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Schwab Charitable Philanthropy Speaker Series Profiling Global Change Makers   Dr. Klaus Leisinger President and Managing Director Novartis Foundation for Sustainable Development October 4, 2011  The Partnership Puzzle:  How global organizations work to solve social issues  
Corporate Responsibilities for Access to Medicines Klaus M. Leisinger Novartis Foundation for Sustainable Development UC Berkeley,  4 th  October 2011
The social and economic context ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],| UC Berkeley | Klaus M. Leisinger | 4 October 2011 | Corporate Responsibilities for Access to Medicines
Poverty and health: a vicious circle Source: Novartis Foundation  for Sustainable Development | UC Berkeley | Klaus M. Leisinger | 4 October 2011 | Corporate Responsibilities for Access to Medicines Basic education for health awareness and appropriate health seeking behavior Freedom from discrimination, violence and harmful traditional practices Good governance incl. appropriate allocation and funds for health and good health policy Sufficient health infrastructure for preventive and curative care Access to diagnosis and medical care (treatment and prevention) Life style choices and risk taking (e.g. food) habits, sexual behavior, smoking Save and adequate food Appropriate habitat incl. good sanitation Save drinking water and good personal and food hygiene Individual and collective poverty State of health
Good health has a lot of influencing factors... ...and many stakeholders contributing to healthcare and prevention Source: Dahlgren G. / Whitehead M. (1991): Policies and strategies to promote social equity in health, Stockholm | UC Berkeley | Klaus M. Leisinger | 4 October 2011 | Corporate Responsibilities for Access to Medicines
The societal context ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],| UC Berkeley | Klaus M. Leisinger | 4 October 2011 | Corporate Responsibilities for Access to Medicines
Causes of death among children aged <5 years and influence of medicines (%) Source: WHO World Health Statistics 2009 | UC Berkeley | Klaus M. Leisinger | 4 October 2011 | Corporate Responsibilities for Access to Medicines WHO region Neonatal HIV/AIDS Diarrhea Measles Malaria Pneumonia Injuries Other African Region 21.0 5.0 16.3 3.9 15.6 20.4 2.4 15.4 Region of the Americas 37.7 0.7 12.7 0.0 0.2 12.7 5.9 30.0 South-East Asia Region 39.0 0.4 19.5 5.5 0.4 13.7 5.3 16.2 European Region 37.8 0.7 14.0 0.1 0.0 14.9 5.7 26.7 Eastern Mediterranean  Region 32.6 0.3 16.7 3.0 2.3 19.6 3.5 21.9 Western Pacific Region 46.2 0.3 12.0 0.8 0.3 9.8 7.5 23.1
“ Health” as an international political subject-matter: UN Millennium Development Goals ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],| UC Berkeley | Klaus M. Leisinger | 4 October 2011 | Corporate Responsibilities for Access to Medicines
The Right to Health debate:  Article 25 ,[object Object],[object Object],[object Object],[object Object],| UC Berkeley | Klaus M. Leisinger | 4 October 2011 | Corporate Responsibilities for Access to Medicines
The Right to Health debate: The International Covenant on Economic, Social and Cultural Rights ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],| UC Berkeley | Klaus M. Leisinger | 4 October 2011 | Corporate Responsibilities for Access to Medicines
The Preamble of the Universal Declaration of Human Rights ,[object Object],[object Object],| UC Berkeley | Klaus M. Leisinger | 4 October 2011 | Corporate Responsibilities for Access to Medicines
What are companies competing with integrity responsible for?   Be successful  in the core competence with integrity and comply  with applicable laws and regulations Corporate Responsibility beyond legality: Legitimacy in the spirit of international  norms Corporate philanthropy and pro bono work Desirable (can) Expected (ought to) Essentials (must) | UC Berkeley | Klaus M. Leisinger | 4 October 2011 | Corporate Responsibilities for Access to Medicines Corporate responsibility excellence Good management practices
