NGO position paper on the Global Fund

Background The Global Fund to fight AIDS, TB, and Malaria (GFATM) has been formed to mobilise additional support for developing countries in tackling the problems of HIV/AIDS, TB, and malaria. The GFATM currently stands at 1.9 Billion dollars, to be spent over the next three years. This level of funding is far below the 7-10 billion per year that the UN has estimated is necessary to tackle HIV/AIDS alone. There is ongoing debate as to the appropriateness of the GFATM and its place in tackling these diseases. In particular there is a lack of consensus on whether it should concentrate on supporting purchase of drugs and other commodities, or on supporting broader initiatives and health systems, or both. This statement does not intend to contribute to or comment on that debate, but rather to ensure that wherever commodities are purchased, this be done by the most sustainable and cost-effective means. Advancing the cause of equity pricing The Doha Declaration of October 2001 on the TRIPS Agreement and Public Health reaffirms ‘that the agreement can and should be interpreted and implemented in a manner supportive of WTO members right to protect public health and, in particular, to promote access to medicines for all.’ While we welcome this clarification, which was supported by the GFATM, the TRIPS safeguards have had little practical application as yet in developing countries. The GFATM has the potential to encourage efforts to establish systematic equity pricing and promote access to medicines, including the development of sustainable tiered pricing systems and the use of generic products. It also has the potential to discourage countries from making use of generic products and TRIPS safeguards, and so undermine the intent of the Doha declaration, by effectively subsidising the use of high priced branded products. We note with concern that a number of proposals have been put forward to the GFATM, applying for funding for branded drugs, under the impression that generic products will not be funded. It is essential that this misunderstanding is corrected and that the GFATM publicise its support for the Doha declaration. As a measure to ensure the quality of available generic products and encourage their use, we welcome the recent publication by WHO of the first list of pre-qualified generic and branded HIV drugs. We encourage rapid expansion of this work to include more products for both HIV and other diseases. Support by the GFATM for equity pricing and the use of TRIPS safeguards to obtain effective products by the cheapest and most sustainable means would provide an invaluable precedent and incentive for greater use of the safeguards in future, and for improvements in access to essential medicines. We ask that the GFATM: 1. Publicise its strong support for the Doha declaration, and issue guidelines to help countries make appropriate use of the provisions outlined in the declaration in their proposals. 2. Make an explicit commitment to support the provision of quality products by the most affordable and most sustainable means, including systematic equity pricing through tiered pricing systems and the use of generic supplies, and make this an explicit part of the criteria by which it considers proposals. 3. Working with WIPO, WTO, WHO, and experts from developing countries, actively support in-country efforts to introduce legislation to support equity pricing, and where relevant to make use of the TRIPS safeguards as clarified at Doha. 4. Actively support and encourage WHO work on pre-qualification of suppliers of affordable medicines to facilitate the best use of funding. 5. Support bulk purchase of drugs through global and/or regional mechanisms, through collaboration with relevant intergovernmental bodies such as the WHO and UNICEF. 6. Make proposals and the reasons for their acceptance or rejection open to public scrutiny, to ensure its accountability to recipients, donors, and to the general public. Signatories: Oxfam-GB Christian Aid International HIV/AIDS Alliance Medecins Sans Frontieres ECHO Health National AIDS Trust Terence Higgins Trust VSO Essential Drugs Project SCF-UK, CAFOD, ACTSA