illness. Glivec® International Patient Assistance Programme (GIPAP™) Leukaemia Novartis 80 developing countries Provided Glivec® at no cost worth USD 751 million; also help in programme development and drug donation Helped 35,000 patients; established a global network of almost 1,000 registered physicians and more than 300 qualified treatment centres, including the leading oncology treatment centres IDF BRIDGES Programme Diabetes Lilly Worldwide Funding worth USD 10 million for research and development; new grant of USD 2million in 2010 ---- India Diabetes Educator Project Diabetes Bayer HealthCare, Lilly India Offers a comprehensive and sustainable approach towards diabetes training; spent USD 130 million on aid ---- Best Possible Pricing on Insulin Diabetes Novo Nordisk 32 developing countries Offers insulin at 20% cost; 99% of insulin sold to Least developed countries is under this scheme. Supplies are enough to treat between 150,000 and 390,000 patients, depending on the daily dose. Novo Nordisk Haemophilia Foundation Haemophilia Novo Nordisk 23 developing countries World Partner Project Diabetes Novo Nordisk 10 developing countries Programmes include awareness creation through distribution of educational material, capacity building and prevention of haemophilia complications; 33 projects going on; Euro 5 million have been earmarked. 31 projects in seven focus countries; organizing clinics, providing distance learning and educating people By 2010, 15,100 people had been diagnosed. Trained 104,000 healthcare professionals, while 122,000 people with diabetes have been educated or treated 168 95 96 97 98 99 100 101 Global Health Partnerships Oncology and tobacco control Pfizer 15 developing countries Committed USD 47 million over four years (20072010); improved diagnosis and treatment facilities. ---- Sanofi-Aventis Diabetes Prevention Diabetes SanofiAventis Burundi, India, Kenya, Madagascar, Mali, Nicaragua, Philippines, Thailand Several projects to help local healthcare systems to manage the disease better and prevent the onset of complications. Since the beginning of the programme, Handicap International has trained 600 health professionals, who in turn have treated 3,000 patients. Sanofi-Aventis: Impact Epilepsy Programme for Developing Countries Epilepsy SanofiAventis Cambodia, Kenya, Laos, Madagascar, Mali Medicines such as Depakine® / VPA are provided on a “no-profit, no-loss” basis In Mali , more than 2,000 patients have been diagnosed and treated; In Kenya, 260 healthcare professionals have been trained and 10,000 patients treated Mental Health Disorders (Schizophrenia) Schizophrenia SanofiAventis Mauritania, Morocco, Vietnam Providing Largactil®, Nozinan®, Piportil L4® and Solian® at preferential prices. Two pilot programmes have been set up in Mauritania and Morocco combining information, education and communication, training and medicines. My Child Matters Childhood cancers SanofiAventis 21 developing countries Work to develop pragmatic approaches to improve awareness, early diagnosis, access to care and treatment, pain control and better management of the social and cultural aspects of the disease. In 2008, 12,875 children benefited from this programme and 2,849 health professionals were trained ScheringPlough & National Cancer Coalition Brain cancer ScheringPlough Dominican Republic, Ecuador, El Salvador, Guatemala, Honduras, Nicaragua, Peru Supplying enough of its brain cancer drug, Temodar®. Treating 115 patients in 13 hospitals The World Diabetes Foundation Diabetes Novo Nordisk 83 developing countries Total USD 227 million have been provided since 2001. Focusing on diabetes awareness, education and capacity-building. As of2009 at least 2,876,565 people have been screened for diabetes in 4,427 screening camps, more than 229,829 have been treated, and 14,433 doctors and 12,835 nurses have been trained. 