1. The Value of Partnerships in Fighting HIV/AIDS in Romania: Bringing Children New Hope Jeffrey L. Sturchio Vice President, External Affairs Europe, Middle East & Africa Merck & Co., Inc. European Health Forum Gastein October 10, 2004

2. Merck’s contributions to the fight against HIV/AIDS Leading scientific discoveries, e.g. structure of protease enzyme Discovery and development of new therapies: CRIXIVAN, STOCRIN Continuing research to develop safe and effective AIDS vaccine International partnerships to increase access to treatment and care –Accelerating Access Initiative –Enhancing Care Initiative –ACHAP –Romania

3. Romania’s HIV crisis 1997 –The issue: Nearly 6000 children in Romania were infected with HIV –Romanian government approached Merck We have a problem We want to deal with this issue

4. Romania’s HIV Crisis (cont’d) Infrastructure –40 local clinics (Infectious Diseases Hospitals) –No equipment for HIV/AIDS monitoring Medical Education –No treatment guidelines –Low medical knowledge (prohibited diagnostic) Low access to treatment –Only 1.5% (30 people )treated according to international guidelines

5. Foundation for Success – The National AIDS Program 1997 - Establishment of National AIDS Committee (NAC) within MoH NAC developed National AIDS Program (NAP) with 3 strategic steps: –Computerized network for case reporting and follow-up –National HIV/AIDS treatment guidelines –Regional AIDS Centers able to monitor the treatment MoH lacked the resources to sustain the Program entirely

6. Merck’s Response to the Crisis 1998 - Funded printing / distribution of first national treatment guidelines on HIV/AIDS 1998 - $40,000 donation to facilitate construction of national AIDS database 1999 - $1 million donation to establish national network of regional AIDS treatment centers –December 1999 - MSD granted Diploma of Excellence by Romanian National AIDS Committee 2002 - Additional $250,000 donation for additional test kits, technical assistance

7. Financial factors leading to increased access Government -- Steady increases in treatment budget from $2.7M in 1997 to $32.0M in 2004 Merck -- March 2001 lowered prices of CRIXIVAN and STOCRIN in Romania by 86% –Inspired Romania to enter AAI in June 2001, which led to promises of price reductions from other companies

8. AIDS Budget & Treated Patients,000 patients Mil. USD Treated Patients

9. Government actions in 2001: A new level of commitment Set new goal - 100% treatment access by end of year Cut import taxes and VAT on treatments Increased treatment budget by 80%, with supplemental allocation for children Decree ensuring rights of children with AIDS, including right to treatment Reached out to patients (UNOPA) Established Intersectoral Committee to ensure coordination and implementation of programs

10. HIV in Romania today: the power of parnterships In 1997, 5 out of every thousand diagnosed patients received HAART Today, all patients who need antiretroviral treatment under international guidelines are being treated –94% on triple combination therapy –6% on other regimens January 2002 GOR announced it had achieved its goal –publicly recognized MSD’s role in achieving the target –May 2002 briefing at UNGASS highlighted success of partnership

11. What did we learn? Political commitment of government is a must –NAC, AIDS Program, increasing funding National capacity can be built –Regional AIDS Centers Engagement of all sectors of national society/global community is necessary –Partnership with NGOs, pharmaceutical industry Safe and secure distribution systems are implementable –Over 20 distributors for AIDS drugs/medical equipment Prices must come down -- but this alone is not enough, and third-party financial support is needed –10 times increase in AIDS budget –Donations, sponsorships, Global Fund support Support for continued investment in R&D by the pharmaceutical industry is critical

12. Bringing Romanian Children New Hope Public-private partnerships, such as the one between the Romanian government and Merck, that combine political commitment with targeted private sector resources, can effectively increase the number of people who have access to international standards of care.