The critical issues that middle-income countries face in ensuring they have access to affordable and high-quality HIV medicines were explored during a consultation held in Brazil’s capital Brasilia this week.
Responding to a situation where global debates around access to medicines tend to focus on lower-income countries, delegates from Brazil, China, Ecuador, India, Indonesia, South Africa and more than 20 middle-income nations from all continents, together with representatives from civil society and international organizations discussed their specific needs, perspectives and concerns. It was recognized that this is especially crucial given that by 2020 the vast majority of people with HIV will be living in such countries.
Many middle-income nations are now paying a high price for AIDS medicines, particularly those used for second- and third-line treatment. In fact, even the WHO-recommended first- line treatment, the one pill a day 3-drug fixed dose combination, is out of the reach of some countries, including Brazil, China and the Russian Federation.
This has profound implications for treatment optimization and long-term affordability and sustainability - identified as the central challenges at the meeting. Middle-income countries, often seen as lucrative markets, may not benefit from international initiatives on access to drugs. Most foot the bill themselves either through government funding or out of pocket expenditure and there is uncertainty as to whether the growing numbers of people on treatment will continue to get the life-saving medicines they need for as long as they need them.
“We must look at specific policy options and mechanisms available to middle-income countries to tackle barriers and ensure universal access to treatment,” said Ed Vela from UNITAID, which co-hosted the June 10 to12 event with UNAIDS, WHO/Pan American Health Organization and the Brazilian government.
There was much analysis and information sharing about the markets and prices of HIV medicines and their regulatory status in different middle-income nations. Individual country experiences and approaches were presented, taking into account the often wide disparities between those at different stages of economic growth.
Jarbas Barbosa da Silva Junior, Vice–Minister and Secretary for Health Surveillance of Brazil noted that his country was taking bold steps to rise to the challenge of inequalities present in a large middle-income country such as Brazil. “This meeting is an essential step to strengthen the cooperation mechanism between middle-income countries (MIC) and will help us reach universal and sustainable access to treatment”.
The key question of public health-focussed management of intellectual property rights was scrutinised in some detail. Supported by UNITAID, the Medicines Patent Pool - where holders voluntarily share their patents on HIV medication - allows generic drugs to be made at a reduced cost. However, the meeting heard that this facility is largely extended to sub-Saharan Africa and that most middle-income countries outside this region are excluded. Participants looked at ways in which policy levers and incentive mechanisms could be implemented to enable more countries to benefit from such voluntary mechanisms.
After three days of discussion, sharing information, ideas and strategies, delegates were keen to ensure that the consultation was not an end in itself but the start of a process. The need to continue to improve implementation of the policy options put forward for increased access to medicines for MICs was agreed. The outcome document from the meeting outlines key next steps in the areas of pricing, intellectual property, research and development, and regulation, by fostering information sharing and south to south collaboration on these areas
According to Mariangela Simao, UNAIDS Director of Gender, Human Rights and Community Mobilization, “The meeting was a valuable step forward bringing together middle-income countries from around the world with different challenges in achieving long term access and sustainability of antiretroviral therapy.”