Success in the core competence serves  people and the common good Sources: OECD Health Data 2004; Health, United States, 2003: Chartbook on Trends in the Health of Americans; Manton KG, Gu X.,  Proc Natl Acad Sci USA 2001 May 22; 98(11):6354-9. | UC Berkeley | Klaus M. Leisinger | 4 October 2011 | Corporate Responsibilities for Access to Medicines Drop in death rates 1990-2000 among US pop. 45-64 US life expectancy Years at birth Females Males Average length of stay in patient days US pop. > 65 with disability Heart Disease Cancer Stroke All causes
Corporate responsibility challenges  Market failures and failing states ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],| UC Berkeley | Klaus M. Leisinger | 4 October 2011 | Corporate Responsibilities for Access to Medicines
There  is  an access-to-medicines problem | UC Berkeley | Klaus M. Leisinger | 4 October 2011 | Corporate Responsibilities for Access to Medicines
But price is only one of several reasons: e.g. poor people use available health services less often  Source: Lancet 2008, 372, 1661-69 | UC Berkeley | Klaus M. Leisinger | 4 October 2011 | Corporate Responsibilities for Access to Medicines
Corporate responsibility tools for „Access to Medicine“ ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],| UC Berkeley | Klaus M. Leisinger | 4 October 2011 | Corporate Responsibilities for Access to Medicines
Political and economic preconditions for differential pricing ,[object Object],[object Object],[object Object],[object Object],[object Object],| UC Berkeley | Klaus M. Leisinger | 4 October 2011 | Corporate Responsibilities for Access to Medicines
Differential pricing controversial issues Differential pricing ,[object Object],[object Object],[object Object],Donations Pro bono research Constructive use of patents ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],| UC Berkeley | Klaus M. Leisinger | 4 October 2011 | Corporate Responsibilities for Access to Medicines
In 2010 Novartis supported more than 85 million patients with access-to-medicine programs  1 Novartis Institute for Tropical Diseases;  2 Novartis Vaccines Institute for Global Health;  3 Based on approximate market value  2010 Programs and research valued at USD 1.5 bn Coartem ®  subsidized  > 82 million treatments shipped – cumulatively delivered > 380 million treatments, helping to save about 950,000 lives of mostly children under 5 years Leprosy medication free of charge > 5 million patients cured since 2000 Tuberculosis medicine donations 500,000 treatments committed, 50% delivered Glivec ®  patient assistance Free to >37,000 patients in about 80 countries NITD 1  in Singapore Focus on tuberculosis, dengue fever and malaria NVGH 2  in Siena, Italy Vaccines research institute for neglected diseases | UC Berkeley | Klaus M. Leisinger | 4 October 2011 | Corporate Responsibilities for Access to Medicines
Current strategy to fight malaria Today’s efforts focus on prevention and cure  ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],Prevention  Cure  | UC Berkeley | Klaus M. Leisinger | 4 October 2011 | Corporate Responsibilities for Access to Medicines
The Novartis Malaria Initiative  A holistic approach to best serve patients needs ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],* 28-day PCR-corrected in evaluable population | UC Berkeley | Klaus M. Leisinger | 4 October 2011 | Corporate Responsibilities for Access to Medicines
We are helping to make a difference Key indicators are showing progress 2004 * Estimate ** 2009 ***2008 Every 30 seconds Child mortality Every 45 seconds*** Malaria  Cases 225 million** 243 million 12 countries served Coartem® deliveries Patient share of ACT market Countries served 30% ACT market share 50% ACT market share* 60+ countries served Average price per treatment USD 1 .57 per treatment Price for public-sector buyers has  dropped by over 50% 82 million treatments 4 million treatments 2010 | UC Berkeley | Klaus M. Leisinger | 4 October 2011 | Corporate Responsibilities for Access to Medicines
Healthcare projects of the Novartis Foundation for Sustainable Development | UC Berkeley | Klaus M. Leisinger | 4 October 2011 | Corporate Responsibilities for Access to Medicines
