美國東部時間2006年1月12日，美國前總統(tǒng)克林頓召開新聞發(fā)布會，正式宣布上海科華公司、美國的Chembio公司、以色列的Orgenics公司（Inverness Medical Innovations 公司的子公司）、印度的Qualpro診斷公司成為克林頓基金會艾滋病快速診斷試劑的四大供應(yīng)商。
January 12, 2006
New York, NY
President Clinton: Hi everyone.
We're here today to announce new price reductions in diagnostics and drugs needed to fight HIV and AIDS around the world.
As all of you know there are more than 40 million people living with the virus. Eight thousand people die every day. Three million new people were infected last year. Too many people die simply because they can't afford or don't have access to the drugs. Too many people are being infected because most of the people who have the virus today have not been tested. This agreement can help to save hundreds of thousands of lives.
Already because of the price reductions in the first line drugs we've negotiated almost a quarter of a million people are receiving drugs under these prices, which are generally the lowest available anywhere in the world. That's about 25% of all the people who have gotten the medicine since we began in 2003.
The agreements announced today are with nine companies. And will lower the prices of HIV rapid tests and antiretrovirals efavirenz) and abacavir by 30% to 50% for the 50 nations that are in our countries procurement consortium. That includes the overwhelming majority of people who are HIV positive in the world.
I'm glad that four of these companies, all of them new partners to our foundation, are here with me today and I will introduce the spokespersons for them in just a moment.
Thanks in part to the price reductions that we have already achieved and the will and commitment of the national governments and NGOs and the donors and the international organizations, which support them access to AIDS treatment has expanded dramatically. Today more than a million people are getting treatment in developing countries. That's up from about 200,000 in 2003.
But five million more need treatment. And 35 million more people living with HIV will need it as their condition progresses.
We also face the challenge of stopping new infections. As I said there were ?I want to say this again because this is very important. That's why this testing is so important. There were three million new infections last year.
Ninety percent of those who are living with the virus today in developing nations don't know it. They need to know their status. These HIV rapid tests make that possible even in the most rural areas of the world because they are easy to use, only take a drop of blood, and most important give results in 20 minutes while the patient is with the counselor or healthcare worker.
The price of HIV rapid tests will be lowered to the range of 49 to 65 cents per test. Four companies will supply at these prices. Chembio Diagnostic Systems, (Qualpro Diagnostics), Shanghai Kehua, and Orgenics, a subsidiary of Inverness Medical Innovations.
Two tests are needed to confirm an HIV positive diagnosis. Compared to the current price of rapid test of 80 cents to $1.44 the use of our tests will reduce the price of HIV diagnosis by roughly 50% in Africa. The savings will be even higher in middle income countries.
One of our partners, Brazil, is already planning on using these deals to buy four million tests at a savings of $10 million or 80%. Making diagnostics cheaper will allows us to extend testing services to more people more rapidly.
Another big challenge we face is expanding HIV treatment, AIDS treatment to the price of second line antiretrovirals. Since all of you know AIDS treatments requires a life long commitment. Over time patients need to switch drugs to ensure that their treatment remains effective.
In Africa the price of second line treatment is 10 times more expensive now than first line. In middle income countries it is four to five times more expensive than that. As a result, even if only a very small number of people need these drugs the cost of treatment can skyrocket. 500,000 people will be on second line treatment in just two years. And obviously if we were treating all 6 million people who need it the numbers would go up even more.
Simply put the cost of AIDS treatment to the world will not be sustainable if the price of second line medicines doesn't come down. So our foundation is working on reducing the price of these. As a first step today I'm announcing price reductions for two drugs. Efavirenz sold under our agreement for $240 per patient per year as compared with the published price of $367 and a range available today of between $328 and $480. That's a reduction of more than 30% from market rates. Abacavir will be available for $447, a reduction of about 40%. The current list price there is about $705.
The active pharmaceutical ingredients for these drugs, which drive the cost of the final product will be sold by one of our long-standing partners Matrix Laboratories. Efavirenz will then be sold to the market by Cipla, Ranbaxy, Aspen Pharmacare, as well as a new partner to our foundation's trides Arcolab. Strides will also now supply first line medicines under our agreement and Cipla will be the supplier of abacavir.
Now this is only a first step. We expect to lower the prices of other second line drugs later this year. I want to applaud these drug and diagnostic companies for their leadership in fighting AIDS. I'm proud to be able to work with them and I am very grateful to them.
I also want to thank Ira Magaziner and the other people at CHAI who have worked so hard to lower the cost of component parts of these medicines and to make the cost of production as low as possible as well as to do the other things that we have tried to do with the first line drugs to organize the market, guarantee sufficient volume to justify the low cost, and prompt payment.
So now I'd like to introduce our partners beginning with Arun Kumar, the CEO and Managing Director of Strides, followed by Larry Siebert, the CEO of Chembio, Sherry Wang from Shanghai Kehua and John Bridgen from Inverness.
Arun?
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Arun Kumar: Thank you.
President Clinton, ladies and gentlemen. There are millions of people worldwide living with HIV and only a fraction of them have access to life saving treatment. These people represent their country's future. Saving the life is imperative for economic growth and the creation of stable economies and societies, which may be our best hope to build a more stable and peaceful world.
