Access to current products and innovation for the future- Some community Thoughts Kenly Sikwese Geneva 1 November 2011
Financing the response Current ART successes have been predicated on sustained new sources of finance Gains made in treatment have been synonymous with huge scale-up supported by funding commitments from donors which resulted in removal of inequities in access to ART, bringing sanity to the ARV market
But Sustainability will depend on Country ownership Clearly demonstrated by increased budget allocations e.g. 15% 2001 Abuja Declaration Strengthening community groups and local CSOs to drive advocacy towards meeting Abuja targets This is not to mean that other countries must not increase their contribution Those that own and manage greater number of resources should contribute to development and related AID to poorer countries More Innovative approaches needed in tapping nontraditional sources of funding: e.g. Unitaid s social marketing strategy
Procurement: Challenges & Possibilities Procurement processes have not been very transparent both in country and by global players Result: Fake or expired ARVs entering markets e.g. in Kenya, Burundi Frequent stock outs in some countries But.. Community involvement, in the purchase, distribution up to point of care dispensing has possibility to support a robust supply chain management system Early warning before stock-outs occur - Use of simple technologies to warn before/when stockouts occur, easily accessible to communities using texting Use of buddies in Rural areas increased retention and adherence levels Rural East Africa Note: the mismanagement of Global Funds disbursements in Zambia were uncovered by community groups long before the OIG Audit which served to explain the who, where, how funds were pilfered
Procurement (2) Patent flexibility and tiered pricing particularly for middle income countries Free licensing, provisions of TRIPS flexibilities must be availed all countries including middle income countries to make UA a reality All pharmaceuticals must come to the table and start negotiations with the MPP
Innovation in Diagnostics Point of care diagnostics cheap, affordable, easy to operate software, at point of care JHPIEGO -Accelovate five-year project which aims to reach $24.9 million by expanding use of simple, inexpensive lifesaving technologies -innovative technologies from the lab to the village that will help save the lives of the most vulnerable people. "This is an exciting new venture that builds on the breadth of Jhpiego's technical expertise and practical experience in bringing low-cost, innovative health care solutions to countries to prevent the needless deaths of women and families," said Leslie Mancuso E.D.,
Innovations in New formulations and new drugs Fixed doses, reduction in toxicity levels and infant friendly formulations Generic manufacturers must be supported to participate fully in bringing their innovative developments quickly to the market and this must not be the preserve of originator pharmaceutical companies Pharmacovigilance mechanisms are needed to bring new drugs to the market quickly in the absence of randomised trials Further research is required to address toxicities, resistance, accelerated D4T phase out and other questions including finding the all illusive cure
Barriers to innovation Black market, Corruption, drug thefts, poor forecasting monitoring mechanisms Q and A not only in drugs quality but also in service delivery Low levels of funding -timely and sustained predictable funding is needed for the whole treatment response to meet the 2015 targets and beyond Restrictive Trade Agreements that stifle universal access goals Current EU/US trade positions threaten to significantly reduce the access-to-medicine terms negotiated in trade deals such as those under President Bush in 2007 creating monopoly privileges for patent holders, further eroding generic competition Need to show flexibilityin licensing agreements and dealings with institutions such as the Medicines Patent Pool
Community involvement -communities of PLHIV will play a major role in increased ART uptake, improve adherence, provide the eyes and ears on the ground -Communities should be involved from inception, from designing, researching, in negotiations, implementation to monitoring by ALL stakeholders