An event last week launching the Pediatric treatment Initiative “to get kids the medicines they need,” included the news of a commitment to double the number of children on treatment with support from the President’s Emergency Plan For AIDS Relief within the next two years. With a continued gap that sees an estimated two million children in need of life-saving treatment for HIV, the announcement was both ambitious and overdue. Meeting the commitment, a PEPFAR representative said, will require a redoubling of efforts that will include improving pediatric HIV case finding, engaging mothers to act as peer counselors, training and mentoring clinicians, and supporting pooled procurement of pediatric antiretroviral medicines with the Global Fund to Fight AIDS Tuberculosis and Malaria.
But, more than all of that, as the event, hosted by the Elizabeth Glaser Pediatric AIDS Foundation and organized by the Medicines Patent Pool highlighted, “the right medicines for pediatric HIV” would be an essential element to progress in one of the most persistent and troubling lags in the global AIDS response. And while the World Health Organization has identified the characteristics of those medicines — appropriate dosages and palatable formulations — needed to simplify treatment and make it accessible to children, developing, producing, and distributing those medicines has remained a lengthy and obstacle strewn process.
Speeding those processes calls for partnerships, Greg Perry of the Medicines Patent Pool told Science Speaks last week. The Medicines Patent Pool along with UNITAID and the Drugs for Infected Diseases Initiative proposed the Pediatric HIV Treatment Initiative with the aim of forging those partnerships. UNITAID, a global health endeavor founded in 2006, brings resources, largely funded through voluntary levies on international airfares, and a mission to find new ways to finance and increase access to essential medicines and diagnostic tools to fight the world’s deadliest infectious diseases. The Drugs for Neglected Diseases Initiative, brings a model and a mission for responding to critical health needs to bring medical commodities where they are needed. And the Medicines Patent Pool brings a strategy of bringing down prices through negotiated voluntary licensing agreements. It is a strategy that recently led to an HIV-treatment-landscape-changing deal that will make dolutegravir, a promising drug for resource-limited settings widely available where it is needed most within months — rather than years — of its approval by the United States Food and Drug Administration.
“It’s a breakthrough,” Perry said.
Now the Medicines Patent Pool is aiming for something faster — medicines that become available where they are needed when they are approved, and medicines that are approved swiftly when they are developed. Most ambitious of all — development that is sped when the need for it is identified. One of the ways to accomplish that, he notes, is through sharing intellectual property.
And that is where partnerships come in — with pharmaceutical companies, civil society groups and government. “We’re not working for the [pharmaceutical] industry, we’re not working against the industry,” he says. “We’re working with the industry for a public health good.”
Paving the way for a ready market helps make that possible. At the same time, the countries where medicines are needed the most are also likely to countries where capacities to clear medicines for use are the most challenged. Perry has encouraged efforts to build those capacities, but notes those efforts have moved slowly. “More has to be done in this area.”
He is encouraged by the potential for change from within though. “One of the great successes of HIV responses has been the political pressure brought by civil society.”
For all of this, outcomes of these partnerships — with pharmaceutical companies that now include Gilead, ViiV and BMS, with UNITAID, the Global Fund and PEPFAR — will, take at least 18 months in the most optimistic scenario get medicines developed, marketed and to the children who need them. It may take as long or longer than three years, Perry said.
“It’s not a perfect world,” Perry said, “but we’re trying to make it more perfect. And that means industry has to be on board.”