Select Committee on International Development Minutes of Evidence

Memorandum submitted by Glaxo Wellcome plc

  As a leading researcher and provider of treatments for HIV/AIDS, Glaxo Wellcome is acutely aware of the growing epidemic in Africa and other parts of the developing world, and of our responsibilities in responding to it. In developed countries, well-resourced prevention campaigns have stabilised and in some cases reduced HIV infection rates. Sophisticated combination antiretroviral therapy is dramatically reducing the number of deaths from AIDS. The challenge now is to find ways of closing the gap in HIV infection rates and AIDs deaths between rich and poor countries.

  While there are considerable obstacles to improving HIV care and prevention in developing countries, we believe that there is much that can be done now to reduce the impact of HIV. Our experience over the last decade in helping to tackle these problems convinces us that a multi-sectoral response involving the UN, national governments, communities, industry and NGOs is crucial. For this to be successful, a strong political lead at the national and international levels is an absolute prerequisite.

Prevention of Mother to Child Transmission of HIV

  One area where there has been some success has been in the prevention of mother-to-child transmission (MTCT) of HIV through short courses of antiretrovirals. Since 1996, Glaxo Wellcome has been collaborating with the international programmes of clinical trials coordinated by UNAIDS. The results of the first of these trials have demonstrated the effectiveness of short course regimens, including Retrovir (AZT) and Epivir (3TC). In January 1998, we announced preferential pricing of up to 75 per cent below global prices on our antiretrovirals for use in MTCT programmes in developing countries. We are now supporting the UNICEF-led international programme in 25 developing countries, providing free initial start up supplies of 30,000 treatment courses of Retrovir, as well as working with the UN and NGOs to engage the support of local communities. In addition, we have worked with the national governments of other countries to establish similar programmes, again with the offer of preferential prices, including Botswana and Burundi. Similarly, in South Africa, we have been in discussion with the Ministry of Health about such a programme since 1997. It is estimated that the total cost of a national programme would be some £9 million a year, of which the drug cost would account for £2.7 million. So far the Ministry has declined to implement the programme on grounds of affordability; but we remain committed to working with the Government to make such a programme available and sustainable in the South African context.

UNAIDS Treatment Access Initiative

  Glaxo Wellcome is also a founding partner of the UNAIDS Treatment Access Initiative. The aim of this two-year-old programme is to evaluate how limited healthcare infrastructure can be adapted to support standards of HIV treatment found in the industrialised world. Besides providing financial and technical support for the establishment of the programme itself, the company has also made available its antiretrovirals at preferential prices.

  However, as the Treatment Access Initiative has demonstrated, the cost of medicines is by no means the only barrier to improved care for people living with HIV/AIDS. Political will to establish the necessary HIV public health context is fundamental. One of the main successes of the UNAIDS initiative has been the establishment of National Advisory Boards, which have placed treatments in the broader context of the country's commitment to prevention and care. In addition, adequate health infrastructure, including effective laboratory services, and trained health care professionals are crucial to ensure the effective use and monitoring of combination antiretroviral therapy.

New Public-Private Partnership to Accelerate Access to Care and Treatment

  Building upon this experience, in May 2000, Glaxo Wellcome joined a new multisectoral collaboration with four other pharmaceutical companies (Boehringer Ingelheim, Bristol Myers Squibb, Hoffman La Roche and Merck) and five UN agencies (UNAIDS, UNICEF, UNFPA, World Bank and World Health Organisation), under the auspices of the International Partnership Against AIDS in Africa initiative (IPAA). The aim is to find practical and specific ways of working together more closely to make HIV/AIDS care and treatment available and affordable to significantly greater numbers of people in need in developing countries.

  The participants have adopted a set of principles that reflect a common vision of how the HIV/AIDS epidemic can be more effectively tackled in developing countries: unequivocal and ongoing political commitment by national governments; strengthened national capacity; engagement of all sectors of national society and the global community; efficient, reliable and secure distribution systems; significant additional funding from national and international sources; and continued investment in research and development by the pharmaceutical industry.

