1. UNITAID Matching Innovation and Sustainability: An Innovative Mechanism for Scaling-up Treatment for HIV/AIDS, TB and Malaria Jorge Bermudez, Executive Secretary, UNITAID (WHO-UNICEF Technical Briefing Seminar 4 Nov 2010)

2.  Building the way  The Leading Group on Innovative Financing (Paris Conference 2006) :  Recent sessions of the Leading Group Innovative mechanisms: a long way forward 2000 - The Millennium Development Goals 2002 - Monterrey International Conference on Financing for Development 2004 - The Global Action against Hunger and Poverty 2005 - New York Declaration on Innovative Sources of Financing for Development – 55 member countries and 3 observer countries, major international organizations and NGOs – a platform for discussion and promotion of innovative financing - New resources, New sectors, New mechanisms - UNITAID - (Proof by example: why expand innovation?). Paris, 28-29 May 2009 - (UNITAID highlighted). Santiago, 28-29 Jan 2010); MDG Summit, 20-22 Sep 2010

3. Official signature of the five founding countries when UNITAID was launched, on 19 September 2006, at the United Nations General Assembly, New York Five founding countries (September 2006)

4. From 5 founding countries (2006): Brazil, Chile, France, Norway, UK Now (2009): supported by 29 countries and the Gates foundation UNITAID membership 5 further countries in the final stages of negotiation and to join shortly

5. UNITAID Can globalization work for the poor? UNITAID is an innovative financing mechanism that uses market-based tools to expand access to quality life-saving treatments for HIV/AIDS, TB and Malaria Leverage price reductions of quality drugs and diagnostics Accelerate availability Partners Working towards the common goal of expanding access to health What is UNITAID?

6. Medicines are in the North, patients in the South Less developed countries represent: 84% of the world population Less than 11% of the global health expenditure More than 93% of the disease burden globally A global challenge for Health…

7. Resource Mobilization Funding from multiple countries from both North and South A hosting agreement with WHO Predictable funding gives UNITAID flexibility to respond quickly UNITAID will pursue measures that increase funding through –Strengthened donor commitments –Results on investments –Increased number of country contributors Long term financing = commitment to projects = ability to impact markets

9. UNITAID: What is Innovative?

11. A flexible 'air tax' approach

12. The 'air tax' decision making process Political decisionInterministerial discussion Collection of revenue Consultation with other stakeholders Entry into force of the law Adoption of the law

13. 93 countries already receive UNITAID support… HIV / AIDS 49 countries Malaria 29 countries Tuberculosis 72 countries US$ 1.3 Billion committed and over 21 million treatments in less than 4 years

14. AIDS/HIV

15. Now (partnering with CHAI): Fixed dose combination 3 tablets a day US $ 60 per patient per year Before: Single dose syrups 16 bottles of syrup monthly US $ 200 per patient per year Better products at lower price Pediatric ARVs

16. Better products at lower price Tuberculosis A rotating stockpile that treats 5800 patients a year New faster diagnostics that can detect MDR-TB in just two days (previous test took six weeks)

17. Policies, norms international standards Participate in lab assessments Provide long-term, on-site monitoring Develop indicators and tools for M&E Funding for essential instruments, reagents, supplies Negotiate with partners to ensure lowest prices Ensure customer support in place Share know-how from product development process Provide long-term, on-site mentoring for technology transfer Coordinate and manage procurement and delivery Engage industry to ensure affordability and sustained price decreases Collaborate with WHO Pre-qualification to include diagnostics BUILDING SOLID PARTNERSHIPS

18. Investing in prevention with long lasting insecticide treated bed nets Provision of ACTs at lower costs UNITAID's recent commitment to the AMFm Better products at lower price Malaria

19. Call for proposal Approval by the Board Year 1Year 2Year 3Year 4Year 5 MoU signed Project monitoring - Sharing information with global partners Project assessment -Market Impact -Public Health Impact Transition -Predictable -Avoid disruption of supplies -Sustainability of demand 2 year extension 3 year project Year on year commitment - ensure predictability Transition

20. AIDS Treatment Needs Expand treatment to all in need Provide improved 1 st line treatment Start ARV treatment earlier (recent guidelines) Ensure 2 nd and 3 rd line treatment available Adapt treatments for resource poor environments

21. Source: Medecins sans Frontieres (www.msfaccess.org) First-lineSecond-linePossible third-line

22. 2006 2008 UNITAID Developed the implementation plan for the medicines patent pool Ongoing dialogue on terms and conditions with patent owners UNITAID Board support to the establishment of the Patent Pool Foundation Decides to fund up to $ 4 Mill Patent Pool Foundation open for business 2010 CIPIH 2006 recommendation: "Patent pools of upstream technologies may be useful in some circumstances to promote innovation relevant to developing countries.” and MSF and KEI proposed to UNITAID to set up a medicines patent pool. May 2008 WHO Global Strategy and Plan of Action included Voluntary Patent Pools July 2008 UNITAID Executive Board Supports the principle of establishing a patent pool and requests the secretariat to undertake all necessary actions for this establishment. 2009 History of Medicines Patent Pool

23. The UNITAID Patent Pool Initiative Preparing for the Future Offers licenses for the use of patents and other relevant intellectual property (IP) related to HIV/AIDS drugs against a payment of royalties. Aim: Bring the price of (new) AIDS medicines down by increasing market competition Enable the development of adapted formulations of AIDS drugs e.g. Fixed-dose combinations (FDCs) & pediatric formulations

24. Will it work? Yes, if: Patent owners and generic manufacturers collaborate Global Health Funding remains of sufficient levels to ensure the market Yes, because: if we do not succeed, we will be faced with large increase in cost of treatment and risk losing progress made

25. Let's Take the Plunge! –(…) –Today patent pools are a favoured system in technology sectors that require common standards, such as the MPEG-2, DVD- video, DVD-ROM and radio. Medicines, though, are trickier terrain. –(…) –UNITAID may be able to pull it off with some luck and lots of hard work. (…) They have a delicate and onerous task before them. Millions of people are waiting hopefully at the patent poolside." –Latha Jishnu/ New Delhi July 23, 2008

26. Summary examples of UNITAID Actions and Impact … Supported 3 out of 4 children on treatment for HIV/AIDS through its funding and partnership with the Clinton Health Access Initiative. Reduced prices by an average of 64% for leading paediatric AIDS regimens and by 43% for leading adult second-line AIDS regimens. Committed US$ 130 million to the Global Fund's AMFm (Affordable Medicines Facility for Malaria) to make available affordable and highly-effective artemisinin-based combination therapy. Invested US$ 54.5 million in the WHO’s Prequalification of Medicines Programme, which has helped make available 29 new and better adapted medicines, including new fixed-dose combinations and paediatric formulations. Established a Medicines Patent Pool for AIDS medicines.

27. What next?