169 102 103 104 105 106 107 108 109 Arogya Parivar Programme Multiple diseases Novartis India The programme focuses on tuberculosis, coughs, colds, allergies, skin and genital infections, malnutrition in mothers and children, diabetes, intestinal worms and digestive problems. ---- AstraZeneca Product Donations Multiple diseases AstraZeneca developing countries Donated USD 646 million in product; total spend on charitable contributions was USD 72 million ---- Strengthening Healthcare Capacity Multiple diseases Boehringer Ingelheim Botswana, Papua New Guinea, South Africa, Venezuela Provide support to develop community health centres, provide training, spread awareness, and supply medicine and equipment. ---- Bristol-Myers Squibb Medical Product Donations Multiple diseases Bristol-Myers Squibb developing countries Donated USD 243 million of medical products since 2003; in 2008, the amount of donation was USD 33 million; focuses on medical supplies; healthcare infrastructure and disaster relief. ---- GSK & Leonard Cheshire Disability in Sri Lanka Disability GSK Sri Lanka Support disabled peoples access to health and rehabilitation services, inclusive education and livelihood opportunities. Supported 500 people with disabilities and increased awareness to 1000 family members of people with disabilities. GSK Nurse Training in Tamil Nadu Nurse training GSK India Provided USD 133,509 of funding from June 2007 to June 2009 ---- Health Training at Egypt's National Training Institute Multiple diseases Pfizer Egypt Provide state-of-the-art training for physicians, nurses and health professionals Nearly 15,000 physicians have been trained through 220 training courses and 21 symposia. Healthy Communities, Healthy Ecosystems Multiple diseases Johnson & Johnson Democratic Republic of Congo, Kenya, Nepal Conducted sex education and HIV/AIDS training; built a dispensary clinic in Kenya and established mobile clinics. ---- 170 110 111 112 113 114 115 116 117 Johnson & Johnson Burn Treatment Centre in Soweto Multiple diseases Johnson & Johnson South Africa Built the Johnson & Johnson Burn Treatment Centre, a state-of-art facility to treat complicated burn injuries. Treats more than 1,500 patients annually; succeeded in reducing the mortality rate among critically ill patients. Medical Outreach Programme Multiple diseases Merck & Co. Inc. developing countries Donations of Merck medicines; in 2008, donated medicines worth USD 43.4 million; total USD 592 million donated in Mectizan and medical outreach programme. ----- Nursing Training in East Africa Multiple diseases Johnson & Johnson Kenya, Tanzania, Uganda Programme provides quality education and greater standards of evidence-based care to nurses and midwives. About 200 nurses from 50 different hospitals have been trained to date. Otsuka Welfare Clinic Multiple diseases Otsuka Pharmaceutical Pakistan Medical doctors, pharmacists, nurses and other medical professionals provide free treatment each day to some 300 patients requiring medical assistance. ---- Phelophepa Healthcare Train Multiple diseases Roche South Africa Provides basic healthcare services to poor patients in remote rural areas Serves more than 45,000 people a year and has reached nearly 13 million in total since 1994 Rabies Control in Tanzania Rabies ScheringPlough Tanzania Donated 200,000 doses of rabies vaccine; USD 20,000 was provided to replace a stolen vehicle Significant reduction in reported rabies cases from 26% to 2%; injuries from rabies dogs have also reduced. ScheringPlough Medicine Donations Multiple diseases ScheringPlough developing countries More than USD 500,000 in support; more than USD 14 million of medicines; donated an additional USD 14million of pharmaceuticals to other NGOs. ---- Tanzanian Training Centre for International Health Multiple diseases Novartis