While the world gears up for meeting the challenges of providing HIV therapy especially in third world countries your humanitarian vision has led to the reduction of testing and treatment costs so that HIV positive people could raise their families, return to work, and participate in the lives of the community.
President Clinton, I salute you sir and your foundation in opening the floodgates of care and compassion for the suffering of the millions. We at Stride are honored to partner your support and support the initiatives. The philosophy of partnership is a foundation of the growth of Strides and partnering with various multilateral aid agencies and global pharmaceutical companies we have emerged as a leading player in this space.
Today's partnership with the Clinton Foundation will expand and strengthen this philosophy. Our campaign against the three deadly diseases of HIV/AIDS, TB, and malaria are showing significant results. We have now developed a comprehensive range of the first line and second line antiretroviral drugs from our FDA approved site in Bangalore, India.
We have forged a very successful marketing and technical line with Novartis and the Sandals Group, which supports the treatment of TB products worldwide. And to combat malaria Strides has an end to end program from plantation of artemisin to the final dosage farm to provide cost effective therapy.
It is in this that we dedicate our support to fight against these global diseases. Thank you President Clinton for giving us this opportunity.
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Larry Siebert: Good afternoon. President Clinton, ladies and gentlemen.
On behalf of all of Chembio Diagnostics?valued employees I want to thank President Clinton, Kate Condliffe, and the entire staff of the Clinton HIV/AIDS Initiative for selecting Chembio to be part of the HIV rapid test supplier consortium.
Chembio is the only U.S.-based producer in this supply consortium. As such by our producing in New York several million more high quality rapid HIV tests as a result of this agreement Chembio will be recirculating AIDS relief being underwritten by United States taxpayers creating productive income and jobs in New York.
Chembio looks forward to quickly and fully implementing this agreement in order to provide greater access to affordable HIV care and prevention services worldwide.
Thank you.
--------------------------------------------------------------------------------
Sherry Wang: I didn't expect I would have a chance to make some sentence.
On behalf of Shanghai Kehua Biotech I'm very ?it's such a great honor and I'm so pleased, so it's a great pleasure to be here to be a supplier of Clinton Foundation.
Shanghai Kehua is leading diagnostic company in China and with bringing this for HIV not only for Chinese government and for WHO, and now we're very great to have the opportunity to work with Clinton Foundation. And we would like to do a big contribution worldwide HIV disease. We would do as best as we can and thank you for Clinton Foundation to providing this opportunity.
Thank you.
--------------------------------------------------------------------------------
John Bridgen: (John Bridgen, Inverness Medical. And I think what this is all about here is this. We supply rapid tests to STD clinics in the United States. And we know that when people go to those clinics and they are tested for a variety of sexually transmitted diseases including HIV, fully 25 to 30% of them never go back to get the results.
So having a test that can provide the results in 10 minutes in the presence of the patient so that you can counsel that patient, prescribe appropriate therapy is crucially important in the third world where travel and communication are much more difficult than in the U.S.
So we're very pleased to be able to supply our products. We are the world's leader in supplying 10 minute tests. We developed the technology. And we are very, very pleased to be able to work with the Clinton Foundation in reducing the spread of this disease throughout the world.
Thank you very much.
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President Clinton: I'll be glad to answer some questions. I do want to make, if I could, just two more points just to drive them home.
First of all, there should be by the end of this year maybe three, maybe four times as many people getting the first line medicine as there are now. We didn't make three million by the end of 2005 as we had hoped but you're going to see an enormous expansion in 2006.
Unless we get these second line drugs down a lot of these countries are just going to be bankrupt. All this effort will have come to naught. And so this is just the beginning of what I hope will be a big, long, process.
I do expect other companies either to participate with us or simply to lower their own prices. When we started with the first line drugs and I announced to you some time ago that we were going to be able to get them for $139, the list price was about $500 a person a year for the generics. And even the bulk purchases were operating in the three to four hundred dollar range. The average price is now down under $200.
So we know that this will be a leader to bring others to bring the price down. So this is very important.
Second point I want to make is about testing. You know, when we first started talking about testing years and years ago in America people were very nervous about it because they said oh, it will just drive people away and there's too much stigma attached to it. But Lesotho, which has the third-highest infection rate in the world has just decided to test everybody over 12. Everybody.
And I want to publicly thank and applaud the government of Lesotho. It is clearly the right thing to do because if 90% of the people who are infected don't know it they're going to go on infecting other people until they do know it.
And so I hope that the availability of this low cost testing and the quickness of the response will encourage employers all over the world, especially in the high infection rate countries, schools, governments and others to take advantage of this. It's long past time when there should be any stigma attached to AIDS but also long past time when we can just look away knowing that 90% of the people who are infected don't know it. And that's one of the reasons we've got 3 million infections a year.
If people know they're positive and they know they can get the medicine and they know they can live, the chances of their behaving responsibly and reducing the number of new infections is enormously increased. So that's the significance of these two announcements today and again, I'm grateful to our partners and grateful to our own AIDS initiative and Mr. Magaziner and all the others who are here for the extraordinary work they've done. Questions? Yes madam?
