Mark Dybul, Executive Director of the Global Fund has written an email responding to a letter from 220 civil society organizations demanding that the Global Fund abandon its “tiered-pricing” proposal.
His response:
“Thank you for your letter. Dialogue is healthy and we appreciate the opportunity to engage. Of course there has not been time to consult with other organizations, but because you mention the world health assembly, I thought it might be useful to send a rapid response from me alone.
We have greatly appreciated the constructive feedback and adjusted the language and approach to be clear that this effort is not about tiered pricing.
In the spirit of listening and learning, it is a great pleasure to accept your first recommendation. As you know from the recent discussion at the who/unitaid hiv forum, the initiative is no longer a blue ribbon task force on tiered pricing. Attached please find an update we sent to our board this week on the equitable access initiative. It seems to deal with the issues you have raised. In fact, it is very much in line with an important outcome of the hiv forum to explore developing a more refined income classification. We have been heartened by the strong interest from governments facing challenges financing health commodities as they look to the future and a strong desire to participate in the process.
I would also like to address the request for data on difficulties the global fund is experiencing in terms of commodities. In fact, working with other large multilateral and bilateral procurers and with direct and effective negotiations with producers, we have achieve substantial reductions in the price of commodities effectively increasing resources available to countries. The issue is less for today than for the future as noted in the update. The intent is to provide a multi-stakeholder, open dialogue with potential solutions to be present to our Board as it considers the role of the Global Fund in middle income countries and country transitions.
We will be talking about the need for equitable access to health commodities at the wha and in other venues, as you suggest, to promote an open dialogue.
Thanks again for your note and we look forward to continuing the dialogue to try to keep up with en every changing landscape.
I would appreciate it if you could share this note and our Board update with your signatories.”
With this email, the Global Fund ED released the text of a formal summary of the Equitable Access Initiative proposal, GF/B31/ER8, which he had distributed to the Global Fund Board on May 15.
- Although the ED, in his email to me, stated that “it [the new proposal] seems to deal with the issues you have raised,” Although there is still much to critique in this proposed initiative including:
- The under-inclusiveness of the problem definition, which focuses on countries transitioning from low- to middle-income status only rather than the broader problem of restricted donor health funding and unaffordability of medicines and other health technologies for poor people and resource-constrained low-, lower-middle, and even upper-middle income countries.
- The continued prioritization of country-tiering, market segmentation, and tiered pricing solutions instead of other more country-led solutions including adoption, use, and expansion of TRIPS flexibilities and delinking the market for R&D from the market for manufacture/distribution.
- Industry is given a privileged role on the Task Force and in input on the Task Force’s concept note despite its obvious conflicts of interest.
- Although country participation is clarified, the proposal does not provide for country leadership by the countries most affected by industry imposition of unaffordable prices and by ineligibility or limited eligibility for donor health funding.
- The process for developing this proposed initiative has been closely held and secretive with no role for civil society and governments and only a limited role for a subset of proposed partner organizations.
For a more detailed critique of the proposal, see the 7-page critical analysis attached.
The appropriateness and viability of this proposed initiative is still in doubt. ED Dybul states that he now wants to engage in more substantial dialogue with civil society and other stakeholders, but there are still fundamental questions of design and process that must be redressed.