Tanzania The aim is to strengthen human resource development in the Tanzanian health sector and beyond ---- 171 118 119 120 121 122 123 124 125 126 Train mid-wife programme Training Abbott Afghanistan To train mid-wives and ensure safe and healthy delivery of babies. ---- Operation Smile Facial deformation Abbott developing countries To increase survival rates of patients treated in emergencies; donated USD 5.4 million since 1993; in 2007 donated products worth USD 500,000 Since 1982, 140,000 children have been treated; trained more than 11,700 medical professionals. Improving neonatal care Neo-natal care Abbott Kosovo A grant of USD 86,800, helped purchase advanced ventilators, 15 CPAP machines, incubators, pulse oximeters and gas analyzers to equip four patient units within the NICU. ---- Care and Prevention of Mother-to-Child Transmission of HIV/AIDS PMTCT Bristol-Myers Squibb Foundation Zambia A USD 433,000 grant to the Adventist Development and Relief Agency ---- 2009 Alliance to Reduce Disparities in Diabetes Diabetes Merck USA Commitment of USD 15 million through 2013 mothers 2 mothers PMTCT Merck African countries Gave USD 5 million in salaries Employs 1625 HIV positive mothers and serves another 300,000 HIV positive women. Nicaragua Rotavirus Vaccine Programme Gastroenteritis Merck Nicaragua USD 75 million; donated more than 1 million doses since 2006. Approximately 81% of eligible infants were vaccinated in 2008. AmpliCare HIV/ AIDS Roche SubSaharan African countries Offers an education programme to keep local doctors and nurses fully informed about the latest advances in HIV/AIDS care. In 2008, 450,000 infants were tested for HIV and an estimated 560,000 patients had their HIV/AIDS treatment monitored. Pandemic Planning Influenza Roche WHO In 2003, 5 million courses were donated. In 2009, donated another 5 million courses. WHO distributed these courses in the developing nations during 2009 outbreak. 172 127 128 129 130 131 132 133 134 CARE HIV/AIDS Roche Africa A forum for healthcare professionals to meet and discuss their experiences of managing HIV/AIDS Exchange meetings have brought together more than 600 healthcare workers – including doctors, nurses, counsellors, pharmacists and laboratory managers – from over 29 countries in Africa and Asia. Roche Organ Transplantation Research Foundation (ROTRF) Organ Transplant Roche _ More than 225 projects have received funds worth over 43 million Swiss francs in total during the last 11 years. ---- Roche Foundation for Anaemia Research (RoFAR) Anaemia Roche developing world Committed just under SFr 20 million francs since 2004; so far awarded around SFr 15 million to 68 research projects around the world. ---- West Africa Hydrocele Surgical Training Programme (WAHSTP) Hydrocele Johnson & Johnson Burkina Faso, Ghana, Mali, Niger and Togo ---- Since 2005, nearly 100 surgeons and surgical nurses have been trained, and more than 2,100 men have benefited from the surgery. Mobilize against malaria Malaria Pfizer Ghana, Kenya and Senegal In 2009, gave Medicines for Malaria Venture access to its library to test 200,000 compounds. ---- Alliance for a Healthy Border Diabetes and CVD Pfizer US-Mexico Border USD 4.5 million over 3 years from 2006 to 2008 More than 50,000 individuals reached with diabetes and CVD prevention messages. HIV The Global Fund ---- Donated more than USD 10.8 billion for various causes Providing antiretroviral therapy (ART) to 2.5 million people; distributed 1.8 billion male and female condoms; provided 790,000 HIVpositive pregnant women with treatment to prevent mother-to-child transmission of HIV, as well as 4.5 million units of basic care and support services to orphans Tuberculosis The Global Fund ---- USD 3.2 billion and 1.8 million TB/HIV interventions Treatment for 6 million people who had active TB 173 135 136 137 138 