Debate at the World Health Assembly: Delivering Appropriate Treatment to Low- and Middle-Income Countries

GP_portrait_04 Greg Perry, Executive Director, The Medicines Patent Pool

On Tuesday, the World Health Assembly appointed a new Director General, Dr. Tedros Adhanom Ghebreyesus. During his acceptance speech that evening, the new Director-General reiterated the importance of the UN Sustainable Development Goals (SDGs) as an “opportunity for the WHO to drastically improve healthcare,” especially for those most vulnerable.

Under his watch, the implementation of the UN SDG for Health, the roadmap for ensuring healthy lives and promoting well-being, will continue to be priority. Yet SDG targets such as ending HIV/AIDS and tuberculosis (TB) and combatting hepatitis, key areas of the Medicines Patent Pool’s work, will require a new mind-set in how we care for patients in the poorest populations. In addition to increased attention on prevention and diagnostics, we must sustain and improve treatment scale-up and advocate for better, more effective therapies.

Thirty-seven million people are currently living with HIV, for example, but only 50% have access to medicines, leaving treatment well below the 90% target proposed by UNAIDS three years ago [1]. There were more new hepatitis C infections than patients who were started on treatment in 2015 [2]. Tuberculosis, also a curable disease, killed almost two million in the same year [3].

Recent developments in the treatment field suggest we can improve standard of care for many high prevalence countries, especially in the HIV area. New HIV medicines such as dolutegravir (DTG) and tenofovir alafenamide (TAF), for example, could be real game changers. Based on clinical trial data, regimens containing these new medicines could have reduced side effects and lower price points than first-line treatments.

A recent forecast developed by the WHO and the Medicines Patent Pool predicted TAF and DTG would be major players in antiretroviral therapy (ART) regimens by 2025, with eight million and 15 million patients using these antiretrovirals respectively. To clear the pathway, local regulatory bodies should speed approval for generic versions of TAF and DTG combinations set to be filed shortly in many resource-limited nations.

In hepatitis C, new direct acting antivirals (DAAs) that can cure the disease in a short course of therapy have revolutionised the approach to treatment. The WHO Global Hepatitis Report issued last month, however, noted that although the cumulative number of persons treated for hepatitis C reached 5.5 million in 2015, only about half a million of these persons had received DAAs. Clearly, these solutions are not reaching patients in low- and middle-income countries where the vast majority of the world’s patients live with the virus.

Here we can take a lesson from the HIV playbook. Innovative science, new funding mechanisms, civil society activism and novel approaches such as industry-supported voluntary licensing were effective in drastically improving the HIV response. They can and should be tapped to meet our targets for hepatitis C and other essential medicines. Last year, for example, the MPP licensed Bristol-Myers Squibb’s new DAA daclatasvir with the potential of working across all genotypes of the virus for generic manufacture. Ten companies are currently developing low-cost versions for 112 low- and middle income countries.

Finally, we cannot eliminate TB by 2030 without new tools in the pipeline today and successful products delivered to patients over the next decade. The dearth of new drugs to combat multi-drug resistant TB (MDR-TB) specifically erodes progress. Last week, G20 Health Ministers acknowledged the tremendous threat of tuberculosis and the need to develop “new drugs, diagnostics and vaccines to tackle drug-resistant tuberculosis consistent with the WHO End TB Strategy.” The MPP has licensed an investigational treatment, sutezolid, long-considered a promising compound, for clinical development and supports the 3P project to incentivise research and pool intellectual property and data to develop new TB drug regimens.

Dr. Tedros Adhanom Ghebreyesus takes the helm of the organisation at a time when WHO’s mandate and expectations are expanding, while budgets for health and overall aid programmes are flatlining or shrinking. The WHO programme budget for 2018-2019 approved this week is a mere three percent over 2015’s appropriated funding with the agency reportedly operating with a $300million shortfall.

The new DG understands the importance of innovative mechanisms and collaborative efforts to address the world’s greatest public health challenges.  As Minister of Foreign Affairs of Ethiopia, he led efforts to negotiate the Addis Ababa Action Agenda, the SDG financing framework. International organisations, industry players, governments, civil society and patient groups must support his SDG agenda.

Greg Perry, Executive Director

Medicines Patent Pool

Greg Perry is Executive Director of the Medicines Patent Pool (MPP), a Unitaid funded initiative, and the only voluntary licensing and patent pooling mechanism in public health. Under his direction, the MPP has signed licensing agreements for 12 antiretrovirals, two hepatitis C medicines, an HIV technology platform and a tuberculosis treatment. Prior to his role at the MPP, Perry was Founding Director and later Director General of the European Generic Medicines Association.

[1] UNAIDS

http://www.unaids.org/en/resources/fact-sheet

[2] World Health Organization Global Hepatitis Report http://apps.who.int/iris/bitstream/10665/255016/1/9789241565455-eng.pdf?ua=1

[3] World Health Organization http://www.who.int/mediacentre/factsheets/fs104/en/

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