International community meeting on drug pricing
Bob Huff for HIV i-Base
During the past year and a half, people living with HIV/AIDS (PLWHA) and HIV community advocates from around the world have begun meeting to discuss how they can advance treatment literacy and increase PLWHA input into decisions by the commercial, research, educational and care programmes that affect them. In Europe and the US, community advisory boards (CABs) have long been an important vehicle for representing the needs of PLWHA to drug companies, researchers and government regulators.
In February 2004, for the first time, a World CAB was convened to enable PLWHA from the developing world to voice their concerns about drug pricing in their regions to senior representatives of the multinational pharmaceutical industry. Twenty-eight individuals from 21 countries gathered in San Francisco, California, in advance of the annual Retrovirus Conference, the year’s most important scientific conference on HIV, to meet with officials responsible for marketing and global pricing policies at Roche, GlaxoSmithKline, and Boehringer Ingelheim. The participants, from South America, Eastern and Western Europe, South and Southeast Asia, and North America, are active in treatment advocacy and literacy efforts in their own countries; many had first met during the First International HIV Treatment Preparedness Conference, held in Cape Town in March 2003.
During the three-day World CAB meeting, participants questioned company representatives about pricing and research policies and asked the pharmaceutical companies to:
1. Review pricing policies within low and middle income countries:
- the economic development criteria used to set prices are often unrealistic
- rigid pricing structures produce inequitable outcomes
- disparities between regions are often not justified
- the continued relevance of Accelerating Access Initiative (AAI) pricing agreements is questionable
- the gap between no-profit prices and prices in middle income countries is too wide
2. Halt corporate activism to win trade advantages in excess of those provide by
- do not undermine the Doha world trade agreement language
- do not lobby for bilateral trade agreements with US (FTAA)
– extension of patent terms to 30 years
– research data as intellectual property
3. Conduct relevant, responsible and ethical research in developing regions:
- publish details of clinical trials being conducted in the developing world
- assure usefulness and rationale of these trials to their particular settings
- assure usefulness and rationale of these trials to their particular settings assure continued availability of tested drugs at affordable prices after research is concluded
- perform long-term side effects research among diverse ethnic groups
- perform interaction studies with opiates and amphetamines
4. Incorporate PLWHA involvement at all levels:
- in the design and conduct of clinical trials in developing world settings
- in discussions with governments, NGOs and drug companies
- in the design of treatment literacy programmes for patients and professionals
5. Promote product availability and utility:
- drugs need to be registered and marketed in middle income countries with small markets
- explore simplifying regimens, including co-formulating and co-packaging with drugs from other manufacturers, including generic makers
- guarantee the development and distribution of paediatric formulations
- extend shelf-life of products for tropical regions
- halt promotion of suboptimal therapies (eg Trizivir in Moldova)
World CAB participants agreed to follow up on these action items:
- ask UNAIDS to review AAI assumptions for relevance in 3 by 5 era (the WHO target of treating .three million people by 2005)
- initiate community contacts with WHO staff in-country
- arrange future CAB meetings with generic manufacturers
- plan follow-up meetings for the International AIDS Conference in Bangkok.
The World CAB pricing meeting was organised by HIV i-Base of London and GMHC of New York. We will be producing a full report from the meeting.
Bob Huff is the editor of GMHC Treatment Issues, the HIV treatment research and policy publication of Gay Men’s Health Crisis (GMHC), New York.