MMV Access Private Sector Initiatives. Anna Wang Vice President, Public Affairs

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1 MMV Access Private Sector Initiatives Anna Wang Vice President, Public Affairs

2 Contents MMV at a glance MMV Access Overall strategy Expanding reach Uganda ACT Subsidy Project

3 MMV s Mission & Vision Discover, develop and deliver safe, effective and affordable antimalarials to treat and protect people most at risk of malaria Provide the public health community with the most appropriate tools to achieve maximum public health impact Our vision is a world in which innovative medicines will cure and protect the millions at risk of malaria and help to ultimately eradicate this terrible disease.

4 How MMV Operates The Partnership model Find solutions which meets the needs of a commercial partner and the needs of MMV Partners are interested in selling products Establishing markets Corporate image Includes a plan for Global Access ensure the medicines reach patients Must be sustainable and win-win The basic bargain : support drug development in exchange for appropriate and affordable medicines

5 MMV Donors MMV - Medicines for Malaria Venture funding from Foundation to 2010 (Oct 2008) (Total Received/Pledged $330 Million) Bill & Melinda Gates Foundation 61.3% Spanish Agency for International Development 1.5% U.K. DFID 8.8% NIH 1.6% Irish Aid 3.3% Rockefeller Foundation 1.7% USAID 4.9% BHP Billiton 0.2% Exxon Mobil Foundation 0.9% Wellcome Trust 6.3% World Bank 1.4% WHO/RBM 1.1% Swiss Government S.D.C. 1.9% Netherlands Minister Devt. Co-operation 5.2% Bill & Melinda Gates Foundation U.K. DFID Rockefeller Foundation Netherlands Minister Devt. Co-operation WHO/RBM Swiss Government S.D.C. World Bank Wellcome Trust Exxon Mobil Foundation BHP Billiton USAID Irish Aid NIH National Institutes of Health Spanish Agency for International Development

clinicians, public health experts 3 countries 19 partners 6

6 MMV works with partners in 33 countries Over 80 academic, industry and endemic country partners More than 600 scientists, clinicians, public health experts 3 countries 19 partners 6 countries 20 partners 10 countries 21 partners 14 countries 27 partners

7 Global Malaria Portfolio- Q MMV is the main driver for antimalarial R&D (50 projects) Launch Research Translational Development Discovery Lead Opt Preclinical Phase I Phase II Phase III Registration Novartis 9 projects DHFR Thailand Ozonides Isoquine IV artesunate Eurartesim Coartem -D GSK 3 projects DHFR NITD MK 4815 Tafenoquine Artemifone Pyramax Amodiaquine Artesunate Broad/Genzyme 5 projects Others 6 projects Pyridones GSK Macrolides GSK Pyridone SAR Trioxanes AQ13 Immtech SAR97276 Choline Artesunate Ferroquine Azithromycin chloroquine Mefloquine Artesunate DHODH Fosmidomycin Azithromycin Others 53 projects Nat Product NITD Arterolane PQP Immucillins Einstein Blue AQ Others 1 project Non-MMV projects

8 MMV s Global Access Model: Ensuring uptake and responsible use to maximize health impact Health Impact Supporting adoption Expanding reach Shaping R&D Market intelligence Sharing insight Partnership

9 Private sector is the first point of call in event of fever in rural communities in Uganda % Kamuli (844) Pallisa (763) Soroti (694) Kamwenge(454) Kabarole (465) Mubende (365) Private clinic/ doctor / clinic/pharmacy/drug shop Gov HC /Hosp CMD Source: MoH-MMV household surveys, Uganda

10 ACT availability largely limited to public sector in rural Uganda Outlets providing antimalarials in study districts* Stores (unlicensed) Market Public sector NGO ACTs available Priv. Disp CDD Pharmacy Drug shops (licensed) *Kamuli, Kaliro, Pallisa, Budaka, 431 outlets identified in 3 districts using census approach in enumeration areas Source: MoH-MMV supply side survey, 2007