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Woman: (What more needs to be done about AIDS in India?)
President Clinton: Well first of all you know some of our major partners live in India - Cipla, Ranbaxy, Matrix. Secondly, Matrix has been working with their Chinese suppliers and have gotten another price reduction so we're working hard to make it affordable. Then we’re working with the Indian Ministry of Health and with the Medical Association, and if I make a mistake Joe correct me but I think this year we'll be training 150 thousand Indian doctors in the high incidence areas to diagnose, care and treat, and a whole lot of paramedical personnel too.
That's the largest training operation we have ever undertaken. So I think that there were a couple of years there where there was a little bit of denial and a lack of awareness. I can only say now, we have received strong support from the Indian government, strong support from the medical community and you have two of the major big producers in Cipla and Ranbaxy and one of the bigger suppliers in Matrix. I think that, and in other Indian companies now getting into this.
So I hope that you will see a big turnaround. I also would like to say a positive word about China. We also, China is one of the few countries where we actually have offices in the Ministry of Health and we work with them. The Indians, the Chinese are attempting to get all of their drug production of first line drugs certified by the World Health Organization and you already see the kind of other work that they have going on here.
I believe that there is a reasonable chance that by the end of the year China will be in a position to treat all of its own people with its own drugs and will have the kind of universal program that we take for granted in the United States and Canada and Europe and Japan.
And if that happens then we can focus on the countries that either don't have the infrastructure or are too poor to deal with this problem. Any other questions? Yes, sir?
Man: (What do you think about the US government's AIDS policies?)
President Clinton: Well let me tell you one thing that I'm hoping we can work out. We, originally the United States government said that none of its money could be used to buy generic drugs. And then there was a change of position which I applauded, which basically said that any generic drugs which have been approved by the World Health Organization also have to go through the American Food and Drug Administration but if they are approved then they can be used, that the American money can be used to buy them.
Now they still have certain packaging and other requirements that are inconsistent with our purchasing consortium. So they can't get the cheapest prices in the world because they can’t use the American money to buy from our consortium. But they can get way, way less expensive prices than they'd been paying. And that means the American money can go further. That will be my focus this year, to try to get the American money, the Global Fund on AIDS, TB and Malaria, everybody else make the money they’re spending go further.
We always talk about how we need more money but if you think about it, our foundation with our donor countries, and keep in mind with one minor exception, we don't directly purchase these drugs. We facilitate the rules and then the drugs go from the suppliers to the countries that need them who have donor help that we recruit if necessary. So they get money from the global fund or they get money from our partners, from Ireland, from Canada, from Norway, from Sweden and the Caribbean, from the UK and France.
But this is all done directly. I'm hopeful that the American money will be, this year will go a lot further. But that’s not a specific, a criticism specific to the American government. I mean it's a problem generally. And one of the things I’m going to try to do this year is get all these donors to analyze whether they're getting the biggest bang for their buck.
Because if you look at the cost that our foundation has arranged to diagnose and treat first line and now second line drugs, if everybody used those economics to scale then with the money presently available we'd have enough money to treat nearly everybody.
So I think that should be the focus. I mean I know there are other controversies about the American policy but I'm just grateful that we have this money out there. In the countries where we work and partnership with PEPFAR, the Bush administration program, we have good relationships with people on the ground. They’ve got good people out there. We're working together the best we can and I think the most important thing is that not just the United States but everybody who’s giving to this effort, when you look at what still needs to be done in TB, when you look at what still needs to be done in malaria, when you look at all these other infectious diseases in Africa and Southeast Asia which could be a problem, which don't affect any of them individually as many people but in the aggregate affect millions of people.
It is simply unthinkable that we would not run the most cost effective program with regard to every threat we face. So that's my focus this year, apart from what I just told you on this, is going to be try to get the biggest bang for the buck if you will, everywhere. The other things we’re working on, I should just mention this, obviously we're trying to get more pediatric AIDS treatments out there. They’re slightly more expensive. They are about $200 a person a year as opposed to $136 for the others.
But we are doing 10,000, we're going to try to get up to 50,000 or 60,000 more and I have to go raise the money for that this year. And we’re working on trying to get the healthcare networks out there in rural areas. We're working in several African countries and Partners In Health from Haiti, (Dr. Farmer’s) group is working in Rwanda where we've already trained over 100 people to go out and work in two rural areas there.
So that's my other job is to make sure that if these people are willing to provide the testing and the medicine that we’ve got somebody out there who can do the administration. Yes ma'am?
Woman: (question on the US healthcare system)
President Clinton: Well in America the fundamental problem we've got is that the healthcare financing system is a tail wagging the healthcare dog. And we’re spending 16% according to the latest news story last week, 16% of our GDP on healthcare when no other country spends more than 11. Canada and Switzerland spend about 11. 5% of GDP in American is over $500 billion a year. To give you an idea of what kind of numbers we're talking about you just asked me the Bush program spends over $2 billion and the Global Fund spends over $3 billion on healthcare, on AIDS in the case of the Global Fund, AIDS, TB and Malaria.
