Concerns Raised To Global Fund Over Panel On Tiered Medicines Pricing

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CAPE TOWN, SOUTH AFRICA – Public groups this week urged Mark Dybul, head of the Geneva-based Global Fund for HIV, Tuberculosis and Malaria, to reconsider the establishment of a panel to look at tiered pricing for middle income countries, potentially allowing companies to charge them higher prices. And separately, activists reported on progress in South Africa’s HIV strategy.

The Global Fund and other funders have had a significant presence at an event here this week, credited with working to advance public health in Africa. Global Fund Executive Director Mark Dybul is among hundreds of health workers and others in Cape Town for the 7-11 December International Conference on AIDS And STIs In Africa (ICASA).

But a recent announcement by the Global Fund that it would establish a “blue ribbon” panel to look at tiered pricing for middle income countries has met with a sharp response from public health advocates who see it as a step backward in medicines pricing and distribution.

At a Global Fund event here yesterday, an AIDS activist from Zambia raised the new pricing initiative with Dybul, according to participants. According to an MSF representative, Dybul clarified that it would only be for middle income countries and that generics companies would be involved in the negotiations.

Then last night, AIDS activists met with Dybul and told him that tiered pricing does not reflect the last 12 years of scaling up HIV treatment by bringing down the price of ARVs through generic competition and the threat of compulsory licences, Sharonann Lynch, HIV/TB advisor for the MSF Access Campaign, told Intellectual Property Watch.

The Global Fund spokesperson could not be reached for comment by press time.

The message activists took away from Dybul last night is that the Global Fund will take their concerns into account, Lynch said.

“We were shocked to hear” about the Global Fund plan for a panel, Lynch said. Tiered pricing would allow companies to charge higher prices to middle income countries. “We’re concerned it would lock in prices instead of letting genuine competition bring prices [down],” she said.

“We are concerned about people sitting around the table setting prices for countries that might be arbitrary instead of based on generic competition,” Lynch said. “We don’t want to give companies a free pass to charge more in middle income countries.”

Lynch gave an example of the recently developed first new TB drug in 60 years being offered to middle income countries for US$3,000 per six months’ treatment, compared with US$900 per six months for low income countries. This would be out of reach for most in the middle income countries, she said.

Tiered pricing represents a “reversal of practices to date,” she added, and the blue ribbon panel presupposes a solution, she said.

Civil Society Report on South Africa’s HIV Strategy

Meanwhile, public health advocacy groups held a press conference on AIDS treatment issues, including a re-launch of report on the progress of South Africa’s National Strategic Plan for HIV, STIs and TB. The at times sharply worded report applauds the country’s “remarkable” turnaround on the issue, but finds remaining cause for concern. AIDS related mortality has come down dramatically but there are still over 150,000 deaths each year.

“Denial of the existence of HIV may be a thing of the past; denial of access to ARVs might be a thing of the past; but denial of the scale of the underlying challenges can be just as deadly for many as their predecessors,” the report said. Authors of the report were the Treatment Action Campaign and Section 27.

The point of the review was to try to fill a gap for an independent, critical, analytical voice that can promote a frontline view … on the actual progress of the strategic plan,” the TAC presenter told the packed press conference. It combines that perspective with some of South Africa’s best experts.

The intent is to ensure that people do not fall into a sense of complacency that all is going well in the fight against HIV and AIDS until it is over.

There is no official evaluation and monitoring function in the plan, he said, which means “we accept a lot as truth” the reports they receive, such as the figure that some 3.4 million people are on antiretrovirals. In fact, that may be the number who started the treatment, but it is not known if that is the number still on it.

Meanwhile, there is a concern about attempts to mute independent voices on the issue, TAC said today.

TAC reported that only about 54 percent of people in the Free State province who should be are on treatment. In a related report also issued today, TAC and others reported on “stock outs,” where treatments are not available. The most severely affected location noted in the report was Free State province, where reports come in nearly every day and orders are backlogged by months at the main depot.

A TAC representative today reported that AIDS workers in a region of the country have faced threats and confiscation of their laptops by local government officials trying to find the source of leaked information. One activist received anonymous death threats, and as the TAC representative said, “anyone who lives in South Africa knows that political intolerance does extend to assassination.”


William New may be reached at

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  1. says

    Tiered pricing seems like such a massive step backwards compared to generics policies it’s bizzare that an organisation as big as the Global Fund would turn to it. Would be interesting to find out more about the motivations that led to such an announcement. Surie Moon also posted a good blog highlighting the evidence behind the limitations of tiered pricing vs generics:


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