“Health systems don’t begin or stop at the clinic,” said Mark Dybul, “because a bunch of health people are not going to deal with the black market.” From involving local law enforcement to INTERPOL to ensure high quality commodities, building effective health systems requires an integrated approach involving the right partners, Dybul, executive director of the Global Fund to Fight AIDS, TB, and Malaria, said at a congressional briefing on Wednesday.
Dybul and other panelists at the briefing hosted by Friends of the Global Fight and the American Enterprise Institute agreed that strengthening procurement systems as well as curtailing the manufacture and distribution of subpar and counterfeit drugs and diagnostics is key for protecting the U.S. investment in the fight against global HIV, TB, and malaria.
Julia Martin, deputy global AIDS coordinator for program quality at the Office of the Global AIDS Coordinator, said OGAC works with various agencies and partners “to get the right commodities to the right places at the right time.” PEPFAR works with the FDA not only in drug approval but also in setting standards and ensuring drug quality.
PEPFAR’s collaboration with the Global Fund is “incredibly important,” she said, and the two organizations’ support for one another “is so intertwined it’s difficult to separate.” PEPFAR and Global Fund collaboration on commodities procurement and distribution has led to scale up of key interventions like prevention of mother-to-child-transmission and medical male circumcision, she said.
The Global Fund also works with the President’s Malaria Initiative to bargain with drug manufacturers to get the lowest prices for antimalarial drugs, Dybul said. Collaboration between multilateral and bilateral organizations also results in better forecasting of drug availability to prevent stockouts, Dybul said, on top of ensuring low prices and speedy delivery.
But better collaboration mechanisms are needed to further strengthen health systems, Dybul said, especially when it comes to procurement. An open source, cloud-based, e-market place for commodities that all countries and organizations would have access to is the next step, he said. “The e-market place advantage is that all countries will be able to see all products and all prices,” he said, and only high quality products would be included in the marketplace so the chance of unknowingly purchasing counterfeit drugs is slim.
Weakening the counterfeit drug market is especially important for the fight against malaria, as subpar and counterfeit drugs contribute to antimalarial drug resistance, which is “the faultline in the ice,” according to Rear Admiral Tim Zeimer, U.S. Global Malaria Coordinator.
Roger Bate with the American Enterprise Institute said countries need help in building their procurement and delivery systems, or when they go through the transition from PEPFAR and PMI to full ownership of their health systems, they won’t know how to best acquire the commodities they need.
Dybul said an e-marketplace for commodities would help in that regard, as national health systems would only need a few people running their procurement program rather than a large and complicated program with dozens of staff.