UNITAID: Health spending in developing countries brings a ‘five-fold return’

Philippe Duneton [UNITAID]

Access to new treatments for the big pandemics in Africa has improved, thanks to falling prices, and the ending of medical patents, Philippe Duneton told EURACTIV France.

Philippe Duneton is the Deputy Executive Director of UNITAID, an international organisation which aims to facilitate access to treatments against AIDS, malaria and tuberculosis in low income countries. UNITAID is in great part financed by a solidarity levy on airline tickets. 

Duneton spoke to Cécile Barbière.

The fight against the major pandemics of HIV, tuberculosis and malaria in developing countries had been one of the development success stories at the start of this century. Is there still a long way to go to end this epidemic?

To end the AIDS epidemic we need to double the number of people receiving treatment in developing countries. Today, around 15 million people are receiving treatment; this has to be increased to 30 million. The screening programme needs to reach 90% of the people infected with the virus, and then 90% of these people need to be treated. The long-term objective on these three diseases is to halt transmission by 2035. Just 20 years ago, they said nothing could be done to treat people with AIDS in Africa…

How does UNITAID facilitate access to treatment for HIV, tuberculosis and malaria in developing countries?

We are working to bring down the price of the treatments for these big pandemics. We are also working to facilitate access to effective and appropriate medication in developing countries, particularly for children. This did not exist ten years ago when UNITAID was founded.

We are deeply involved in innovation, for example in the development of easier-to-use screening tests for AIDS – like saliva tests –, and in improving diagnostic tools, because lots of people don’t even know whether or not they have the virus.

And we are working on preventive tools. For example, for some high risk social groups, we have developed preventive medication regimes to arm this part of the population against contamination. In some urban areas of South Africa, 20% of young people are HIV positive. In these areas, the use of preventive medication has brought down the infection rate by 80%.

Finally, we are actively trying to simplify many treatments. The simplicity of a particular treatment determines how likely a patient is to continue with it. Patients are more prone to abandon treatments that involve taking lots of medication or that have lots of side effects.

Thanks to a partnership with Partners in Health and Doctors Without Borders, we have brought the treatment of tuberculosis down from a 24-month series of injections to a nine-month regimen of pills. It is important for all patients, but particularly so for those who live in poverty and cannot afford to lose their job.

The exorbitant prices charged by the pharmaceutical companies are one of the main factors restricting access to medication. How can we bring down the price of treatments enough to make them accessible to the countries of the Global South and the poorest populations?

Ten years ago we managed to bring down the cost of treatments by making open calls for tender among generic manufacturers. In exchange for a guaranteed price, we commit to buying a certain volume of the drug. This allowed us to agree a far lower price than we would have been offered by the pharmaceuticals laboratories.

Today the laboratories working on HIV treatments commit to giving up their patent before the drug even comes to market, through the Medicines Patent Pool system. This is a fundamental change, which allows makers of generics to develop treatments far faster than in the past. Treatments developed in the North are now available two or three years later in developing countries, notably in Africa, for a reduced price. When UNITAID was founded, this process took 12 years.

New HIV treatments that are used in developed countries are more effective and lead to less resistance in patients.

But these cost around €15,000 per patient per year. We hope to get this down to between €100 and €300 per patient per year in developing countries.

How do you ensure the financing of the fight against AIDS and the other big pandemics?

Of course we need financial resources, and international aid plays its part. But developing countries largely finance the fight against these diseases themselves. They cover 50% of the cost of AIDS treatment, 70% for tuberculosis and 60% for malaria.

Investments in health bring extremely good returns because they have a fundamental impact on the country’s development. UNITAID, which has had a budget of around €2.5 billion over the last ten years, estimates that every euro invested has generated a five-fold return.