Positive or negative? Technician tests blood for HIV virus

“We regard AIDS as being the single most important issue at the moment in Africa because of the devastating effect that it has had throughout the Continent, and it is not something that is deferrable to discussions of economic or other issues,” President Jim Wolfensohn said of today’s announcement.  “The emerging epidemic in Asia, Europe and Central Asia and the Caribbean is also a tremendous concern. This initiative will help to get treatment to those most in need - the world's poorest people.  The Bank is pleased to be a partner in the program and fully supports it.”

Countries will be required to provide guarantees of payment, to conduct long term tenders and to ensure the security of drug distribution. The Global Fund, the Bank and UNICEF will support their funding recipients in complying with these terms, as consistent with their policies and existing practices. As a result of these agreements, the Clinton Foundation will work with its suppliers to find ways to make the low-priced medicines and tests available to more countries as soon as feasible. 

First line treatment  

Former U.S. President Bill Clinton said, “I am grateful for this collective effort, which will soon help many hundreds of thousands of people, and eventually millions of people, live longer, healthier lives.  With these agreements, we are one step closer to making sure future generations can live without the scourge of AIDS.  We are hopeful that developing countries and those who support them in the fight against AIDS will take full advantage of this agreement and act quickly to do all they can to help in this fight." 

The Global Fund focuses more than 60 percent of the $2.1 billion committed for two years, the Bank has committed $1.6 billion to and UNICEF spent $111 million during 2003 in the fight against AIDS..

Richard Feachem, Executive Director of the Global Fund, affirmed that, “Access to HIV treatment for all who need it is a moral imperative and now the target of growing financial commitments.  Today’s agreements build on sound science, agreed policy and market economics to maximize the reach of those commitments.  As a result, hundreds of thousands of additional people will receive the drugs they need to stay alive and remain healthy.”
 
The Executive Director of UNICEF, Carol Bellamy, added, “This new partnership works to break down some of the barriers - - such as price, supply and demand - - that are impeding access to life-saving AIDS medicines and diagnostics in developing countries. UNICEF is very proud to be part of this creative initiative that promises to save lives and bring hope to millions of children and families around the world.”
 
The drugs in these agreements include individual formulations and two- and three-drug fixed dose combinations which have been pre-qualified by the World Health Organization to assure quality and efficacy.  This standard is a prerequisite for procurement under Global Fund, Bank and UNICEF policies. These medicines are critical components of the four regimens recommended by the World Health Organization as “first line” treatment for AIDS in its 3x5 initiative. 
 
The pharmaceutical manufacturers in these agreements are Aspen Pharmacare Holdings in South Africa; Cipla, Hetero Drugs Limited, Ranbaxy Laboratories, and Matrix Laboratories in India.  The price for the most common first line formulation under these agreements is as low as $140 per person per year, one-third to one-half of the lowest price otherwise available in most settings.
 
The diagnostic tests are offered by five leading medical technology companies and include CD4 tests from Beckman Coulter, Inc. and BD (Becton Dickinson and Company) and viral load tests from Bayer Diagnostics, bioMérieux and Roche Diagnostics.  The prices available for these tests under the agreement include machines, training, reagents and maintenance and are up to 80% cheaper than otherwise available in the market.

Scaling up antiretroviral therapy

The cooperation between the Bank and the Foundation is indirect and different from a typical Bank partnership. Neither money nor in-kind support will be exchanged between the Bank and the Foundation.  Rather, the Bank and the Foundation will share information (e.g. procurement assessments), and the Bank has agreed to adapt some procurement procedures for its borrowers who want to benefit from the Foundation's drug and diagnostics purchase program.  However, countries will enter into "partnership" agreements directly with the Foundation and will conduct their own procurements for the drugs and the supplies.  Procurement staff will receive instructions shortly on how to adapt the bidding documents to enable countries to comply with the requirements of the agreements that the Foundation has signed with governments and suppliers.

Jim Wolfensohn on a recent visit to Nigeria

The Bank is also working with all major stakeholders in scaling up antiretroviral therapy and has recently issued technical guide, “HIV/AIDS Medicines and Related Supplies: Contemporary Context and Procurement,” setting out principles and advice for the procurement of HIV/AIDS medicines and related supplies.  The Guide adapts the World Bank’s guidelines on the procurement of the health goods to the HIV/AIDS context.

The Guide also examines the elements that are required for the establishment and continuity of supplies for health delivery, including medicines and other commodities. It provides extensive guidance on key topics:  Management of the Supply Cycle, Intellectual Property Rights (IPRs), Quality Assurance, Selection & Quantification of pharmaceuticals, Procurement Strategies and Pricing & Financing.

"The World Bank has dramatically increased its efforts to fight HIV/AIDS to ensure that prevention care and treatment reach those in need,” said Debrework Zewdie, Director, Global HIV/AIDS Program.  “As the AIDS agenda world-wide moves from advocacy to implementation, we welcome the collaboration of partners such as the Clinton Foundation towards accelerating access to antiretroviral treatment so that it reaches poor people and marginalized sections of society."