Billions of, countries representing billions of people. So we're just spending $500 billion a year that has nothing to do with the healthcare of our people. And about half of it is due to excess administrative costs. Administrative costs in the healthcare system in America are 34% of total cost for the providers and the insurers. The next highest that I’ve been able to find is Canada at 19%. That's over 2% of GDP.
That's about $250 billion right there. Then there are other problems. We pay more for medicine than any other country on Earth by a big stretch. Malpractice is too expensive and some of the preventive practices are not taken care of.
And we spend more money on the (unintelligible) than anybody else. We had some significant problems here and our system is wildly inefficient. We haven't computerized it which is one of the things that Hillary and Senator Frist passed a bill to try to computerize medical records which could save literally up to $100 billion a year if we do it right.
So the fundamental problem is the financing and then those other things that I mentioned are about the, in the aggregate about another half of the problem. And it's going to, we just have to decide whether we’re going to continue to in effect throw away $500 billion a year. I don't think, and we’re not getting better health outcomes for it.
And so we tried to deal with this several years ago, and the problem we had then, even though the insurance companies were against it, the real problem was that we were running a big deficit and therefore we couldn't, we didn’t have any tax money to subsidize people for example buying into the health insurance system that the federal employees have.
Our early retirees buying into Medicare are giving the states the money so that the parents of children who are in the Children's Health Insurance Program could buy into that. If you did those three things you could cover just about everybody. Without increasing the systems cost but we almost had to do it with an employer mandate on all businesses above a certain size because we had such a big deficit. And when I left, one of the things I hoped would be done with the surplus I left was that we could have, we could then shift into a system which would cut administrative costs and cover people.
And so it's, now we’re back to the same dilemma we had in '93. But America is going to have to decide whether you want to keep spending 16% of your income on healthcare and nobody else spends more than 11. And we don’t get better outcomes.
So you just, and basically over 2 million work every year in a tug of war. The people in the financing try to keep from paying as long as they can and the people who are providing try to get the money as quick as they can and they all have to hire 2 million people. You can just imagine a million on each side pulling a big rope with a pile in the middle. That's what’s going on.
Anything else? Yes?
Man: (question on how CHAI negotiated reduced prices).
President Clinton: How do you get what? How do we get the cost down here?
Man: (repeat question).
President Clinton: We tried to do several things. We tried to lower the cost of the component parts to the manufacturers of the medicine. We, where it's appropriate we did this a lot with the first line drugs. We actually tried to improve the production process. And some of them have done things. Some of them have updated, they bought more modern equipment, which has lowered the cost. Some have moved their production to countries with lower labor costs which would lower the costs.
And then what we tried to do is to organize the market so that we can guarantee them in a predictable way, larger volumes. Everyone is in our consortium, fir example, has to make regular updates on what their demand for the pills is. And it may sound like a little thing but if you know, the key thing here is to get companies, even generic companies to go from a high margin, low volume business to a low margin, high volume business.
Think of it as selling your jewelry store and buying a grocery store. That's the key thing. And so we try to get the volumes up and then guarantee prompt payment. That’s also a big thing. You have to charge a premium if you know you're not going to get paid half the time and because we have reliable donors and we have really good relationships with our government that are treating people they get prompt payment.
So prompt payment, higher volumes, lower cost of production equals a lower purchase price. You had a question. One more.
Man: (unintelligible).
President Clinton: Okay. Yeah?
Man: (question on the general response of drug companies to CHAI agreements).
President Clinton: Well I wish there were more of the big drug companies who were doing this but Merck for example, has been really good. They licensed one of our companies to produce this drug. So I think this, it's inevitable. Some of the other companies, there’s less cooperation.
But I think we're moving in the right direction. Inevitably people are going to have to provide these drugs at lower costs, or just let people keep dying. I mean there aren’t, there's no other option here. And I think that after they’ve been out a certain amount of time and it's clear that the companies have recovered their R&D costs, that there’s really no reason not to do it. So we're working hard on doing it with them.
Man: (why would some companies not be interested?).
President Clinton: Well, you'd need to ask them. I mean I think some of them are staying with the high-volume - I mean a high-margin, low-volume business. But it seems to me that if you get a high-volume, low-margin business and it’s still profitable because the volumes are so great and the payment is so sure, that that is both morally better and from all of our own perspectives as a practical matter, it's a better thing to do. And that’s why I applaud what these companies are doing.
Same thing is true in testing. I'm going to be very interested to see if what they’ve done here will bring down the price of rapid tests. Not just the drugs, the tests. Keep in mind; I cannot emphasize this enough, I think that neither I nor anyone else who's been active in this field has hammered this enough.
And it all goes back to the overhang we had in the '80s when we first started facing the AIDS crisis in America. And people were horribly stigmatized. And then in almost every country, when you start, they’re horribly stigmatized.
You know, one of the things I just did; the Chinese government just asked me, you remember, last year I went to China and went to several rural cities. The central government asked me to go there because they said in rural areas people still have mixed feelings about it. Even in these areas where they just got it through tainted blood transfusion equipment. You know, so you just got to keep driving this point home, but once you get the leaders committed to ending the stigma, then there's no reason not to get everybody tested as quickly as possible.