Foundation research on access-to-healthcare obstacles: A complex and multi-dimensional issue  Source: Obrist B.  et al. (2007): Access to health care in contexts of livelihood insecurity: A framework for analysis and action. In: PLoS Med 4( 0): e308.doi: 0. 37 /journal.pmed.0040308 Are there enough points of care to serve the population? Do drug supplies suffice? What is the geographical distance between points of care and the homes of intended users? Do the prices of services match patients‘ ability to pay? Does the organisational set up meet patients‘ needs and expectations? Does the information and treatment provided take local values into account? | UC Berkeley | Klaus M. Leisinger | 4 October 2011 | Corporate Responsibilities for Access to Medicines
Foundation research on “Community effectiveness of malaria treatment” | Access to Medicines UC Berkeley| Klaus M. Leisinger | October 2011 Provider compliance  with official guidelines Patient adherence  Source: Alba et al. 2010:  Improvements in access to malaria treatment in Tanzania following community, retail sector and health facility interventions - a user perspective. In: Malaria Journal 2010, 9:163. | UC Berkeley | Klaus M. Leisinger | 4 October 2011 | Corporate Responsibilities for Access to Medicines
Video on the ACCESS project in Tanzania Improving access to effective malaria treatment ,[object Object],| UC Berkeley | Klaus M. Leisinger | 4 October 2011 | Corporate Responsibilities for Access to Medicines
ICATT: Innovative e-learning tool to scale up training in childhood diseases (1/2) ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],| UC Berkeley | Klaus M. Leisinger | 4 October 2011 | Corporate Responsibilities for Access to Medicines
ICATT: Innovative e-learning tool to scale up training in childhood diseases (2/2) ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],| UC Berkeley | Klaus M. Leisinger | 4 October 2011 | Corporate Responsibilities for Access to Medicines
Overall results of the Novartis Foundation healthcare projects and programs ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],| UC Berkeley | Klaus M. Leisinger | 4 October 2011 | Corporate Responsibilities for Access to Medicines
NIBR efforts to address medical needs in the  developing world: infectious disease examples (1/2)  Tuberculosis (Prevalence/100,000 – WHO 2004) Dengue Fever (Incidence/100,000 – WHO 2005) Malaria (Prevalence/100,000 – WHO 2004) Infectious Diarrhea (Mortality rate/100,000- WHO 2002) Chagas (Prevalence/100,000 – WHO 2002) Typhoid Fever (Incidence/100,000 – WHO 2004) | UC Berkeley | Klaus M. Leisinger | 4 October 2011 | Corporate Responsibilities for Access to Medicines <1 >250 Known risk <25 >25000 <50 >1000 1-5 >100 <1000 >6000 >100 10-100 <10
NIBR efforts to address medical needs in the  developing world: infectious disease examples (2/2)  | UC Berkeley | Klaus M. Leisinger | 4 October 2011 | Corporate Responsibilities for Access to Medicines Malaria TB Infectious Diarrhea Dengue Fever Typhoid Fever Chagas Disease Incidence 250 million (Tropics, mostly Africa) 9 million (Developing World) 2.5 billion children (Dev World) 50 million (Tropics &  Subtropics) 16-33 million (Developing World) 10 million (mostly Latin America) Mortality (per year) 1 million (mostly children) 1.3 million (often AIDS patients) 1.6 million children  (3-5 million total) >100,000 (mostly children) >200,000 (mostly children) >10,000 Organism Plasmodium Myco- bacterium GI bacteria (incl. cholera)  Flavivirus Salmonella Trypano-soma Medical need/issue Drug resistance (incl. Coartem) Multi /extensive drug resistance; treatment length; HIV co-infection Drug resistance; rapid dehydration No effective treatment for hemorrhagic  fever  Drug resistance; no pediatric vaccine (<2yrs) No available treatment for chronic disease Collaboration NITD, GNF  & two European Research  Centers NITD, GNF &  TB Alliance, NIAID Grand Challenges in Global Health (GC11) grantees NIBR (RESP)  & OneWorld Health  Singapore Dengue Consortium (incl. NITD) NVGH NIBR (ID), NITD and GNF Outside Funding MMV, Wellcome Trust & Singapore Gov Gates  Foundation  & GC11 Grant Gates Foundation ,[object Object],[object Object],NIH & Drugs for Neglected Disease initiative  Research Status Drug candidate NITD609  entering clinic Compound discovery Lead optimization Compound discovery  Vaccine  vi-CRM197 in Phase II trials Screening & biomarker  discovery