  The participants in the effort acknowledge that affordability of HIV/AIDS-related care and treatment is an issue in developing countries-though only one among many obstacles to access, including social/political/structural and economic issues, healthcare financing, physical barriers, and information gaps. They are willing to work with committed governments, international organisations and other stakeholders to find ways to broaden access while ensuring rational, affordable, safe and effective use of drugs for HIV/AIDS-related illnesses. The companies, individually, are offering to improve significantly access to, and availability of, a range of medicines.

  Within UN-supported and nationally led HIV prevention and care programmes, Glaxo Wellcome is now extending its programme of preferential pricing to include Retrovir, Epivir and Combivir (the fixed dose combination of AZT and 3TC). The price of a double combination would be around £1.30 per day. These preferential prices are offered for use in international partnership programmes in developing countries which simultaneously address the healthcare infrastructure and drug distribution aspects which are necessary to ensure access to safe and effective on-going treatment.

Positive Action: Community Care Support and Education

  Improving the quality of HIV care and prevention also means reducing stigma and discrimination, as well as improving the social and economic conditions of people living with and affected by HIV/AIDS. An additional aspect of Glaxo Wellcome's commitment to combat HIV/AIDS in developing countries is Positive Action, a long-term programme of community care, support and education. Since its launch in 1992, Positive Action has collaborated extensively with HIV community groups and NGOs to help affected communities to develop effective, sustainable and culturally appropriate responses to the epidemic. Positive Action jointly developed with the international HIV/AIDS Alliance (UNAIDS collaborating centre) a three year programme designed to help developing country community groups to improve the quality of their HIV/AIDS work and the support given to community groups by regional and international policy-makers and donors. The programme is being conducted in Senegal, Burkina Faso, Zambia, Ecuador, Sri Lanka, Bangladesh and Cambodia. Positive Action is launching a new initiative to increase the involvement of people living with HIV in support of the UN-International Partnership Against AIDS in Africa. Grass-roots community groups will be strengthened through direct training and technical support from similar groups in the continent.

Glaxo Wellcome's Response as an Employer

  Glaxo Wellcome has operated a global HIV policy and education programme since 1996; these have been used and adapted by a number of other international companies. Within Glaxo Wellcome, the policies have been put into practice in supporting individual employees around the world who are living with or affected by HIV/AIDS.

  Glaxo Wellcome was a founder member of the Global Business Council on HIV/AIDS, which was established by the Chief Executives of 15 international companies in 1997 with the support of UNAIDS. Through its programme of support for national business HIV coalitions in developing countries, and advocacy with other multinational companies, it is seeking to strengthen the response from the broader corporate sector globally, through workplace education programmes, care for affected workers, and corporate responsibility outreach programmes.

Intellectual Property Rights and Access to Treatment

  It is sometimes claimed that the current lack of access to HIV/AIDS care and treatment in developing countries is caused by the cost of medicines, which itself results from the intellectual property rights attaching to those medicines. It is further argued that abrogating those rights would bring prices down, thereby improving access to treatment.

  However, in many developing countries, current antiretrovirals do not benefit from intellectual property protection. Generic versions of zidovudine (AZT) are legally available in countries such as India, and yet the problems of access to treatment are severe. We believe that in countries which have decided to make HIV/AIDS a public health priority, companies such as Glaxo Wellcome can make a significant contribution, through preferential pricing of our medicines, and as full partners in a broader multi-sectoral response.

  It is essential that the research-based pharmaceutical industry is recognised as part of the solution. Despite the hope offered by combination therapy, there is still no cure for HIV/AIDS. Efforts to develop vaccines must be accelerated. In addition, industry's extensive research and development capabilities must continue to be harnessed in order to produce new, easier-to-use medicines that will be increasingly useful in developing countries. Our ability to continue to invest in R&D is, however, critically dependent upon the existence of intellectual property protection.


  Glaxo Wellcome is committed to playing a full part in international efforts to combat the HIV epidemic in developing countries. To this end, we will continue to establish new and innovative partnerships with UN agencies, governments, local communities and NGOs.

Glaxo Wellcome plc

June 2000

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