I went to Zanzibar, which has a fairly low infection rate, but it's 98-1/2% Muslim. Because there were women at the support groups that I visited who every day wear t-shirts around town in some town —— the capital of Zanzibar —— that says I’m HIV positive. So they've got this sort of national campaign to break the stigma.
January 12, 2006
New York, NY
President Clinton: Hi everyone.
We're here today to announce new price reductions in diagnostics and drugs needed to fight HIV and AIDS around the world.
As all of you know there are more than 40 million people living with the virus. Eight thousand people die every day. Three million new people were infected last year. Too many people die simply because they can't afford or don't have access to the drugs. Too many people are being infected because most of the people who have the virus today have not been tested. This agreement can help to save hundreds of thousands of lives.
Already because of the price reductions in the first line drugs we've negotiated almost a quarter of a million people are receiving drugs under these prices, which are generally the lowest available anywhere in the world. That's about 25% of all the people who have gotten the medicine since we began in 2003.
The agreements announced today are with nine companies. And will lower the prices of HIV rapid tests and antiretrovirals efavirenz) and abacavir by 30% to 50% for the 50 nations that are in our countries procurement consortium. That includes the overwhelming majority of people who are HIV positive in the world.
I'm glad that four of these companies, all of them new partners to our foundation, are here with me today and I will introduce the spokespersons for them in just a moment.
Thanks in part to the price reductions that we have already achieved and the will and commitment of the national governments and NGOs and the donors and the international organizations, which support them access to AIDS treatment has expanded dramatically. Today more than a million people are getting treatment in developing countries. That's up from about 200,000 in 2003.
But five million more need treatment. And 35 million more people living with HIV will need it as their condition progresses.
We also face the challenge of stopping new infections. As I said there were ?I want to say this again because this is very important. That's why this testing is so important. There were three million new infections last year.
Ninety percent of those who are living with the virus today in developing nations don't know it. They need to know their status. These HIV rapid tests make that possible even in the most rural areas of the world because they are easy to use, only take a drop of blood, and most important give results in 20 minutes while the patient is with the counselor or healthcare worker.
The price of HIV rapid tests will be lowered to the range of 49 to 65 cents per test. Four companies will supply at these prices. Chembio Diagnostic Systems, (Qualpro Diagnostics), Shanghai Kehua, and Orgenics, a subsidiary of Inverness Medical Innovations.
Two tests are needed to confirm an HIV positive diagnosis. Compared to the current price of rapid test of 80 cents to $1.44 the use of our tests will reduce the price of HIV diagnosis by roughly 50% in Africa. The savings will be even higher in middle income countries.
One of our partners, Brazil, is already planning on using these deals to buy four million tests at a savings of $10 million or 80%. Making diagnostics cheaper will allows us to extend testing services to more people more rapidly.
Another big challenge we face is expanding HIV treatment, AIDS treatment to the price of second line antiretrovirals. Since all of you know AIDS treatments requires a life long commitment. Over time patients need to switch drugs to ensure that their treatment remains effective.
In Africa the price of second line treatment is 10 times more expensive now than first line. In middle income countries it is four to five times more expensive than that. As a result, even if only a very small number of people need these drugs the cost of treatment can skyrocket. 500,000 people will be on second line treatment in just two years. And obviously if we were treating all 6 million people who need it the numbers would go up even more.
Simply put the cost of AIDS treatment to the world will not be sustainable if the price of second line medicines doesn't come down. So our foundation is working on reducing the price of these. As a first step today I'm announcing price reductions for two drugs. Efavirenz sold under our agreement for $240 per patient per year as compared with the published price of $367 and a range available today of between $328 and $480. That's a reduction of more than 30% from market rates. Abacavir will be available for $447, a reduction of about 40%. The current list price there is about $705.
The active pharmaceutical ingredients for these drugs, which drive the cost of the final product will be sold by one of our long-standing partners Matrix Laboratories. Efavirenz will then be sold to the market by Cipla, Ranbaxy, Aspen Pharmacare, as well as a new partner to our foundation's trides Arcolab. Strides will also now supply first line medicines under our agreement and Cipla will be the supplier of abacavir.
Now this is only a first step. We expect to lower the prices of other second line drugs later this year. I want to applaud these drug and diagnostic companies for their leadership in fighting AIDS. I'm proud to be able to work with them and I am very grateful to them.
I also want to thank Ira Magaziner and the other people at CHAI who have worked so hard to lower the cost of component parts of these medicines and to make the cost of production as low as possible as well as to do the other things that we have tried to do with the first line drugs to organize the market, guarantee sufficient volume to justify the low cost, and prompt payment.
So now I'd like to introduce our partners beginning with Arun Kumar, the CEO and Managing Director of Strides, followed by Larry Siebert, the CEO of Chembio, Sherry Wang from Shanghai Kehua and John Bridgen from Inverness.
Arun?
--------------------------------------------------------------------------------
Arun Kumar: Thank you.
President Clinton, ladies and gentlemen. There are millions of people worldwide living with HIV and only a fraction of them have access to life saving treatment. These people represent their country's future. Saving the life is imperative for economic growth and the creation of stable economies and societies, which may be our best hope to build a more stable and peaceful world.