139 140 141 142 Malaria The Global Fund ---- Approved funding worth USD 5.3 billion Distributed 104 million insecticide-treated nets (ITNs) to prevent malaria; treated 108 million cases of malaria Paediatric HIV/AIDS UNITAID ---- Donated funds close to USD 235.5 million More than 285,000 patients treated by 2009 Secondline HIV/AIDS UNITAID ---- USD 241.1 million has been donated to various partnerships. More than 180, 000 patients have been treated Tuberculosis UNITAID ---- Total funds committed of USD 146,226,874 Total number of patients treated exceeds 1.7 million Multiple U.K. Department for International Development Total funds committed to various issues is GBP7.9 billion by 2010/11; written off 100% of the debt owed to DFID by the world's most heavily indebted poor countries. Globally: proportion of people in developing countries living in extreme poverty fell from 28% in 1990 to 22%. Kenya: HIV/AIDS prevalence has fallen from over 11% to 5.9% over the past eight years. Uganda: Between 2003 and 2006, 1.4 million people have been lifted out of poverty. Malaria Bill and Melinda Gates Foundation ---- USD 202 million for the Medicines for Malaria Venture; USD 79 million for the Malaria Control and Evaluation Partnership in Africa HIV/AIDS Bill and Melinda Gates Foundation ---- USD 258 million for Avahan; USD 151 million for research on microbicides to prevent HIV transmission; USD 50 million to support the African Comprehensive HIV/ AIDS Partnerships ---- Tuberculosis Bill and Melinda Gates Foundation ---- USD 309million to the Aeras Global TB Vaccine Foundation; USD 33 million to improve TB control in China; USD 86 million for the Foundation for Innovative New Diagnostics Approximately 32 million patients were treated under DOTS (directly-observed treatment, short-course) between 1995 and 2007 ---- 174 143 144 145 146 147 148 149 Vaccine Preventable Diseases Bill and Melinda Gates Foundation ---- USD 1.5 billion to the GAVI Alliance The GAVI Alliance has helped to immunize 213 million children, preventing more than 3.4 million future deaths Polio Bill and Melinda Gates Foundation ---- USD 355 million to Rotary International to support global polio eradication activities; USD 150 million to UNICEF and WHO ---- Pneumonia and Flu Bill and Melinda Gates Foundation ---- USD 41 million to PATH to develop new vaccines; USD 4 million for the University of Maryland to introduce a vaccine for Hib pneumonia in West Africa. ---- Nutrition Bill and Melinda Gates Foundation ---- USD 109 million to GAIN (Global Alliance for Improved Nutrition); USD 15 million to UNICEF to eliminate iodine deficiency Each year, GAIN’s partnerships with the food industry make it possible to fortify 2.9 million metric tons of flour and 100,000 metric tons of soy sauce Diarrhoea Bill and Melinda Gates Foundation ---- USD 7 million for the International Centre for Diarrhoeal Disease Research to implement a zinc treatment programme; USD 50 million to PATH (Programme for Appropriate Technology in Health) to develop vaccines against bacteria that cause diarrhoea ---- Maternal and Neonatal Health Bill and Melinda Gates Foundation ---- USD 25 million to the NGO, BRAC, and USD 110 million to Save the Children to expand access to simple, low-cost tools to improve newborn health ---- Tobacco Bill and Melinda Gates Foundation ---- Committed to investing USD 125 million over 5 years to fight the global tobacco epidemic, including a USD 24 million grant to the Bloomberg Initiative to reduce tobacco use. ---- 175 150 HIV/AIDS The President's Emergency Plan for AIDS Relief (PEPFAR) ---- Started in 2003 with funding of USD 15 billion; In 2008, USD 48 billion was authorized for a period of 5 years (2009 to 2013). 