On May 12, a session of the Fresk of Unitaid took place in Madrid, an initiative aimed at exploring the Access Map and understanding the barriers that hinder access to health technologies worldwide, especially in low- and middle-income countries.
The event, organized by Salud por Derecho together with the Spanish Agency for International Development Cooperation (AECID) and Unitaid itself, was attended by representatives from the Ministries of Health, Foreign Affairs, Science, and Economy, research organizations such as the Carlos III Health Institute and the CSIC, and public foundations like the FCSAI Foundation.
Inspired by the Climate Fresk and developed in collaboration with the Global Health Centre (Geneva Graduate Institute), the Fresk of Unitaid develops group and collaborative dynamics to:
- Increase knowledge about how the global health system works.
- Recognize its scale, complexity, and the key actors that compose it.
- Explore the relationship between innovation and access.
- Understand how international norms and policies regulate its functioning.
- Identify the obstacles that impede access and how to intervene on them.
A necessary initiative
Diversity was one of the keys to an enriching discussion. In her welcome, Blanca Yañez Minondo, head of multilateral cooperation and the European Union at AECID, emphasized the importance of generating such spaces to foster synergies, share knowledge, and strengthen more effective international cooperation that brings us closer to universal health coverage, especially in complex contexts like the current one.
Carmen Pérez Casas, strategy lead at Unitaid in the area of diagnostics and medicines for HIV, explained the origin and necessity of this initiative, as the complexity of the global health system and access mechanisms often makes their understanding difficult. Hence the commitment to a participatory methodology that allows for collectively visualizing and internalizing this global architecture.
Unitaid and innovation for access
Carmen presented the work of Unitaid, an organization created in 2006 by the governments of France and Brazil to increase the effectiveness of the health response. Spain and other countries joined in 2007, and today, along with communities, the African Union, and private actors, they are part of its Executive Board based in Geneva.
“We fund projects that make the responses of other actors (including countries) more effective, accelerating the introduction and access to innovative health products for diagnosis, prevention, or treatment, ensuring that their availability is affordable and sustainable over time, and promoting partnerships so that innovation also addresses the communities living with diseases.”
Since its creation, Unitaid has participated in the optimization and market incorporation with better access to more than 100 health products, including malaria vaccines, pediatric treatments for HIV, and preventive therapies for tuberculosis. In addition to these three diseases, it has extended its work to maternal and child health in general and, since COVID, also offers responses to health emergencies. “We also do things at a cross-cutting level: intellectual property, regional production, drug quality, decentralization of production, or strengthening health systems and adaptation to climate change… That is, issues that affect all diseases.”
A global architecture… without an architect
In her presentation, Carmen commented on how many actors work both in the development of new medicines or diagnostics, as well as in the work that needs to be done before commercialization and marketing authorization, and in the work to ensure that the products reach all the people who need them. These steps require a strategy that brings together everyone’s efforts so that from the early stages of development, developing countries are taken into account, the products are accessible and affordable, and they can be brought to scale.
Global health—or the so-called global architecture (according to Carmen, there is no architect, but rather it arises from improvisation)—is of colossal size, with a $1.5 trillion pharmaceutical market per year. However, 65% of the global pharmaceutical market is concentrated in 10 high-income countries, with 25% going to another 22 “emerging” countries, while only 10% reaches poorer countries, which thus have very little influence on the pharmaceutical agenda.
Something similar happens with R&D investment, although it is difficult to speak with certainty about how much is invested. “We’re talking about around $240 billion per year, and 60% comes from the private sector, 30% from the public sector, and 10% from philanthropy, although there are signs of change in some middle-income countries, which are increasingly relevant players in this sector.”
Carmen concluded her presentation by reviewing the evolution of access to medicines since the 1990s, highlighting how growing awareness of the relationship between health, development, and the economy spurred greater global investment and attention to neglected diseases. This period also marked the beginning of debates on intellectual property and access to medicines.
The turn of the century brought Millennium Development Goals that were very focused on health and a dominance of multilateralism, with the creation of organizations like the Global Fund or Unitaid, and a boom in public-private partnerships. At that time, the United Nations recognized for the first time access to medicines as a human right. From 2015 onward, Carmen recalled, we entered the era of the SDGs, and goals were set to eliminate AIDS, malaria, and tuberculosis by 2030, while also including many other diseases and committing to Universal Health Coverage.
The outbreak of COVID-19 once again changed the debate, highlighting the need for equitable access and marking a turning point with the creation of initiatives such as ACT-A and the current discussions around the pandemic treaty being negotiated by the WHO.
Participatory dynamics and case studies
Adrián Alonso, from Salud por Derecho, presented the dynamics of the Fresque, which was followed by two highly participatory group sessions. In them, participants created a mapping of the medicine value chain—from basic research to the use of the medicine by patients—some of the rules that define this system, and its key actors.
Among them, Carmen was able to give a historical overview of the struggle for access to HIV treatment, highlighting how 31 million people today receive antiretroviral therapy thanks to decades of collective struggle.
In addition, she analyzed obstacles and addressed specific cases, such as that of dolutegravir, an HIV medicine whose price dropped drastically thanks to licenses and generic production, or lenacapavir, a new preventive HIV drug that can protect against infection with just two injections per year and with 100% effectiveness. Despite its enormous potential, the extremely high price set by the pharmaceutical company Gilead—around $42,000 per year—makes it inaccessible for most countries, even though various studies state it can be manufactured for less than €40. Although Gilead has signed voluntary licenses, these are very limited and exclude a large number of countries in regions such as Latin America or Asia. A few months ago, from Salud por Derecho, we published this study on the drug and its licensing agreements.
The day concluded with words from Vanessa López, Salud por Derecho director, who once again emphasized the importance of these types of collaborative spaces for advancing toward a fairer, more equitable, and accessible global health system.