While the world gears up for meeting the challenges of providing HIV therapy especially in third world countries your humanitarian vision has led to the reduction of testing and treatment costs so that HIV positive people could raise their families, return to work, and participate in the lives of the community.
President Clinton, I salute you sir and your foundation in opening the floodgates of care and compassion for the suffering of the millions. We at Stride are honored to partner your support and support the initiatives. The philosophy of partnership is a foundation of the growth of Strides and partnering with various multilateral aid agencies and global pharmaceutical companies we have emerged as a leading player in this space.
Today's partnership with the Clinton Foundation will expand and strengthen this philosophy. Our campaign against the three deadly diseases of HIV/AIDS, TB, and malaria are showing significant results. We have now developed a comprehensive range of the first line and second line antiretroviral drugs from our FDA approved site in Bangalore, India.
We have forged a very successful marketing and technical line with Novartis and the Sandals Group, which supports the treatment of TB products worldwide. And to combat malaria Strides has an end to end program from plantation of artemisin to the final dosage farm to provide cost effective therapy.
It is in this that we dedicate our support to fight against these global diseases. Thank you President Clinton for giving us this opportunity.
--------------------------------------------------------------------------------
Larry Siebert: Good afternoon. President Clinton, ladies and gentlemen.
On behalf of all of Chembio Diagnostics?valued employees I want to thank President Clinton, Kate Condliffe, and the entire staff of the Clinton HIV/AIDS Initiative for selecting Chembio to be part of the HIV rapid test supplier consortium.
Chembio is the only U.S.-based producer in this supply consortium. As such by our producing in New York several million more high quality rapid HIV tests as a result of this agreement Chembio will be recirculating AIDS relief being underwritten by United States taxpayers creating productive income and jobs in New York.
Chembio looks forward to quickly and fully implementing this agreement in order to provide greater access to affordable HIV care and prevention services worldwide.
Thank you.
--------------------------------------------------------------------------------
Sherry Wang: I didn't expect I would have a chance to make some sentence.
On behalf of Shanghai Kehua Biotech I'm very ?it's such a great honor and I'm so pleased, so it's a great pleasure to be here to be a supplier of Clinton Foundation.
Shanghai Kehua is leading diagnostic company in China and with bringing this for HIV not only for Chinese government and for WHO, and now we're very great to have the opportunity to work with Clinton Foundation. And we would like to do a big contribution worldwide HIV disease. We would do as best as we can and thank you for Clinton Foundation to providing this opportunity.
Thank you.
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John Bridgen: (John Bridgen, Inverness Medical. And I think what this is all about here is this. We supply rapid tests to STD clinics in the United States. And we know that when people go to those clinics and they are tested for a variety of sexually transmitted diseases including HIV, fully 25 to 30% of them never go back to get the results.
So having a test that can provide the results in 10 minutes in the presence of the patient so that you can counsel that patient, prescribe appropriate therapy is crucially important in the third world where travel and communication are much more difficult than in the U.S.
So we're very pleased to be able to supply our products. We are the world's leader in supplying 10 minute tests. We developed the technology. And we are very, very pleased to be able to work with the Clinton Foundation in reducing the spread of this disease throughout the world.
Thank you very much.
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President Clinton: I'll be glad to answer some questions. I do want to make, if I could, just two more points just to drive them home.
First of all, there should be by the end of this year maybe three, maybe four times as many people getting the first line medicine as there are now. We didn't make three million by the end of 2005 as we had hoped but you're going to see an enormous expansion in 2006.
Unless we get these second line drugs down a lot of these countries are just going to be bankrupt. All this effort will have come to naught. And so this is just the beginning of what I hope will be a big, long, process.
I do expect other companies either to participate with us or simply to lower their own prices. When we started with the first line drugs and I announced to you some time ago that we were going to be able to get them for $139, the list price was about $500 a person a year for the generics. And even the bulk purchases were operating in the three to four hundred dollar range. The average price is now down under $200.
So we know that this will be a leader to bring others to bring the price down. So this is very important.
Second point I want to make is about testing. You know, when we first started talking about testing years and years ago in America people were very nervous about it because they said oh, it will just drive people away and there's too much stigma attached to it. But Lesotho, which has the third-highest infection rate in the world has just decided to test everybody over 12. Everybody.
And I want to publicly thank and applaud the government of Lesotho. It is clearly the right thing to do because if 90% of the people who are infected don't know it they're going to go on infecting other people until they do know it.
And so I hope that the availability of this low cost testing and the quickness of the response will encourage employers all over the world, especially in the high infection rate countries, schools, governments and others to take advantage of this. It's long past time when there should be any stigma attached to AIDS but also long past time when we can just look away knowing that 90% of the people who are infected don't know it. And that's one of the reasons we've got 3 million infections a year.
If people know they're positive and they know they can get the medicine and they know they can live, the chances of their behaving responsibly and reducing the number of new infections is enormously increased. So that's the significance of these two announcements today and again, I'm grateful to our partners and grateful to our own AIDS initiative and Mr. Magaziner and all the others who are here for the extraordinary work they've done. Questions? Yes madam?
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Woman: (What more needs to be done about AIDS in India?)
