1. ACCESS TO MEDICINES | 1 Access to Antimalaria Medicines: the Impact Malaria approach F. Bompart, M Bernhardt ICIUM 2011, Antalya, November 16, 2011 Session 4f. Malaria : the role of medicines outlets in improving access to medicines

2. ACCESS TO MEDICINES | 2 Access to Medicines’ Mission & Objectives ● Mission ● In emerging and developing countries, to improve access to medicines for all patients, in particular the poorest, for selected diseases in which the Group has developed an expertise ● Two objectives ● Corporate Social Responsibility: help break “disease-poverty” cycle ● Economic: develop Sanofi’s presence in emerging and developing countries

3. ACCESS TO MEDICINES | 3 Four Strategic Levers ● In partnership with external stakeholders, we mobilize Sanofi’s core skills to sustainably improve access to medicines by 1. Developing medicines to meet current and future patient needs 2. Making medicines affordable, through tiered-pricing 3. Providing information and educational tools for malaria management

4. ACCESS TO MEDICINES | 4 The Impact Malaria program

5. ACCESS TO MEDICINES | 5 15-25 kg >35 kg 25-35 kg 5-15 kg AMPM Artemisinin-based combinations in 2004 Adult (>35 kg) Child (17-35 kg) Toddler (8-17 kg) Infant (<8 kg) Artesunate-Amodiaquine Co-blister Arthemeter Lumefantrine

6. ACCESS TO MEDICINES | 6 15-25 kg >35 kg 25-35 kg 5-15 kg AMPM Artemisinin-based combinations since 2007 Adult (>35 kg) Child (17-35 kg) Toddler (8-17 kg) Infant (<8 kg) Artesunate-Amodiaquine Co-blister Arthemeter Lumefantrine “ASAQ”

7. ACCESS TO MEDICINES | 7 Malaria - Industrial ● Production of ASAQ in Morocco ● WHO-certified GMP production ● Production capacity increased to more than 70 million treatments/year: 15 -20% of plant activity

8. ACCESS TO MEDICINES | 8 Public markets Artesunate-Amodiaquine Winthrop ® 25 blisters / box Preferential price, including “no profit-no loss” prices < $1 for adults, <$0.50 for children Private markets Coarsucam ® 1 blister / box $2-3 wholesalers price Affordable Medicines : Tiered-pricing policy

9. ACCESS TO MEDICINES | 9 Information and Educational tools ● Drugs alone are not enough ● Tools to promote comprehensive disease management ● Prevention ● Diagnosis ● Treatment ● “Tool Box” to be adapted by local stakeholders

10. ACCESS TO MEDICINES | 10 Communities and families > Health posts > National hospitals > Dispensaries Primary care centers > District hospitals > Regional hospitals Physicians-GPs Nurses Healthcare technicians Tools for comprehensive management of malaria

11. ACCESS TO MEDICINES | 11 Côte d’Ivoire

12. ACCESS TO MEDICINES | 12 Burkina Faso

13. ACCESS TO MEDICINES | 13 « Schoolchildren against malaria » 1. Information on malaria to teachers 2. Schoolchildren informed on malaria 3. Schoolchildren design a theatre play 4. Contest between schools for best play ● Côte d’ivoire (3 sessions), Ghana (2), Burkina Faso (2) ● End 2010: > 200 000 children involved

14. ACCESS TO MEDICINES | 14 ASAQ Winthrop ® - Delivery status Global Fund Global Fund, World Bank and/or PMI Direct country purchase ASAQ used in 21 countries 2008: 6 million treatments 2009: 25 million treatments 2010: 44 million treatments July 2011: cumulative sales > 100 million

15. ACCESS TO MEDICINES | 15 Partnerships for Access to Medicines

16. ACCESS TO MEDICINES | 16 Partnerships ● Access to medicines and to health: a complex set of issues ● Political commitment ● Budgets ● Human resources ● Heath infrastructures ● Social security, insurance ● Access to commodities, including medicines Affordable Adapted Accessible Quality ● The pharmaceutical industry is only one of many stakeholders, based on its ● Areas of expertise ● Areas of legitimacy

17. ACCESS TO MEDICINES | 17 ● Operating model based on partnerships ● Test new business models for the “base of the pyramid” patients ● Access to medicines ● Integrated disease management: prevention, diagnosis and treatment. Access to Medicines: a source of innovation

18. ACCESS TO MEDICINES | 18