Unitaid strengthens malaria response by targeting threats to progress

Unitaid is to intensify its contribution to fighting malaria by targeting pregnant women and their babies, who are especially at risk, and promoting new approaches to overcome mounting resistance to existing tools for controlling the deadly mosquito-borne disease.

Meeting in Geneva, the Executive Board announced that Unitaid would focus malaria investments in three areas: expanding access to preventive chemotherapy in pregnant women; accelerating adoption of innovative vector control tools to combat emerging mosquito resistance to insecticide; and fast-tracking introduction of emergency treatments for life-threatening severe malaria.

Global health goals call for the 90 percent reduction of malaria cases and deaths and the elimination of malaria from at least 35 countries by 2030.  Despite a 37 percent fall in malaria cases worldwide since 2000, gains are fragile with deaths from the disease exceeding 400,000 in 2015, almost 80 percent of them children under the age of five.

Each of the areas targeted by Unitaid addresses serious challenges that could weaken efforts to end malaria:

  • More than 40 percent of pregnant women in sub-Saharan Africa are not being reached by preventive treatment for malaria. As a result, up to 200,000 deaths of newly born babies are linked to malaria infections during pregnancy.
  • The effectiveness of insecticide-treated mosquito nets and of spraying of homes with insecticide is being undermined as malaria mosquitoes develop resistance to these chemicals, posing a big threat to progress against the disease.
  • A significant number of children are dying from severe malaria, when the disease is so acute that it seriously endangers life. Unitaid will pilot test the use in countries of rectal artesunate, an emergency treatment that can buy enough time for a child to be taken to a health facility for curative therapy.

The Executive Board also asked Unitaid to explore how its investments could help improve access to diagnostic tests and treatments through channels such as private health facilities, village stores and informal vendors, which are an important conduit for healthcare especially in rural areas in Africa.

By defining clear areas for intervention to guide its work, Unitaid is ensuring that its grants drive innovation in support of global health goals and are more focused and efficient in a way that achieves more impact with scarce resources.

“Unitaid is positioning itself as a very competent facilitator that helps develop innovative ideas and solutions to fight killer diseases and make them accessible to countries at affordable prices,” said Marta Mauras Perez, Vice-Chair of the Board, who stood in for the Chair Philippe Douste-Blazy, who had an official travelling engagement. “Unitaid has reached an important new stage in its evolution as an organization that develops crucial tools in the fight against the three diseases.”

The Board also approved a broadening of the scope of an extended grant to the Medicines Patent Pool (MPP) beyond the original focus of HIV to include tuberculosis and hepatitis C.

MPP, which is wholly funded by Unitaid, seeks to develop better treatments that are better adapted to people’s needs and to lower drug prices through licensing agreements with patent holders.

A process was also launched by the Board to develop a new five-year strategy for 2017-21 that will ensure that Unitaid constantly adapts to a fast-changing global health environment.

HIV/AIDS diagnostics technology landscape – 5th edition

Patent landscape: grazoprevir

Unitaid brings innovation to the global response to HIV/AIDS, TB and malaria

UNITAID is taking steps to accelerate grant-making and maximize impact and value for money by targeting specific areas where its investments can best contribute to ending HIV/AIDS, tuberculosis and malaria as global epidemics.

At a meeting in Rio de Janeiro, the Executive Board announced it would as a first step focus investments in three areas, all of them identified in consultation with partners, as being crucial to help achieve a global target of putting 90 percent of all people diagnosed with HIV on treatment by 2020.

The three areas are: improving antiretroviral therapy for adults in low and middle-income countries; enabling the expanded use, or “scale-up”, of first pre-exposure prophylaxis (PrEP) as a means of preventing HIV transmission; and the development of better tools to diagnose hepatitis C virus (HCV), in particular for people who are co-infected with HIV/HCV.

Meeting the 2020 goals – which also include ensuring 90 percent of people living with HIV are aware of their HIV status and that 90 percent of those on treatment have viral suppression – will require the number of people on treatment in low and middle-income countries to more than double within 5 years.

“With the introduction of these ambitious new changes, UNITAID is intensifying efforts to end the three diseases, making the best strategic use of investments in areas where there is greatest need, ” said Executive Board Chair Philippe Douste-Blazy,

Each of these areas is subject to market constraints that are holding back scaled-up use of effective new treatments, diagnostics and other tools and putting the achievement of global health targets at risk.

“By working closely with our partners to identify where the greatest needs are and where UNITAID can intervene we will contribute to a more coordinated and effective response,” said UNITAID’s Executive Director Lelio Marmora.

