By GARY COHEN
One way to assess just how far a journey has progressed is to take a look back to the starting place. For many companies that today are deeply involved in helping address a wide range of unmet global health needs among resource-limited populations, the HIV & AIDS pandemic was where their journey began.
The origins of collaborative business engagement in the HIV & AIDS pandemic can in part be traced back to 1997, when meetings began between four large pharmaceutical companies, the Financial Times, and MTV Networks in what became known as the “Global Business Council.” Membership grew to over 20 companies, and meetings were held in Davos, Switzerland. The focus of these meetings was establishing best practices and getting member companies to commit to an AIDS strategy, both internally and externally. Sir Richard Sykes, then Chairman of Glaxo served as the first chair, and Bill Roedy, then Chairman and CEO of MTV Networks International, assumed the role of chair in 1999.
Advancements in anti-retroviral therapy (ART) in the 1990’s increasingly enabled HIV to be managed as a chronic disease rather than becoming a certain cause of death. But an enormous disparity emerged in access to ART among people living in developed versus developing countries. In particular, HIV prevalence rates were highest in southern Africa (representing approximately 75 percent of the global HIV burden at the time), yet access to ART in Africa was essentially non-existent at the turn of the millennium in 2000.
A key area of focus for health for officials and policymakers was to substantially reduce the cost of ART drugs in order to support massively expanded access. The Clinton HIV/AIDS Initiative (CHAI for short, today the Clinton Health Access Initiative) was particularly instrumental in this effort. CHAI leaders understood that the most feasible way to achieve massive increases in access and manufacturing scale was to help companies establish sustainable business models with volume commitments that enabled a sufficient profit to be earned at drastically reduced prices. CHAI negotiated pricing and volume agreements with both branded and generic ART manufacturers. CHAI leaders also recognized that scale-up of sophisticated laboratory tests, particularly CD4 count and viral load, would be necessary to support efficacious initiation and monitoring of ART, and they engaged in negotiations with manufacturers of these diagnostic tests, similar to the approach taken with ART manufacturers. For example, BD (Becton, Dickinson and Company) entered into an access pricing agreement with CHAI that reduced the price of the company’s CD4 tests by up to 75 percent. This access price was extended to 55 developing and emerging countries. BD also worked collaboratively with CHAI and other partners to train over 8,000 laboratory technicians in these countries on proper procedures for conducting CD4 tests, contributing to substantial expansion in diagnostic testing capacity throughout the developing world, particularly in sub-Saharan Africa. This agreement was signed in January 2004.
*Due to a report of a terrorist threat in Nairobi only a few members of the delegation traveled to Kenya. This threat was later determined to be unsubstantiated.
DR. Keiji Fukuda
Antibiotics have been miracle drugs for several decades, saving millions of lives from infections and providing the safety net from infections needed for complex surgeries, cancer chemotherapy and conditions such as diabetes.
The use of antiparasitic and antiviral drugs to prevent and treat malaria and HIV have been life-saving and life-changing for millions. Moreover, antibiotics have been critical tools for farmers to protect livestock, poultry, and fish from infectious diseases, and to help meet a growing global demand for protein-rich food. But the continual capacity of these medicines to work: in keeping people healthy, and in supporting sustainable food, is being lost. The widespread use, overuse, and misuse of these medicines in both health, and agriculture is driving up levels of antimicrobial resistance.
Antimicrobial resistance, or AMR, is when infection causing microbes become increasingly resistant to the antimicrobial medicines used in treatment. The implications of this phenomenon should not be underestimated. AMR is occurring in all parts of the world, both through local use of antimicrobial medicines, as well as through travel or trade, of resistant microbes. It is happening now, and is affecting many common infections. Every year, drug-resistant infections kill an estimated 700,000 people worldwide—most of these in developing countries. Recent estimates suggest that by 2050, the death toll from AMR may rise to 10 million—more than the number of people who currently die from cancer.
By threatening the health and lives of people, especially vulnerable populations such as newborns, children, and women; by creating escalating costs through the need for prolonged or more complex health care, the loss of productive lives, and by undermining critical social needs such as sustainable food and agriculture, AMR is more rightly seen as a broad social and development challenge, and not a health challenge alone. Unless major steps are taken to change the way we use these medicines in humans and animals, AMR is projected to cause a loss of $100 trillion from global GDP over the next 35 years. Developing countries will disproportionately suffer, with the poorest populations suffering the most.
The problem is compounded by a prolonged lack of sufficient research to develop new antibiotics. No new class of antibiotics has been discovered in more than three decades, to replenish the current, eroding armament.
On 21 September, leaders from around the world will gather at a dedicated high level meeting at the United Nations General Assembly in New York to commit to tackling AMR. The purpose of such a meeting reflects growing recognition beyond the health and agricultural sectors that AMR poses a major challenge to achieving the Sustainable Development Goals (SDGs)—the roadmap to end poverty and fight inequality by 2030 adopted at the UN General Assembly last September. Several SDGs depend upon the sustained availability of and access to affordable and effective antimicrobials. Furthermore, it reflects recognition that
without the high-level political commitment needed to enable and foster rapid, comprehensive and multisectoral action, we will continue the slide towards, what has been termed, a “post-antibiotic era”.
Some of the key elements needed to address AMR are in place. A Global Action Plan was adopted by governments at the World Health Assembly in May 2015, and supported by the governing bodies of the Food and Agriculture Organization of the United Nations (FAO) and the World Organization for Animal Health (OIE). The plan provides a technical blueprint for countries to adapt, to meet their specific needs. Other technically solid guidelines are also available. Broader engagement is finally being recognized as necessary. On 5 September 2016, the G20 Leaders’ Summit in Hangzhou, China, acknowledged the seriousness of the threat posed by AMR to global economic growth and stability. They requested WHO, FAO, OIE, and the OECD to work together to fight antimicrobial resistance, including the economic aspects, and to report back on options at the July 2017 G20 Summit in Hamburg, Germany. Perhaps most fundamentally, the private sector, particularly those in the food sector are paying attention to consumers and are taking their own actions by paying much greater attention to whether the food they serve contains antibiotics.
In this context, political commitments by heads of state and governments can further catalyze and intensify the actions needed. This is only the fourth time a health issue has been taken up (the others were HIV, noncommunicable diseases, and Ebola) by the UN General Assembly. The expected outcome of the high-level meeting is a political declaration and not a technical roadmap. But even the UNGA high-level meeting is not the complete answer. Real change will depend on what people do, and what governments do through effective public policies, legislation, multisectoral collaboration, and new drug development to support them. This global health crisis can be reversed through a thorough and collaborative effort from all stakeholders.