Why become involved in health and access issues beyond the conventional business model? ,[object Object],[object Object],| UC Berkeley | Klaus M. Leisinger | 4 October 2011 | Corporate Responsibilities for Access to Medicines
Plausible arguments for a “Business Case”  ,[object Object],[object Object],[object Object],[object Object],[object Object],| UC Berkeley | Klaus M. Leisinger | 4 October 2011 | Corporate Responsibilities for Access to Medicines

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Klaus Leisinger Novartis Foundation 10 04 2011

  • 1. Schwab Charitable Philanthropy Speaker Series Profiling Global Change Makers   Dr. Klaus Leisinger President and Managing Director Novartis Foundation for Sustainable Development October 4, 2011 The Partnership Puzzle: How global organizations work to solve social issues  
  • 2. Corporate Responsibilities for Access to Medicines Klaus M. Leisinger Novartis Foundation for Sustainable Development UC Berkeley, 4 th October 2011
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  • 4. Poverty and health: a vicious circle Source: Novartis Foundation for Sustainable Development | UC Berkeley | Klaus M. Leisinger | 4 October 2011 | Corporate Responsibilities for Access to Medicines Basic education for health awareness and appropriate health seeking behavior Freedom from discrimination, violence and harmful traditional practices Good governance incl. appropriate allocation and funds for health and good health policy Sufficient health infrastructure for preventive and curative care Access to diagnosis and medical care (treatment and prevention) Life style choices and risk taking (e.g. food) habits, sexual behavior, smoking Save and adequate food Appropriate habitat incl. good sanitation Save drinking water and good personal and food hygiene Individual and collective poverty State of health
  • 5. Good health has a lot of influencing factors... ...and many stakeholders contributing to healthcare and prevention Source: Dahlgren G. / Whitehead M. (1991): Policies and strategies to promote social equity in health, Stockholm | UC Berkeley | Klaus M. Leisinger | 4 October 2011 | Corporate Responsibilities for Access to Medicines
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  • 7. Causes of death among children aged <5 years and influence of medicines (%) Source: WHO World Health Statistics 2009 | UC Berkeley | Klaus M. Leisinger | 4 October 2011 | Corporate Responsibilities for Access to Medicines WHO region Neonatal HIV/AIDS Diarrhea Measles Malaria Pneumonia Injuries Other African Region 21.0 5.0 16.3 3.9 15.6 20.4 2.4 15.4 Region of the Americas 37.7 0.7 12.7 0.0 0.2 12.7 5.9 30.0 South-East Asia Region 39.0 0.4 19.5 5.5 0.4 13.7 5.3 16.2 European Region 37.8 0.7 14.0 0.1 0.0 14.9 5.7 26.7 Eastern Mediterranean Region 32.6 0.3 16.7 3.0 2.3 19.6 3.5 21.9 Western Pacific Region 46.2 0.3 12.0 0.8 0.3 9.8 7.5 23.1
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  • 12. What are companies competing with integrity responsible for? Be successful in the core competence with integrity and comply with applicable laws and regulations Corporate Responsibility beyond legality: Legitimacy in the spirit of international norms Corporate philanthropy and pro bono work Desirable (can) Expected (ought to) Essentials (must) | UC Berkeley | Klaus M. Leisinger | 4 October 2011 | Corporate Responsibilities for Access to Medicines Corporate responsibility excellence Good management practices
  • 13. Success in the core competence serves people and the common good Sources: OECD Health Data 2004; Health, United States, 2003: Chartbook on Trends in the Health of Americans; Manton KG, Gu X., Proc Natl Acad Sci USA 2001 May 22; 98(11):6354-9. | UC Berkeley | Klaus M. Leisinger | 4 October 2011 | Corporate Responsibilities for Access to Medicines Drop in death rates 1990-2000 among US pop. 45-64 US life expectancy Years at birth Females Males Average length of stay in patient days US pop. > 65 with disability Heart Disease Cancer Stroke All causes