Mr. Marmora also thanked Fiocruz, a prominent health institute attached to Brazil’s Health Ministry, for organizing the Board meeting. “We are especially grateful to Fiocruz, which has played such a dominant role in fighting disease in Brazil over the past century, for hosting such a productive meeting.”

The Executive Board also approved the introduction of a new operating model, which aims to make grant development faster, more focused and efficient, while ensuring that grants are fully consistent with global health goals and help global health partners achieve more with scarce resources.

Under the new approach UNITAID will launch targeted calls for proposals from grant applicants, guided by the specific areas of intervention that are identified through engagement with partners and countries.

UNITAID’s mission is to find new ways to treat, diagnose and prevent the three diseases faster, better and more effectively.

Health leaders see partnership driving innovation

Top public health officials from South Africa, Chile, Brazil, Cote d’Ivoire and France, and from organizations targeting HIV, TB and malaria met in Geneva to discuss leveraging innovation to accelerate the end of the three epidemics.

Opening the event on Sunday on the eve of the World Health Assembly, Philippe Douste-Blazy, Under Secretary General for the UN and Chair of the UNITAID board, said there was a clear link between innovative solutions and progress in global health.

Calling for increased efforts to promote innovation, Dr. Douste-Blazy cited GeneXpert as an example of a new diagnostic technique which had reduced the time it takes to detect TB from many weeks to a matter of hours.

The event, co-hosted by UNITAID and the Medicines Patent Pool (MPP) featured global and country perspectives to inform discussions at the World Health Assembly this week on the achievements of the Millennium Development Goals (MDGs).

Minister of Health for South Africa, Aaron Motsoaledi, said UNITAID and the Medicines Patent Pool had played a big part in bringing down the prices of antiretroviral drugs and putting large numbers of patients on treatment. “This is where UNITAID and MPP have played a significant part and I would hope that they are able to expand their role to other diseases such as TB.”

Lelio Marmora, Executive Director of UNITAID said the past eight years since UNITAID’s creation had shown how facilitating access to new solutions can have a game-changing impact on global health. “Cutting prices by 70% of critical medicines for HIV, by 40% for a new test for multi-drug resistant tuberculosis, and making it possible for more than 300 million of the best anti-malarials to be supplied, have contributed to significant progress against three major global pandemics,” he said. “We must continue to realize ever greater opportunities to leverage innovation to achieve the global goals.”

Others who addressed the meeting included MPP Chairman Charles Clift, Brazil’s Health Minister Arthur Chiaro, Chilean Health Minister, Carmen Castillo, Cote d’Ivoire’s Health Minister Raymonde Goudou Coffie and Benoit Vallet, General Director for Health at France’s Ministry of Social Affairs, Health and Women’s Rights.

As part of a global response to HIV/AIDS, TB and malaria, UNITAID was created in 2006 to play a catalytic role in global health, transforming game-changing ideas into practical solutions that overcome obstacles to progress. It does so by speeding the delivery of new, better and more affordable medicines and technologies; and, by investing in innovative solutions that match identified needs.  Ultimately it allows the broader landscape of donors, countries, communities, and other purchasers to do more with less in resource-limited settings.

UNITAID created the Medicines Patent Pool (MPP) in 2010 as a key component of its market shaping efforts to improve access to HIV medicines. The MPP aims to lower the prices of HIV medicines and facilitate the development of better-adapted therapies, such as simplified “fixed-dose combinations” (FDCs) and special formulations for children through voluntary licensing and patent pooling. “As the world’s only patent pool for HIV medicines, MPP partners with a range of stakeholders – including industry and civil society – to increase access to WHO-recommended ARVs in low and middle income countries,” said Greg Perry last evening. “We think this approach has merit and can play a key role in scaling up treatment for millions of people living with HIV and thus meeting HIV global targets.”

World Malaria Day 2015

Giving More Children Protection Against Malaria.

As the world marks malaria day with a call to ”invest in the future, defeat malaria,” we can celebrate that the global malaria map is steadily shrinking as millions more are reached with measures to prevent, diagnose and treat the mosquito-borne disease.

Yet despite a nearly 50 percent fall in mortality since 2000, malaria still claims more than half a million lives globally every year, most of them children under the age of five in sub-Saharan Africa.

The technical means already exist to make significant progress in tackling this disease. Cases of malaria could be reduced sharply by providing children with anti-malarial drugs at monthly intervals during the rainy season, when the spread of malaria is highest. However this approach to preventing malaria in children, known as seasonal malaria chemoprevention (SMC), is currently reaching only 3 percent of eligible children.

