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Inter-Country Meeting on Anti-Retroviral Pricing, Procurement and Supply Management : Inter-Country Meeting on Anti-Retroviral Pricing, Procurement and Supply Management Cairo, Egypt 05-07 April 2005 Béchir N’Daw, UNAIDS Secretariat


Estimated adult and child deaths from AIDS during 2004 : Estimated adult and child deaths from AIDS during 2004 Total: 3.1 (2.8 – 3.5) million Western & Central Europe 6 500 [<8 500] North Africa & Middle East 28 000 [12 000 – 72 000] Sub-Saharan Africa 2.3 million [2.1 – 2.6 million] Eastern Europe & Central Asia 60 000 [39 000 – 87 000] East Asia 51 000 [25 000 – 86 000] South & South-East Asia 490 000 [300 000 – 750 000] Oceania 700 [<1 700] North America 16 000 [8 400 – 25 000] Caribbean 36 000 [24 000 – 61 000] Latin America 95 000 [73 000 – 120 000]


Slide3 : Differential pricing Generic competition Voluntary licensing Flexibility in TRIPS High volume purchases Local production Elimination of tariffs and taxes … a combination of strategies to obtain affordable medicines:


We are getting closer: The year 2000 price shift and beyond : We are getting closer: The year 2000 price shift and beyond Price reductions of a first line ARV regimen in Uganda Launch of Accelerating Access Initiative (AAI) Negotiation with R&D Pharma within AAI Generic companies offer of price reduction to Uganda Further price reductions by R&D Further discussion with Generics Negotiations with J. Clinton Foundation with 4 genetic companies Further discussion with Generics Prices (US$/year) of a first-line antiretroviral regime in Uganda: 1998-2003 Price US$ Jun-98 Jul-98 Aug-98 Sep 98 June 2000 Dec-00 Jan-01 Feb-01 Mar-01 Apr-01 May-01 Jun-01 Jul-01 Aug-01 Oct-00 Nov-00 Sept-03 Oct-03 Mar-03


Global Fund to Fight AIDS, Tuberculosis and MalariaReport of the Third Board Meeting(10-11 October 2002) : Global Fund to Fight AIDS, Tuberculosis and Malaria Report of the Third Board Meeting (10-11 October 2002) C. PROCUREMENT AND PRICING … 10. Lowest possible price … The Fund encourages Recipients to comply with national laws and applicable international obligations in the field of intellectual property including the flexibilities provided in the TRIPS agreement and referred to in the Doha Declaration in a manner that achieves the lowest possible price for products of assured quality.


TRIPS Flexibility Compulsory Licensing – Article 31 : TRIPS Flexibility Compulsory Licensing – Article 31 Effective use of TRIPS flexibility depend upon national legislation Authorization to produce, sale and import the patented product or process without the consent of the patent holder


Grounds for using Compulsory Licensing : Grounds for using Compulsory Licensing Public non-commercial use/Government use National emergency Circumstances of extreme urgency Voluntary license from the patent holder on reasonable commercial terms (Art. 31b) Anti-competitive practices (Art. 8; 40)


Parallel Imports : Parallel Imports Purchasing drugs at a lower price To promote pricing equity by authorizing importation of a patented product Principle of international exhaustion of rights (Art. 6)


The Doha Declarationon the TRIPS Agreement and Public Health(Doha, Qatar - November 2001) : The Doha Declaration on the TRIPS Agreement and Public Health (Doha, Qatar - November 2001) Primacy of public health in international trade “… the Agreement can and should be interpreted and implemented in a manner supportive of WTO Members’ right to protect public health and, in particular, to promote access to medicines for all.” (Paragraph 4) Reaffirmed WTO Members ability to use the flexibilities of the TRIPS Agreement


Doha - Importing under Compulsory Licensing : Doha - Importing under Compulsory Licensing “Each Member has the right to grant compulsory licences and the freedom to determine the grounds upon which such licences are granted”. (Paragraph 5 a.) Paragraph 6 issue - “ … predominantly for the supply of the domestic market” - TRIPS Art. 31 (f) Transition period for least developed country Members to provide patent protection for pharmaceutical products extended to 2016


WTO 30 August Decision of 2003 : WTO 30 August Decision of 2003 “… allows any member country to import and export pharmaceutical products made under compulsory licences within the terms set out in the decision » Temporary waiver allowing export of generic pharmaceuticals under a compulsory license To help WTO Members with insufficient manufacturing capacity


World Health Assembly resolutions : World Health Assembly resolutions Resolution WHA57.27 in May 2003 expressed "concerns about the current patent protection system, especially as regards access to medicines in developing countries", and urged Member states to "adapt national legislation in order to use to the full the flexibilities contained in the TRIPS Agreement" Resolution WHA57.14 of 22 May 2004 urged Member States to "encourage that bilateral trade agreements take into account the flexibilities contained in the WTO TRIPS Agreement and recognized by the Doha Ministerial Declaration on the TRIPS Agreement and Public Health".


Free Trade Agreements (FTAs) : Free Trade Agreements (FTAs) Already negotiated: Australia, Bahrain, Canada and Mexico (NAFTA), Chile, Israel, Jordan, Morocco, Singapore and US-DR-CAFTA Under negotiations: Andean countries (Bolivia, Colombia, Ecuador, Peru), FTAA, Panama, SACU (Botswana, Lesotho, Namibia, South Africa, Swaziland), Thailand


Intellectual Property Rights provisions in FTAs A TRIPS-plus world? : Intellectual Property Rights provisions in FTAs A TRIPS-plus world? Adoption of more stringent IPR regime – beyond 20 years Undermine the TRIPS flexibilities, Doha Declaration and the WTO 30 August Decision Limit or delay access to affordable medicines Data exclusivity for pharmaceutical test data Drug Regulatory Authorities to enforce patents


ARV therapy coverage in developing and transitional countries, December 2004 : ARV therapy coverage in developing and transitional countries, December 2004


Future Challenges : Future Challenges Access to treatment for children Still high prices in middle-income countries Capacity of generic companies Fees for services and financial issues Poor human resources in health sector