11 MoH-MMV AMFm-like pilot to fill private sector access gap for affordable ACTs CAPSS* will provide a highly subsidized ACT through the private sector to complement public sector and HBMF Contribute to reduced malaria-related morbidity and mortality Inform national policy, the Affordable Medicines Facility, malaria (AMFm) and MMV = 6 Intervention *Consortium for ACT Private Sector Subsidy districts MOH, MMV, NDA, PSI, Surgipharm, Malaria Consortium, MSH Study areas: Total population 3 million DEMOCRATIC REPUBLIC CONGO Fort Portal Kas ese Kaba role Bush enyi Rukun Mbarara giri Kanu Ntung ngu Kab amo Kis ale oro RWANDA Kamw enge Kyenj ojo Iband a Kiruhur Ising iro Ar ua Hoi ma Ne bbi Kiba ale a Yum be Semb abule Moy o Adju mani Mube nde Ra kai Masi ndi Kib oga Mas aka Mpi gi SUDAN Gul u TANZANIA Ap ac Kalan gala Kitg um Pad er Lir a Kma ido Kotido Kata kwi Mor oto Nakapiri pirit Sor oti Ku B Nakaso Palli mi u Siro k ngola Kam Kalisa Mle nko Knga e uli ro Buta d Luwer Iga e lejator Bu a o Jinja nga oro May giri Bu Muk KAMPA uge sia Wakis ono KENYA LA o Naka seke Bud aka Kapch orwa = 2 Control districts

12 Specifics of the programme: Product choice Phase 1 (East): Single brand (Coartem) / Single distributor Phase 2 (West): Multiple brands / Multiple distributors Product selection criteria: Fixed-dose combination Only WHO- prequalified ACT today Product selection criteria: Fixed dose combination WHO prequalified to enable purchase with international funding And / or NDA approved FDC if local funding is available

Specifics of Phase I: Affordable price Maximum

to ensure transparency and adherence Category Price to

05) UGS 200 ($0.12) 15 < 25 kg UGS 165 ($0.

15) UGS 600 ($0.36) >35 kg UGS 330 ($0.20) UGS 800 ($0.

13 Specifics of Phase I: Affordable price Maximum Recommended Retail Price (MRRP) to be printed on pack to ensure transparency and adherence Category Price to importer Retail price (MRRP) 5 < 15kg UGS 82.5 ($0.05) UGS 200 ($0.12) 15 < 25 kg UGS 165 ($0.10) UGS 400 ($0.24) 25 < 35 kg UGS ($0.15) UGS 600 ($0.36) >35 kg UGS 330 ($0.20) UGS 800 ($0.48) Adequate margins to ensure stocking: Importer 25%, Wholesaler 17%, Retailer 35% Surgipharm

14 Key elements of CAPSS Quantification and Procurement Repackaging THE REPUBLIC OF UGANDA

15 Key elements of CAPSS: Ensuring correct dispensing and use Training Training Case management and referral Pharmacovigilance Surgipharm Logistics and orders

16 Key elements of CAPSS: Getting the drugs on the shelves Distribution Adequate margins Distribution Via distributors Direct Surgipharm THE REPUBLIC OF UGANDA

17 Key elements of CAPSS: Generating demand Community mobilization Official launch Demand generation

18 Key elements of CAPSS: Tracking progress and impact Independent M&E M&E Exit interviews Retail audits Household surveys Health Impact

19 AMFm-like pilot experience in Uganda Responds to a real need High uptake of subsidized drug by outlets Preliminary results awaited Strong political commitment at the highest levels Ownership of AMFm - concept at all levels Need to assist local manufacturers to meet WHO PQ

20 MMV s Global Access Model: Ensuring uptake and responsible use to maximize health impact Health Impact Supporting adoption Expanding reach Shaping R&D Market intelligence Sharing insight Partnership

21 Working in partnership is a core principle and a reality THE REPUBLIC OF UGANDA..and many more

22 MMV Access: Improving patients access to effective treatment

Challenges with changing prescribing practices from CQ/SP to ACT in the private sector

Challenges with changing prescribing practices from CQ/SP to ACT in the private sector A presentation at MMV Access Symposium Getting Antimalarials to Patients Kampala 9 th May 2007 Compiled by Dr James