Lelio Marmora, Executive Director of Geneva-based UNITAID, which works under the aegis of the World Health Organisation, has many aces up his sleeve. The organisation appears to be liaising successfully with big pharma companies to make life-saving drugs cheaper. However, that hasn’t kept criticism off its door. In a conversation with BusinessLine , Marmora addresses questions over transparency, ethics, IP and the rights of companies as well as developing nations. Excerpts:

UNITAID, in partnership with major pharma companies, has recently brought new paediatric drugs for HIV and TB. Are more such projects in the offing?

We are not a delivery agency and do not give money to countries to pay for treatments. We identify new ways for fighting different diseases and do all the work for bringing them to reality as fast as possible.

For example, for TB, we just presented a new treatment for kids, in the absence of any specific paediatric treatment. The new medicine is more palatable, more solvable and easier to administer.

Do clinical trials cause road blocks?

Countries have their regulations, but if they are open to finding solutions, clinical trials can take place. India is insisting on performing clinical trials. Some pharmaceutical companies are okay with that and others are not. These are methodological issues that should not be affecting things.

What affects is problems such as health systems not functioning well or low budgetary allocation. Some countries are not investing what they should on health. The case of India is important because if you compare the public health situation in India 40 years ago and now, it has dramatically changed. The commitment of the government to create the fiscal space and to make the effort has been phenomenal. Of course, still a long way to go.

Despite India’s low budgetary allocation, do you think India is doing well in terms of public health?

It’s not just about money. It is about the importance of health in your political agenda, and the engagement with your industry. All the promotion to develop pharma in India has been extremely important for the country and for the world.

Further, the national health programme in India is very powerful, as are the malaria and TB programmes. Now, with HCV, India is taking important steps for mapping out the disease.

UNITAID’s Medicines Patent Pool (MPP), under which these drugs are being negotiated, appears to have a limited geographical reach…

It is the story of a cup half full versus half empty. Today, we have 100 countries (for HCV medicines), which is huge. Before that, we had zero. Earlier, pharma companies were negotiating with countries individually. We now have a one-stop shop, where originators can put their patents and make them available for generic companies to develop and produce them at affordable prices. That’s a very important change in my opinion. Of course, we will continue evolving and the MPP will continue to perfect its model.

How are these deals under the MPP negotiated with companies?

MPP reaches out to companies and is always in dialogue with them to make patents available for generic companies. The good thing in this process is that you see an increase in number of companies giving their patents to make drugs available.

When we started MPP, the agreements were few. Now, we are signing new agreements and new projects every month because pharma companies also realise there is a market in the developing world.

Developing nations have some flexibility under the TRIPS Agreement with respect to life-saving drugs. So, why do we need MPP? With MPP, wouldn’t developing countries’ bargaining powers at the WTO reduce?

We have to be pragmatic. If the best is to negotiate some licences under the MPP for generic companies, so be it. If it’s better to promote a country’s pharma — not just generic copies, but also developers of new drugs — that is a good strategy too. If you don’t have any room for movement and need a compulsory licence, you apply that. If you need to do parallel imports, you do it.

I don’t think MPP will reduce bargaining power. Look at countries testing their people and having good health facilities for these tests. Once they negotiate the prices, they have to deliver the drugs and follow up on the treatment. There is a multiplicity of problems that we need to address and not just the IP issue.

comment COMMENT NOW