President Clinton: Well first of all you know some of our major partners live in India - Cipla, Ranbaxy, Matrix. Secondly, Matrix has been working with their Chinese suppliers and have gotten another price reduction so we're working hard to make it affordable. Then we’re working with the Indian Ministry of Health and with the Medical Association, and if I make a mistake Joe correct me but I think this year we'll be training 150 thousand Indian doctors in the high incidence areas to diagnose, care and treat, and a whole lot of paramedical personnel too.
That's the largest training operation we have ever undertaken. So I think that there were a couple of years there where there was a little bit of denial and a lack of awareness. I can only say now, we have received strong support from the Indian government, strong support from the medical community and you have two of the major big producers in Cipla and Ranbaxy and one of the bigger suppliers in Matrix. I think that, and in other Indian companies now getting into this.
So I hope that you will see a big turnaround. I also would like to say a positive word about China. We also, China is one of the few countries where we actually have offices in the Ministry of Health and we work with them. The Indians, the Chinese are attempting to get all of their drug production of first line drugs certified by the World Health Organization and you already see the kind of other work that they have going on here.
I believe that there is a reasonable chance that by the end of the year China will be in a position to treat all of its own people with its own drugs and will have the kind of universal program that we take for granted in the United States and Canada and Europe and Japan.
And if that happens then we can focus on the countries that either don't have the infrastructure or are too poor to deal with this problem. Any other questions? Yes, sir?
Man: (What do you think about the US government's AIDS policies?)
President Clinton: Well let me tell you one thing that I'm hoping we can work out. We, originally the United States government said that none of its money could be used to buy generic drugs. And then there was a change of position which I applauded, which basically said that any generic drugs which have been approved by the World Health Organization also have to go through the American Food and Drug Administration but if they are approved then they can be used, that the American money can be used to buy them.
Now they still have certain packaging and other requirements that are inconsistent with our purchasing consortium. So they can't get the cheapest prices in the world because they can’t use the American money to buy from our consortium. But they can get way, way less expensive prices than they'd been paying. And that means the American money can go further. That will be my focus this year, to try to get the American money, the Global Fund on AIDS, TB and Malaria, everybody else make the money they’re spending go further.
We always talk about how we need more money but if you think about it, our foundation with our donor countries, and keep in mind with one minor exception, we don't directly purchase these drugs. We facilitate the rules and then the drugs go from the suppliers to the countries that need them who have donor help that we recruit if necessary. So they get money from the global fund or they get money from our partners, from Ireland, from Canada, from Norway, from Sweden and the Caribbean, from the UK and France.
But this is all done directly. I'm hopeful that the American money will be, this year will go a lot further. But that’s not a specific, a criticism specific to the American government. I mean it's a problem generally. And one of the things I’m going to try to do this year is get all these donors to analyze whether they're getting the biggest bang for their buck.
Because if you look at the cost that our foundation has arranged to diagnose and treat first line and now second line drugs, if everybody used those economics to scale then with the money presently available we'd have enough money to treat nearly everybody.
So I think that should be the focus. I mean I know there are other controversies about the American policy but I'm just grateful that we have this money out there. In the countries where we work and partnership with PEPFAR, the Bush administration program, we have good relationships with people on the ground. They’ve got good people out there. We're working together the best we can and I think the most important thing is that not just the United States but everybody who’s giving to this effort, when you look at what still needs to be done in TB, when you look at what still needs to be done in malaria, when you look at all these other infectious diseases in Africa and Southeast Asia which could be a problem, which don't affect any of them individually as many people but in the aggregate affect millions of people.
It is simply unthinkable that we would not run the most cost effective program with regard to every threat we face. So that's my focus this year, apart from what I just told you on this, is going to be try to get the biggest bang for the buck if you will, everywhere. The other things we’re working on, I should just mention this, obviously we're trying to get more pediatric AIDS treatments out there. They’re slightly more expensive. They are about $200 a person a year as opposed to $136 for the others.
But we are doing 10,000, we're going to try to get up to 50,000 or 60,000 more and I have to go raise the money for that this year. And we’re working on trying to get the healthcare networks out there in rural areas. We're working in several African countries and Partners In Health from Haiti, (Dr. Farmer’s) group is working in Rwanda where we've already trained over 100 people to go out and work in two rural areas there.
So that's my other job is to make sure that if these people are willing to provide the testing and the medicine that we’ve got somebody out there who can do the administration. Yes ma'am?
Woman: (question on the US healthcare system)
President Clinton: Well in America the fundamental problem we've got is that the healthcare financing system is a tail wagging the healthcare dog. And we’re spending 16% according to the latest news story last week, 16% of our GDP on healthcare when no other country spends more than 11. Canada and Switzerland spend about 11. 5% of GDP in American is over $500 billion a year. To give you an idea of what kind of numbers we're talking about you just asked me the Bush program spends over $2 billion and the Global Fund spends over $3 billion on healthcare, on AIDS in the case of the Global Fund, AIDS, TB and Malaria.
Billions of, countries representing billions of people. So we're just spending $500 billion a year that has nothing to do with the healthcare of our people. And about half of it is due to excess administrative costs. Administrative costs in the healthcare system in America are 34% of total cost for the providers and the insurers. The next highest that I’ve been able to find is Canada at 19%. That's over 2% of GDP.