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  • 15. There is an access-to-medicines problem | UC Berkeley | Klaus M. Leisinger | 4 October 2011 | Corporate Responsibilities for Access to Medicines
  • 16. But price is only one of several reasons: e.g. poor people use available health services less often Source: Lancet 2008, 372, 1661-69 | UC Berkeley | Klaus M. Leisinger | 4 October 2011 | Corporate Responsibilities for Access to Medicines
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  • 20. In 2010 Novartis supported more than 85 million patients with access-to-medicine programs 1 Novartis Institute for Tropical Diseases; 2 Novartis Vaccines Institute for Global Health; 3 Based on approximate market value 2010 Programs and research valued at USD 1.5 bn Coartem ® subsidized > 82 million treatments shipped – cumulatively delivered > 380 million treatments, helping to save about 950,000 lives of mostly children under 5 years Leprosy medication free of charge > 5 million patients cured since 2000 Tuberculosis medicine donations 500,000 treatments committed, 50% delivered Glivec ® patient assistance Free to >37,000 patients in about 80 countries NITD 1 in Singapore Focus on tuberculosis, dengue fever and malaria NVGH 2 in Siena, Italy Vaccines research institute for neglected diseases | UC Berkeley | Klaus M. Leisinger | 4 October 2011 | Corporate Responsibilities for Access to Medicines
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  • 23. We are helping to make a difference Key indicators are showing progress 2004 * Estimate ** 2009 ***2008 Every 30 seconds Child mortality Every 45 seconds*** Malaria Cases 225 million** 243 million 12 countries served Coartem® deliveries Patient share of ACT market Countries served 30% ACT market share 50% ACT market share* 60+ countries served Average price per treatment USD 1 .57 per treatment Price for public-sector buyers has dropped by over 50% 82 million treatments 4 million treatments 2010 | UC Berkeley | Klaus M. Leisinger | 4 October 2011 | Corporate Responsibilities for Access to Medicines
  • 24. Healthcare projects of the Novartis Foundation for Sustainable Development | UC Berkeley | Klaus M. Leisinger | 4 October 2011 | Corporate Responsibilities for Access to Medicines
  • 25. Foundation research on access-to-healthcare obstacles: A complex and multi-dimensional issue Source: Obrist B. et al. (2007): Access to health care in contexts of livelihood insecurity: A framework for analysis and action. In: PLoS Med 4( 0): e308.doi: 0. 37 /journal.pmed.0040308 Are there enough points of care to serve the population? Do drug supplies suffice? What is the geographical distance between points of care and the homes of intended users? Do the prices of services match patients‘ ability to pay? Does the organisational set up meet patients‘ needs and expectations? Does the information and treatment provided take local values into account? | UC Berkeley | Klaus M. Leisinger | 4 October 2011 | Corporate Responsibilities for Access to Medicines
  • 26. Foundation research on “Community effectiveness of malaria treatment” | Access to Medicines UC Berkeley| Klaus M. Leisinger | October 2011 Provider compliance with official guidelines Patient adherence Source: Alba et al. 2010: Improvements in access to malaria treatment in Tanzania following community, retail sector and health facility interventions - a user perspective. In: Malaria Journal 2010, 9:163. | UC Berkeley | Klaus M. Leisinger | 4 October 2011 | Corporate Responsibilities for Access to Medicines
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  • 31. NIBR efforts to address medical needs in the developing world: infectious disease examples (1/2) Tuberculosis (Prevalence/100,000 – WHO 2004) Dengue Fever (Incidence/100,000 – WHO 2005) Malaria (Prevalence/100,000 – WHO 2004) Infectious Diarrhea (Mortality rate/100,000- WHO 2002) Chagas (Prevalence/100,000 – WHO 2002) Typhoid Fever (Incidence/100,000 – WHO 2004) | UC Berkeley | Klaus M. Leisinger | 4 October 2011 | Corporate Responsibilities for Access to Medicines <1 >250 Known risk <25 >25000 <50 >1000 1-5 >100 <1000 >6000 >100 10-100 <10
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