By Lelio Marmora, Executive Director of UNITAID
What role does UNITAID play in fighting HIV/AIDS, tuberculosis (TB) and malaria?
LELIO MARMORA: UNITAID is in business to find smart new ways to prevent, treat and diagnose all three of these diseases more quickly, more cheaply and more effectively. Working with our partners, such as USAID and the Global Fund, we encourage them to “scale up” the use of the best game changing innovations that we can find in health programs across the globe.
How do you go about your work?
LM: We trawl through the world of innovation in universities and industry for ground-breaking drugs and diagnostic methods. And if we are persuaded they can work, UNITAID provides the capital to help test their viability and speed up their introduction, using buying power to secure price reductions, quality improvements and to build a solid base of evidence backed by data.
Is UNITAID’s approach effective?
LM: UNITAID has played a pivotal role in many of the advances over the past few years against HIV/AIDS, TB and malaria. By helping to reduce costs of new better-performing health solutions we can maximize the impact of every dollar spent to improve the lives of the millions of people who are most exposed to these lethal diseases. In short, UNITAID bridges market gaps to kick-start the introduction of new, better, faster-acting and more affordable medicines, technologies and systems as quickly as possible.
What are your biggest contributions to fighting disease?
LM: UNITAID was instrumental in greatly expanding the use of the GeneXpert diagnostic technology for tuberculosis. This is speeding up detection of a disease as old as humanity itself. The launch of GeneXpert, which had originally been developed to detect anthrax in the US, is especially well-timed. The health community urgently needed improved testing capabilities following decades of neglect in development of new TB diagnostics.
Are there pros and cons to GeneXpert?
LM: GeneXpert can be used in remote health facilities to reach more people and provide results in just two hours, compared with older methods that take up to two months. Patients can then immediately start treatment, helping to halt the disease’s transmission. However, a challenge we faced early on was that the test cartridges used by GeneXpert were prohibitively expensive, contributing to doubts over its viability as a practical solution.
So how did you deal with that challenge?
LM: In 2012, UNITAID invested in the largest global scale up of its kind at the time, when machines were installed in 21 high burden countries. A steep reduction in the price of the test cartridges, available for 145 countries, was negotiated with UNITAID’s partners, generating global savings of more than $70 million to date. The technology was shown to be a practical and affordable new tool in TB detection, especially of drug resistant strains that are harder to diagnose.
What has the payoff been?
LM: Success has been swift. In 2014, WHO noted that 60 percent of affected countries now included GeneXpert in their national plans and also recognized the significant contribution the diagnostic technology had played in increasing worldwide detection of drug resistant TB. It is estimated that by 2020, GeneXpert could help to avert up to 1.5 million deaths from the disease.
What is the Medicine Patents Pool?
LM: Intellectual property remains a significant barrier to accessing HIV medicines in developing countries. New, better-performing drugs are likely to be granted 20-year patents, even in low- and middle-income countries. Patents keep prices of such life-preserving medicines prohibitively high and hinder the development of new formulations. In response, UNITAID established the Medicines Patent Pool in 2010 to make it easier for generic manufacturers to tap patent licenses.
How does it work?
LM: It allows more affordable versions of key medicines to be produced and for new improved formulations to be created, resulting in more people being treated and with better medicines. Licenses have been secured for 11 priority antiretroviral drugs.
Among other priority projects, UNITAID
works to allow generics manufacturers to access patents for life-saving medicines and devices to prevent or treat HIV/AIDS, TB and malaria.
What is the focus of your latest work with PSI?
LM: Finding more of the currently undiagnosed patients is a global priority and the focus of one of UNITAID’s latest initiatives. We are partnering with PSI to explore the viability of oral self-tests as a way to expand testing options to reach some of the 19 million people estimated to be living with HIV who are still undiagnosed. (see page 16 or pulse.psi.org for more on HIV self-testing)
Where do you see the greatest potential in fighting malaria?
LM: Using anti-malarial drugs to prevent disease during the high transmission season, particularly in high burden countries, can drastically reduce cases of malaria. WHO has recommended such an approach since 2013 and estimates that up to three quarters of all cases and deaths could be prevented by administering these drugs to under five-year-olds at monthly intervals during the high transmission season. However, only 3 percent of eligible children received this prevention, known as seasonal chemo prevention, last year in part due to supply issues.
What are you doing to remedy the situation?
LM: UNITAID is now investing in the large-scale implementation of seasonal chemo prevention. The project we are funding will help increase the number of suppliers of the drug to increase production capacity, reliability of drug supply and cut delivery costs. We estimate up to 70 percent of children in all targeted areas can be protected and 50,000 lives saved over two years.