The United Nations goal of eliminating mother-to-child transmission of HIV/AIDS is within reach, the Global Fund to Fight AIDS, Tuberculosis and Malaria said in a progress report released today.

A public/private partnership, the Geneva-based Global Fund acts as a financing institution for projects aimed at fighting three of the world’s most widespread and dangerous diseases. It does this through a grant-making process. To date about US $10 billion has been disbursed through this process, according to Global Fund statistics; half of this was done in 2008 and 2009.

The 2010 report is available here [pdf].

In 2010, the organisation will be undergoing its third “voluntary replenishment” process, so the report is in part intended to communicate to potential donors. Replenishment happens every three years and involves a series of invitation-only consultations. The first meeting [pdf] for this round will take place 24-25 March in The Hague with a followup on 4-5 October in New York. The New York meeting is where donors will make pledges as to how much they will give in this round.

Currently most funding comes from the governments of the United States, the European Commission, the United Kingdom, Italy and Japan, said Global Fund Deputy Executive Director Debrework Zewdie. Private contributions, including from private foundations, is about 6 percent of the funding she added, and here the biggest single donor is the Bill and Melinda Gates Foundation. Zewdie spoke at an 8 March press conference.

The results achieved by the Global Fund since it was founded in 2002 “were unimaginable before,” said Rifat Atun, its director of strategy, performance and evaluation. Results include 2.5 million people now on antiretroviral therapy for HIV/AIDS and 104 million insecticide-treated mosquito nets given away to prevent malaria contraction. Julian Fleet, deputy director of the Roll Back Malaria Partnership, said the Global Fund had “pioneered the ‘affordable medicines for malaria’ programme.”

Forty-five percent of HIV-infected mothers are now receiving prophylaxis intended to prevent mother-to-child transmission of the illness, said Paul De Lay, the deputy executive director of UNAIDS, which partners with the Global Fund.

The Global Fund is a primary contributor to these efforts, said Zewdie.

But there is still a lot to do. “There’s a misperception that the AIDS epidemic is over,” said De Lay. But there are 7,400 new infections each day, five for every two people who start on treatment.

And second-line treatments are needed for both HIV/AIDS and tuberculosis. There are new TB drugs in the pipeline, said Marcos Espinal, executive director of the Stop TB Partnership. But institutions like the World Health Organization and the Global Fund are necessary “to stimulate industry and also to negotiate affordable prices that can be reached by low income countries,” he added.

“The elephant in the room is funding,” said Hiroki Nakatani, the assistant director general of the WHO programme on HIV/AIDS, TB, Malaria and Neglected Tropical Diseases.

Encouraging Drug Innovation

The Global Fund does not deal with intellectual property rights as it is not an implementing agency, Atun said in response to a question from Intellectual Property Watch.

Countries go for international tenders to procure the drugs that they need, also getting support from groups such as drug-purchasing mechanism UNITAID. Atun later mentioned the UNITAID patent pooling scheme another possible source of support. Intellectual property is a “complex landscape,” said Atun, but the institution does not [corrected] negotiate on IP issues.

“It is countries who negotiate in competitive bidding” and decide “what to buy and from whom to buy it,” said Zewdie. “What we help with is the magnitude of the purchase.”

However, “by signalling large amounts of funding, we create a demand pool so more companies are able to enter the market.” The new competition helps lower costs; over the last few years there has been an almost 12 percent decline per year on prices, he said, adding that more fixed-dose and combination therapies are appearing.

Zewdie called this “voluntary pooled procurement.”

One of the major critiques of the IP system from those that worry about neglected tropical diseases is that it skews research and development toward the diseases of the wealthy who will be able to afford the eventually-created cures.

But “by creating the demand pool we are encouraging innovation of existing companies and the entrance of new companies,” on AIDS, TB and malaria, said Atun.

Nakatani said that member states at the WHO still need further consultation on IP. There will be a meeting on 13 May to discuss the results of an expert working group on research and development financing for neglected diseases, which was not ready in time for full discussion at the WHO Executive Board meeting in January (IPW, WHO, 20 January 2010).