The Value of Partnerships in Fighting HIV/AIDS in Romania: Bringing
Children New Hope
Jeffrey L. SturchioVice President, External AffairsEurope, Middle East & Africa
Merck & Co., Inc.
European Health Forum GasteinOctober 10, 2004
Merck’s contributionsto the fight against HIV/AIDS
• Leading scientific discoveries, e.g. structure of protease enzyme
• Discovery and development of new therapies: CRIXIVAN, STOCRIN
• Continuing research to develop safe and effective AIDS vaccine
• International partnerships to increase access to treatment and care– Accelerating Access Initiative– Enhancing Care Initiative– ACHAP– Romania
Romania’s HIV crisis
• 1997
– The issue: Nearly 6000 children in Romania were infected with HIV
– Romanian government approached Merck
• We have a problem• We want to deal with
this issue
Romania’s HIV Crisis (cont’d)
• Infrastructure– 40 local clinics (Infectious Diseases Hospitals) – No equipment for HIV/AIDS monitoring
• Medical Education– No treatment guidelines– Low medical knowledge (prohibited diagnostic)
• Low access to treatment – Only 1.5% (30 people )treated according to
international guidelines
Foundation for Success – The National AIDS Program
• 1997 - Establishment of National AIDS Committee (NAC) within MoH
• NAC developed National AIDS Program (NAP) with 3 strategic steps:– Computerized network for case reporting and
follow-up – National HIV/AIDS treatment guidelines– Regional AIDS Centers able to monitor the
treatment• MoH lacked the resources to sustain the Program
entirely
Merck’s Response to the Crisis
• 1998 - Funded printing / distribution of first national treatment guidelines on HIV/AIDS
• 1998 - $40,000 donation to facilitate construction of national AIDS database
• 1999 - $1 million donation to establish national network of regional AIDS treatment centers – December 1999 - MSD granted Diploma of
Excellence by Romanian National AIDS Committee• 2002 - Additional $250,000 donation for additional test
kits, technical assistance
Financial factors leading to increased access
• Government -- Steady increases in treatment budget from $2.7M in 1997 to $32.0M in 2004
• Merck -- March 2001 lowered prices of CRIXIVAN and STOCRIN in Romania by 86%– Inspired Romania to enter AAI in June 2001, which led
to promises of price reductions from other companies
AIDS Budget & Treated Patients,000 patientsMil. USD
Treated Patients
3230
25
21
13
8.5
5.5
2.7
5.7
4.94.6
4.4
3
2.42.1
1.9
0
5
10
15
20
25
30
35
40
1997 1998 1999 2000 2001 2002 2003 2004
0
1
2
3
4
5
6
Government actions in 2001: A new level of commitment
• Set new goal - 100% treatment access by end of year• Cut import taxes and VAT on treatments• Increased treatment budget by 80%, with
supplemental allocation for children• Decree ensuring rights of children with AIDS,
including right to treatment• Reached out to patients (UNOPA)• Established Intersectoral Committee to ensure
coordination and implementation of programs
HIV in Romania today: the power of parnterships
• In 1997, 5 out of every thousand diagnosed patients received HAART
• Today, all patients who need antiretroviral treatment under international guidelines are being treated– 94% on triple combination therapy– 6% on other regimens
• January 2002 GOR announced it had achieved its goal– publicly recognized MSD’s role in achieving the target
– May 2002 briefing at UNGASS highlighted success of partnership
What did we learn?• Political commitment of government is a must
– NAC, AIDS Program, increasing funding• National capacity can be built
– Regional AIDS Centers • Engagement of all sectors of national society/global community is
necessary– Partnership with NGOs, pharmaceutical industry
• Safe and secure distribution systems are implementable– Over 20 distributors for AIDS drugs/medical equipment
• Prices must come down -- but this alone is not enough, and third-party financial support is needed– 10 times increase in AIDS budget– Donations, sponsorships, Global Fund support
• Support for continued investment in R&D by the pharmaceutical industry is critical
Bringing Romanian Children New Hope
• Public-private partnerships, such as the one between the Romanian government and Merck, that combine political commitment with targeted private sector resources, can effectively increase the number of people who have access to international standards of care.