7,304,525 pregnant women received HIV counselling and testing services in 2009; number of individuals receiving counselling and testing in 2009 are 21,236,500; number of individuals on antiretroviral treatment in 2009 are 2,485,300; number of Individuals trained or retrained in 2009 are 1,547,600; number of individuals reached with community outreach HIV/AIDS prevention activities is 77,653,600. 176 List of the 50 Least Developed Countries 177 178 Selected Socioeconomic Indicators For The 50 Least Developed Countries Country Population (millions) Infant Estimated Share of mortality Adult Average life number of total GDP per rate people literacy expectancy labour capita (USD (per (aged 0-49 rate at birth force in current) 1,000 years) agriculture (%) (years) live living with (%) births) HIV/AIDS (thousands) 2002 2002 2002 2000 2000-05 2000-05 end 2001 Afghanistan 22.9 .. 66 36 162 43 .. Angola 13.2 863 71 42 140 40 350 Bangladesh 143.8 329 54 40 64 61 13 Benin 6.6 410 52 37 93 51 120 Bhutan 0.9 698 94 47 54 63 0c Burkina Faso 12.6 225 92 24 93 46 440 Burundi 6.6 109 90 48 107 41 390 Cambodia 13.8 266 69 68 73 57 170 Cape Verde 0.5 1,390 22 74 30 70 .. Central African Republic 3.8 282 71 47 100 40 250 Chad 8.3 232 73 43 115 45 150 Comoros 0.7 343 73 56 67 61 .. Dem. Rep. of the Congo 51.2 111 62 61 120 42 1,300 Djibouti 0.7 861 78 65 102 46 .. Equatorial Guinea 0.5 4,517 69 83 101 49 6 Eritrea 4 146 77 56 73 53 55 179 Ethiopia 69 87 82 39 100 45 2,100 Gambia 1.4 280 78 37 81 54 8 Guinea 8.4 380 83 41 102 49 .. Guinea-Bissau 1.4 149 82 38 120 45 17 Haiti 8.2 437 61 50 63 50 250 Kiribati 0.1 512 26 .. .. .. .. Lao People’s Dem. Rep. 5.5 304 76 65 88 54 1 Lesotho 1.8 405 39 83 92 35 360 Liberia 3.2 174 67 54 147 41 .. Madagascar 16.9 267 73 66 91 54 22 Malawi 11.9 158 82 61 115 38 850 Maldives 0.3 2,000 21 97 38 67 0c Mali 12.6 251 80 26 119 49 110 Mauritania 2.8 350 52 40 97 52 .. Mozambique 18.5 211 81 44 122 38 1,100 Myanmar 48.9 .. 70 85 83 57 .. Nepal 24.6 223 93 42 71 60 58 Niger 11.5 188 87 16 126 46 .. Rwanda 8.3 210 90 67 112 39 500 Samoa 0.2 1,482 33 99 26 70 .. Sao Tome and Principe 0.2 321 63 .. 32 70 .. Senegal 9.9 501 73 37 61 53 27 Sierra Leone 4.8 166 61 36 177 34 170 180 Solomon Islands 0.5 517 72 .. 21 69 .. Somalia 9.5 .. 70 24 118 48 43 Sudan 32.9 410 59 58 77 56 450 Timor-Leste 0.8 548a 81 43a 80a 57a .. Togo 4.8 288 59 57 81 50 150 Tuvalu 0.0b .. 25 .. … .. .. Uganda 25 235 79 67 86 46 600 United Rep. of Tanzania 36.3 259 80 75 100 43 1,500 Vanuatu 0.2 1,133 35 .. 29 69 .. Yemen 19.3 538 48 46 71 60 10 Zambia 10.7 344 68 78 105 32 1,200 Least developed countries 699.6 281 69 52 97 50 13,348 All developing countries 5,018.5 1,195 54 74 61 63 37,476 Source: UNCTAD The Least developed countries Report 2004 a Data for 2001. b Population 10,466. c <100 181 The Cameron Institute is an alternative, not-for-profit, public policy think tank specializing in the independent study of current health, social, and economic issues in Canada and internationally. The Institute researches policy concerns in the health world related to the need for balance between patient safety and access to new, innovative, affordable therapies. It is an objective of The Cameron Institute to provide decision makers with analyses that will help inform choices. The Institute is also dedicated to educating and better preparing patients, providers, and payers to make appropriate clinical choices. Dr. D. Wayne Taylor has worked as an executive in the private sector, as a senior civil servant, as a political assistant, and was the Founding Director of both the MBA Programme in Health Services Management and the Health Leadership Institute at McMaster University. He remains a tenured faculty member in the DeGroote School of Business at the Ron V. Joyce Centre for Advanced Management Studies while serving as the Executive Director of The Cameron Institute and as president of his own private international consultancy as well as Finergy Analytics. 182