That's about $250 billion right there. Then there are other problems. We pay more for medicine than any other country on Earth by a big stretch. Malpractice is too expensive and some of the preventive practices are not taken care of.
And we spend more money on the (unintelligible) than anybody else. We had some significant problems here and our system is wildly inefficient. We haven't computerized it which is one of the things that Hillary and Senator Frist passed a bill to try to computerize medical records which could save literally up to $100 billion a year if we do it right.
So the fundamental problem is the financing and then those other things that I mentioned are about the, in the aggregate about another half of the problem. And it's going to, we just have to decide whether we’re going to continue to in effect throw away $500 billion a year. I don't think, and we’re not getting better health outcomes for it.
And so we tried to deal with this several years ago, and the problem we had then, even though the insurance companies were against it, the real problem was that we were running a big deficit and therefore we couldn't, we didn’t have any tax money to subsidize people for example buying into the health insurance system that the federal employees have.
Our early retirees buying into Medicare are giving the states the money so that the parents of children who are in the Children's Health Insurance Program could buy into that. If you did those three things you could cover just about everybody. Without increasing the systems cost but we almost had to do it with an employer mandate on all businesses above a certain size because we had such a big deficit. And when I left, one of the things I hoped would be done with the surplus I left was that we could have, we could then shift into a system which would cut administrative costs and cover people.
And so it's, now we’re back to the same dilemma we had in '93. But America is going to have to decide whether you want to keep spending 16% of your income on healthcare and nobody else spends more than 11. And we don’t get better outcomes.
So you just, and basically over 2 million work every year in a tug of war. The people in the financing try to keep from paying as long as they can and the people who are providing try to get the money as quick as they can and they all have to hire 2 million people. You can just imagine a million on each side pulling a big rope with a pile in the middle. That's what’s going on.
Anything else? Yes?
Man: (question on how CHAI negotiated reduced prices).
President Clinton: How do you get what? How do we get the cost down here?
Man: (repeat question).
President Clinton: We tried to do several things. We tried to lower the cost of the component parts to the manufacturers of the medicine. We, where it's appropriate we did this a lot with the first line drugs. We actually tried to improve the production process. And some of them have done things. Some of them have updated, they bought more modern equipment, which has lowered the cost. Some have moved their production to countries with lower labor costs which would lower the costs.
And then what we tried to do is to organize the market so that we can guarantee them in a predictable way, larger volumes. Everyone is in our consortium, fir example, has to make regular updates on what their demand for the pills is. And it may sound like a little thing but if you know, the key thing here is to get companies, even generic companies to go from a high margin, low volume business to a low margin, high volume business.
Think of it as selling your jewelry store and buying a grocery store. That's the key thing. And so we try to get the volumes up and then guarantee prompt payment. That’s also a big thing. You have to charge a premium if you know you're not going to get paid half the time and because we have reliable donors and we have really good relationships with our government that are treating people they get prompt payment.
So prompt payment, higher volumes, lower cost of production equals a lower purchase price. You had a question. One more.
Man: (unintelligible).
President Clinton: Okay. Yeah?
Man: (question on the general response of drug companies to CHAI agreements).
President Clinton: Well I wish there were more of the big drug companies who were doing this but Merck for example, has been really good. They licensed one of our companies to produce this drug. So I think this, it's inevitable. Some of the other companies, there’s less cooperation.
But I think we're moving in the right direction. Inevitably people are going to have to provide these drugs at lower costs, or just let people keep dying. I mean there aren’t, there's no other option here. And I think that after they’ve been out a certain amount of time and it's clear that the companies have recovered their R&D costs, that there’s really no reason not to do it. So we're working hard on doing it with them.
Man: (why would some companies not be interested?).
President Clinton: Well, you'd need to ask them. I mean I think some of them are staying with the high-volume - I mean a high-margin, low-volume business. But it seems to me that if you get a high-volume, low-margin business and it’s still profitable because the volumes are so great and the payment is so sure, that that is both morally better and from all of our own perspectives as a practical matter, it's a better thing to do. And that’s why I applaud what these companies are doing.
Same thing is true in testing. I'm going to be very interested to see if what they’ve done here will bring down the price of rapid tests. Not just the drugs, the tests. Keep in mind; I cannot emphasize this enough, I think that neither I nor anyone else who's been active in this field has hammered this enough.
And it all goes back to the overhang we had in the '80s when we first started facing the AIDS crisis in America. And people were horribly stigmatized. And then in almost every country, when you start, they’re horribly stigmatized.
You know, one of the things I just did; the Chinese government just asked me, you remember, last year I went to China and went to several rural cities. The central government asked me to go there because they said in rural areas people still have mixed feelings about it. Even in these areas where they just got it through tainted blood transfusion equipment. You know, so you just got to keep driving this point home, but once you get the leaders committed to ending the stigma, then there's no reason not to get everybody tested as quickly as possible.
I went to Zanzibar, which has a fairly low infection rate, but it's 98-1/2% Muslim. Because there were women at the support groups that I visited who every day wear t-shirts around town in some town —— the capital of Zanzibar —— that says I’m HIV positive. So they've got this sort of national campaign to break the stigma.