1. UNITAID actions and main achievements A new innovative mechanism for scaling up access to medicines and diagnostics for HIV/AIDS, TB and malaria XVII International AIDS Conference Satellite Forum ANRS France – Ministry of Health Brazil (Mexico, 4 th August 2008) Jorge Bermudez Executive-Secretary, UNITAID

2. The MDGs (New York, 2000) Monterrey consensus on financing for development (18 to 22 March 2002, 50 Member States) 44 countries discussing innovative ways for financing development The Global Action against Hunger and Poverty (20 September 2004, 111 Member States) The Paris Declaration on Aid Effectiveness (2 March 2005, 100 member States) Global Health landscape Globalization, Trade and Health "There is a ‘fundamental imbalance’ with the world spending US$900bn on defense; around US$325bn on agricultural subsidies and only US$50bn to US$60bn on aid." James Wolfensohn Former President of the World Bank Context for UNITAID

3. Unaddressed issues at stake: medicines for children, second-line treatments A plus to existing initiatives, supporting the worst affected and most vulnerable countries A new and innovative mechanism for financing treatment Long-term funding: manufacturer-attractive Global forecasting ensures supply; a comprehensive approach to access addressing demand and supply factors Building solid and strong partnerships with current initiatives A multi-dimensional approach (addressing quality, regulation, IPR, pricing, in-country support for supply systems) Influencing the Health Agenda Why UNITAID ?

4. Official signature of the five founding countries when UNITAID was launched, on 19 September 2006, at the United Nations General Assembly, New York Five founding countries (Sept. 2006)

5. Official signature of the five founding countries when UNITAID was launched, on 19 September 2006, at the United Nations General Assembly, New York Five founding countries (Sept. 2006)

6. Countries that implemented the air tickets levy Tax adopted : - France - Chile - Cote d’Ivoire - Congo - Mali - Madagascar - Mauritius - Niger - Republic of Korea - Norway (CO2 tax on kerosene) Countries committed to implement the tax : Benin, Brazil, Burkina Faso, Cameroon, Cyprus, Gabon, Guinea, Liberia, Mali, Morocco, Namibia, Central African Republic, Senegal, Sao Tome & Principe, Togo Countries committed to implement a budget contribution : South Africa Countries contributing to UNITAID Budget contribution : - Spain - United Kingdom

7. Impact of the air tickets levy: an example Tax received on each ticket by UNITAID (in France) Economy class First class or business Flight in France or in Europe 1 €10 € International flight 4 €40 € An aircraft with 300 passengers on board leaving from Paris will cover the treatment for 1 person with multi drug resistant tuberculosis (approx. 4.000 $) or 60 HIV-positive children for one year Antimalarial treatment for 2 children 1 HIV-positive child under treatment for 1 year ex: flight Paris - Berlin ex: flight Paris - Dakar Furthermore… no economic impact on air traffic Impact of the levy: the French exemple

8. UNITAID use of funds allows to: 1/ Impact markets and reduce prices: more drugs for same budget ex: price reduction on pediatric (- 40%) and 2 nd line ARVs (-25% to – 50%) 2/ Have manufactured medicines better adapted to patient needs ex: first fixed dose combinations for pediatric ARVs in 2007 3/ Contribute to address quality issues (incentive for manufacturers to invest) ex: support to WHO program for prequalification of products 4/ Deliver rapidly medicines in the countries in need (basic model - medicines instead of funds) ex: treatments already provided in a number of countries for ARV, TB and ACT UNITAID added value

9. More than 80 countries already receive UNITAID support… UNITAID ongoing actions HIV / AIDS 51 recipient countries Malaria 22 recipient countries Tuberculosis 58 recipient countries - Pediatric ARV - Second line ARV - PMTCT - ACT- First line TB - Pediatric TB - MDR-TB

10. AFRO Angola Benin Botswana Burkina Faso Burundi Cameroon Chad DRC Cote d'Ivoire Ethiopia Ghana Guinea Kenya Lesotho Liberia Malawi Mali Mozambique Namibia Nigeria Rwanda Senegal Swaziland Tanzania Togo Uganda Zambia Zimbabwe SEARO India WPRO Cambodia China Lao Papua New Guinea Vietnam AMRO Dominican Rep. Guyana Haiti Jamaica OECS (Anguilla, Dominica, St Lucia, Antigua & Barbuda, Grenada, St Christopher & Nevis, British Virgin Islands, Montserrat, St Vincent & Grenadines) EURO Moldova Serbia EMRO Djibouti Morocco Tunisia 51 recipient countries from UNITAID funds against HIV/AIDS

11. Unit of measure *Footnote Source:Source 11 Existing market impact by UNITAID 2 6 - - 2 (+ 8) Availability--1 Diagnostics (ped.) GMP-1 (+2)1 Co-trimoxazole GMP-2 (Africa)1 RUTF 1 2 1 N/A - 6 11 Additional nb of products AVAILABILITYPRICEQUALITY Price containment/Stockpile establishment Price stabilizationN/A 1 st line TB FDCs in 26 countries + price reduction Av. 60%12 (FDC) Pediatric ARV HIV Accelerated access to TDF/3TC + Price reduction Av. 30%12 2 nd line ARV Specific pack-- PMTCT Main market impact Price reduction New drugs pre qualified in 2007 Nb of new productions lines* NicheDisease -1(+ 7)1 ACT scale up Malaria Stockpile establishment/PreQ incentives Price reductions targeted for 2010 2 MDR-TB (2 nd line) TB Availability/PreQ incentives Cost savings/price discounts due to pool procurement. Further reductions targeted. 1 Pediatric TB * Nb of new products developed X nb of manufacturers

12. Unit of measure *Footnote Source:Source 12 UNITAID initiatives have already driven major price reductions (partnering with CHAI) Change in peds ARV prices (AZT FDC vs. individual syrups) US$/patient per year 2006Q1 2008 50% $66 $130 Change in 2 nd -line ARV prices (TDF+3TC) US$/patient per year 2006 Q1 2008 50% $159 $315

13. Now (UNITAID-CHAI): Fixed dose combination 3 tablets a day 60 $per patient per year Before: Single dose syrups 16 bottles of syrup monthly 200 $ per patient per year Better products at lower price

14.  Consolidate current niches and necessary transitions with partners  Identify areas to expand (diagnostics…)  VSC (a worldwide citizenship solidarity contribution)  Moving towards a patent pool UNITAID: challenges ahead

15. www.unitaid.eu