Founded more than a dozen years ago, Unitaid has received more than $3 billion in donations for its work to research and identify solutions to such tenacious diseases as HIV/AIDS, tuberculosis, and malaria.
The global organization, which is hosted by the World Health Organization, has helped lower prices and to widen access to various medicines to vulnerable populations through its work with the Medicines Patent Pool, which licenses treatments from drug makers. In keeping with that mission, Unitaid recently endorsed the idea of having the WHO create a voluntary pool to collect intellectual property, which would gather patents, regulatory test data and other information to ensure “equitable access” to vaccines, treatments, and other medical products for combating Covid-19.
We spoke with Philippe Duneton, the interim executive director, about Unitaid efforts to combat the pandemic and why widening access to medical products must be a global priority. This conversation has been lightly edited for clarity.
Pharmalot: Unitaid approved up to $30 million for work against Covid-19. What exactly is Unitaid doing?
Duneton: The issue is that we need to start at the beginning and recognize the unprecedented situation we’re facing. The world hasn’t faced a pandemic like this before. Nobody knows this virus. It is having an impact on the whole global health system and we don’t know yet what will be the damage or how long it will stay.
A vaccine may be a medium- or long-term solution, but we need to recognize it won’t be the only solution. We need to think about treatments, new treatments and not just vaccines. Unfortunately, most of the trials are being conducted in developed countries. This may not be conducive or easy to use in the [the southern hemisphere], because you don’t have intensive care units and there are two phases of the disease — respiratory issues and immunologic responses — that cause death.
So we need to push for solutions that work in the south. We need to look at a way to repurpose drugs and there are several drugs that can be looked at. And we believe we can contribute and address that. But we never work alone. We always look for end-to-end solutions and partners … We are trying to connect the innovation with the people who need access.
Pharmalot: OK, but how is the $30 million to be used?
Duneton: There are three things. The first is to make sure we rely on existing interventions in a country [and] work out where we can bring added value. One example is to access to PCR tests (which detect genetic material in a virus). Over the last eight years, we’ve tried to push tests for TB and measuring viral load at point-of-care. This is the way we can detect active infections among patients. We’re negotiating with the Clinton Health Access Initiative and UNICEF for the first batch of these sorts of tests for Africa.
The second is to establish the kind of impact that Covid-19 may have on people living with HIV… We don’t know the effect will be, but we want to know whether certain HIV drugs may have an effect. We already have a network of facilities and researchers in place in countries in Africa and active, ready to work on this. And the third is to increase access to oxygen for people with severe cases of pneumonia. The immediate response will be based on what we already have on the ground.
Pharmalot: Let’s talk about the voluntary pool proposal and why you support that.
Duneton: The pool could be supported by the Medicines Patent Pool, which we created and funded over the last 10 years. I think it’s an important part of the discussion, but has to be articulated with other tools. But we need large-scale production and incentives to increase the speed of access. So it is a question of how to produce and the ability to do so in volumes. We also need to recognize it’s not only the subject of the WHO or the MPP, and that it’s not just linked with intellectual property. There are other elements. And intellectual property, by the way, is not part of the problem, but part of the solution. What we need to achieve is getting the right product. But we need public funds. That’s the first thing.
The second thing is if we can have a product, it has to be available for potentially all the people who need it… If governments around the world will put money into R&D and to potentially protect their own populations, there will be benefits. But they need first to have a way to do this rapidly and have an idea about capacity. No single manufacturing company has the strength to produce at scale to cover all the needs of the world… I believe more and more people agree on that. So it is not a debate about IP. If we want to make it happen, there is a need to participate, so if a product demonstrates efficacy, the solution can be done without delay.
Pharmalot: Why do you think this can work?
Duneton: If you believe there is this need, yes, it can work. And by the way it has worked before. As a reference, we have demonstrated we can decrease some pandemics – HIV, malaria and TB – with combinations of testing and treatments, more or less, for people in the South. Through the work we have been doing with the MPP, we have worked with generic and brand companies and have increased volume and price and competition and access… For HIV, we now have a product that had cost $10,000 a year but now costs less than $70 a year for millions of people in Africa. We need to do the same for Covid-19. The volumes are different and the speed we need to work is different, but the basic principles are the same.
Pharmalot: What is that Unitaid can do then to make a difference? The NIH, for instance, is gathering drug companies to coordinate research.
Duneton: The issue is that we particularly do is look at need of the vulnerable people in the south. The NIH partnership is looking at the north and doesn’t take into account the needs of people in the south, where there are specific needs. This is a global problem and we need a global response. And the solution has to be easy for all the people who need it. It has to be easy enough to produce and to take. In the north, you can more readily increase the access. That’s not the case everywhere.