SMC works by keeping enough drugs in the bloodstream to prevent malaria-related illness for the duration of the  main malaria transmission season. SMC has the potential to reduce malaria cases and deaths in children under five years of age by 75 percent, and has been recommended by WHO since 2012.

UNITAID is now investing more than $67 million in the largest-yet programme to kick-start widespread deployment of SMC. This initiative, led by the Malaria Consortium with other partners, intends to reach 70 percent of eligible children in the targeted areas in seven high malaria-burden countries in sub-Saharan Africa where the main malaria transmission closely coincides with the rainy season: Burkina Faso, Chad, Guinea, Mali, Niger, Nigeria and The Gambia.

Philippe Douste-Blazy, Chair of the UNITAID Executive Board commented on how “this is a very important initiative for global child health, adding significantly to the toolkit for use against malaria.”

“SMC has huge potential to avert malaria cases and save lives,” said Lelio Marmora, UNITAID’s Executive Director. “With a $2.5 billion shortfall in global funding for malaria in 2013, investing in this project is part of UNITAID’s role to fund the development and implementation of ever-more effective tools to maximise impact from the resources available.”

The investment will help increase the supplier base, production capacity and reliability of SMC drug supply, as well as reducing the cost of SMC delivery. The programme will deliver the first doses of SMC drugs in May 2015 and will supply an estimated 15 million SMC treatments in 2015 and 30 million in 2016 – targeting a total of 7.5 million children and preventing over five million cases of malaria and up to 50,000 deaths over the life of the programme.

Mr Marmora added that as global efforts against malaria increasingly set sights on eliminating the disease, more pinpointed targeting of interventions is required – SMC is a good example of such an effort, tailored to the situation in the Sahel sub-region of Africa.

UNITAID is also investing in other key areas to support the control, management and elimination of malaria, including the deployment of malaria rapid diagnostic tests (RDTs) in private sector outlets and treating severe malaria using injectable artesunate and rectal artesunate. It has been estimated that if all cases of severe malaria were treated with injectable artesunate instead of quinine, nearly 200,000 lives would be saved each year.

Enabling better treatment of severe malaria — a photo story. (en anglais seulement)

Enabling better treatment of severe malaria — a photo story

Injectable artesunate has been recommended by WHO since 2011 as the most effective way to treat severe malaria. Today there are around 8 million cases a year, mostly occurring in small children, and is near-100% fatal if left untreated. Ethiopia responded quickly to the WHO recommendations and introduced injectable artesunate into its national malaria plan. However the product wasn’t being widely used as staff were unfamiliar with it and untrained in administering it. This has changed through UNITAID’s investment to facilitate better uptake of the product, including the roll out of a training programme. The UNITAID project is paving the way for the increased use of injectable artesunate in six high burden malaria countries, with the aim of enabling widespread global use down the road.

Unitaid urges support for ‘pharmaceuticals exemption’ for LDCS

UNITAID is concerned about the expiry of the ‘pharmaceuticals exemption’ for least-developed countries (LDCs) which originates from the Doha Declaration on the TRIPS Agreement and Public Health.

Due to this exemption, least developed countries (LDCs) are not obliged to grant or enforce patents and data protection for pharmaceuticals.

“As an organization that funds projects to improve access to medicines for HIV, TB and malaria in 94 countries, including many LDCs, UNITAID strongly supports the request by the least-developed counties for an extension of the transition period for pharmaceuticals.” said Lelio Marmora, Executive Director of UNITAID. “This exemption has facilitated access to affordable medicines in LDCs, and UNITAID urges WTO Members to unconditionally approve the request by the LDCs.”

The TRIPS Agreement makes it mandatory for countries to grant patents, including for medicines. “Patents can spur innovation, but can also delay generic competition, and have a negative impact on access to medicines, especially in poor countries.”

However, TRIPS also contains a number of flexibilities and safeguards. These flexibilities can be, and have been, used to ensure access to medicines – clearly an important social and public health objective for many WTO Members, as well as for the international community. The flexibilities and safeguards essentially relate to instances where countries have the freedom to interpret, define or defer the implementation of certain provisions of the Agreement.

One of the most important flexibilities for least developed countries (LDCs) is that they are not obliged to implement key sections of the TRIPS Agreement – notably the granting of patents and the provision of data protection – with regards to pharmaceuticals. This exemption will expire at the end of this year. Yet LDCs still face many constraints with regard to ensuring access to medicines for their populations. In this context, LDCs have requested an extension of this important exemption “until they cease to be a least developed country”.

“UNITAID believes that it is crucial that countries can make use of ‘TRIPS flexibilities’ in order to safeguard access to medicines.” said Mr Marmora “This certainly should apply to the most vulnerable members of the international community: the LDCs.”