Increasing Global Access to Medicines and Encouraging Appropriate Use: What Lies Ahead? Dr. Suwit Wibulpolprasert Ministry of Public Health, Thailand Dr. Suwit 1
New global initiatives : • GAVI, GDF, GF • DNDi, IAVI, MMV, • MDGs, “ 3 x 5” • Doha, TRIPS+, FTA • . . . … etc. Dr. Suwit 2
Global Fund : “Scale up prevention and care on HIV/AIDS, TB, Malaria” 02 -03 : 2. 1 bil. $ - 40% to drug “Technical Challenges? ” “Infrastructure and HRH”? “Financial sustainability? ” Dr. Suwit 3
Thailand situation on ARVs • Start triple ARVs in 1998 -- app. 8, 000 ARV under Mo. PH in 2002 • % 70~remain at the end of first year • 60% with more than 90% adher~ence • % 42~effective compliance • Targeted 50, 000 ARV in 2004, 20% GF • May require 500, 000 ARVs in 10 years Dr. Suwit 4
Financial requirement “Can money buy everything? ” 50, 000 1, 000 m 2004 Dr. Suwit 100, 000 3, 000 m 2009 250, 000 7, 000 m (7. 5% of health budget) 2013 “Worst case? ” - Require 500 M. D. 500, 000 14, 000 m (15% of health budget) 200, 000 6, 000 m 2009 2013 “Best case? ” - Require 1, 000 M. D. 5
Is it possible to sustain HR, infrastructures, and financial support for the scaling up of AIDS prevention and care? How can we make the impossible, possible? Dr. Suwit 6
CARE (HAART + …) investment LOW HIGH Prevention investment LOW Dr. Suwit HIGH I. CATASTROPHE III Bad investment II. Health at Low Cost IV. Best Case 7
Number of cases Projection of HIV/AIDS in Thailand - Baseline Scenario, 1985 -2020 I II IV 2020 IV+ Dr. Suwit Year 8
Social Vaccines w Targeted education w Life skill training for teenagers in schools w 100 % condoms in CSW w Community actions to reduce stigmatization Dr. Suwit 9
Social Vaccines v Highly effective and available at low cost v v HIV/AIDS Drugs Unwanted pregnancies Violence Polyvalent No IPRs – Unrelated to TRIPS Use more social HRH than institutional v Dr. Suwit 10
The Prevention Access GAP Percent of Individuals at risk with access to key interventions Intervention Prevention of mother-to-child HIV transmission Voluntary counseling and testing Harm reduction for injecting drug users AIDS education Condoms Dr. Suwit Percent Source : UNAIDS 11
Percentage Financial sustainability- Additionality Year Dr. Suwit Source: Bureau of Budget 12
Publicly owned “New Technologies” F “Health Promotion Fund” from ‘Sin tax’: $US 50 million/year; independent organization. F Global “Wisdom Fund” (R&D Fund)from ‘Stupidity Tax’ ? • entertainment • Stock market Dr. Suwit • Gambling • Patented drugs 13
Universities RIs IHCAR Industries MSH Knowledge WHO TNRUD Comm. Consumers Media Society Professionals INRUD Politics Parties Cabinet Bureaucrats “TRIANGLE THAT MOVES THE MOUNTAIN” Dr. Suwit 14
“WMDS” for success (IT THI BAHT 4) Work hard Meditate/Concentrate Development - continuous Spiritual based - with love and passion and compassion not with greed. Dr. Suwit 15
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