Two decades of life-saving medicines in Africa

Championing equitable access for medicines to fight HIV, malaria, tuberculosis, and other diseases affecting the developing world

According to United Nations figures, in 2021, around 650 000 people died from AIDS-related illnesses worldwide, compared to two million in 2004 and 1.4 million people in 2010 (UNAIDS, 2022). From 2000 to 2015, the number of malaria deaths fell by almost 40%, from 896,000 deaths per year to 562,000, the World Health Organisation reports (Rosner and Ritchie, 2019).

Through ground-breaking collaborative efforts, the Cipla Global Access (CGA) initiative has over 20 years successfully and drastically brought down the cost of medicine, to ensure that people have equitable access to life-saving treatment. By making HIV, tuberculosis, and malaria treatments available to people in poverty-stricken regions, there has been a major difference not only in their quality of life, but also their long-terms socio-economic prospects.

“Built on the foundation of ‘caring for life’, Cipla has championed access to quality, affordable medicines through more than 1500 products across 65 therapeutic categories in over 50 dosage forms through the Cipla Global Access (CGA) initiative,” says Paul Miller, CEO of Cipla South Africa. “For more than 20 years, antiretroviral (ARV) drugs have been made available to patients around the developing world at affordable prices, and Cipla has been leading the development of paediatric fixed-dose variations of these ARV treatments for children.

“This has only been possible through the Global Access business mode, which sources consistent funding from donor communities and agencies while working closely with procurement agencies to identify reliable suppliers and deliver medicines efficiently to target nations,” Miller says.

Rather than working in isolation, this highly efficient model establishes a reliable network of donors, such as The Bill & Melinda Gates Foundation, The World Bank and USAID.

Funding agencies like The Global Fund, the U.S. President's Emergency Plan for AIDS Relief (PEPFAR) and the Joint United Nations Programme on HIV/AIDS UNAIDS (UNAIDS) create an added layer of advocacy for accelerated, coordinated and comprehensive action on global health activism.

From there, procurement agencies such as I+ Sulotions, Chemonics International,  Médecins Sans Frontières, or Doctors Without Borders (MSF), United Nations International Children’s Emergency Fund (UNICEF), and United Nations Development Programme (UNDP), and ensure that resources are effectively deployed and accounted for, utilising the most trusted suppliers, and distributing medicines efficiently, mainly to low-income countries around the world.

Advancing HIV treatment

In 2001, using this model, CGA enabled the world’s first ever recommended 3-in-1 fixed dose anti-retroviral combination (Stavudine + Lamivudine + Nevirapine) to be made available at less than $1 per day, compared to the prevailing $12 000 per patient per year. It changed HIV from a death sentence to something that can be managed like a chronic illness for millions across the developing world.

In 2015, Cipla became the first company to provide ground access of lopinavir/ritonavir to infants and children in the form of easily palatable oral pellets. Prior to that, the only treatment available for babies and very young children in South Africa consisted of a syrup that contained 40% alcohol and required refrigeration. Caregivers struggled to give this bitter-tasting formulation to young children, leading to poor adherence. With the introduction of oral pellets, adherence is predicted to improve substantially, leading to better treatment outcomes.

By 2022, Cipla became the first to offer a FDC of abacavir (ABC), lamivudine (3TC), lopinavir (LPV) and ritonavir (RTV) for first-line paediatric patients. The product was dispatched in September ’22 to the Democratic Republic of Congo (DRC), as per temporary authorisation received for the country. Cipla is also the first to develop and file for the first fixed-dose combination of abacavir, lamivudine and dolutegravir for children, helping streamline pill burden and therefore improving adherence for first-line paediatric patients.  CGA has helped to expand the regulatory footprint for new therapies with key complex molecules across the world, focusing on aggressive, competitive pricing for active pharmaceutical ingredients which will result in massive savings for patients.

One of the big focuses of CGA is to help de-risk supplies for critical medication, such as anti-retrovirals for people living with HIV in countries with meagre resources. Doing this gives Cipla the ability to continuously improve the process of equitably distributing these life-saving drugs. In addition to this, there has also been an immense focus on expanding the regulatory footprint for key molecules.

From a sustainability perspective, the CGA model has been a key instrument in identifying and executing Cipla’s three-pronged approach to becoming more ecologically responsible. These pillars are:

• trilingual artwork adoption,
• eco-friendly projects and
• the digitisation of Summary of Product Characteristics (SmPC) and Patient Information Leaflet (PIL).

Trilingual artwork adoption involves increasing access to information by adding data for Summary of product characteristics (SmPC) and Patient Information Leaflet (PIL) in three primary languages (English, French and Spanish). This enables a broader audience to easily access the information.

To further facilitate this,  Cipla is embarking on a programme to digitise SmPC and PIL, replacing paper SmPC and PIL with QR codes for digital access. This means that real-time data can updated for both patients and healthcare professionals. Moreover, reducing lengthy PILs save on paper and the added weight during transportation, which helps to reduce the carbon footprint.

Finally, Cipla’s eco-friendly projects have seen plastic pallets replace the wooden pallets as a more cost effective and environmentally sustainable solution. CGA has implemented carton-less packs for Aba-Lami 30s and 60s pack, to improve packaging efficiencies and costs.

“Most of these innovations would not be possible without the tried-and-tested CGA model,” Milller says. “Over time, its collaborative strategy has become increasingly efficient in delivering these vital medicines to the places that need them the most.

“In these regions, this has led to a gradual improvement in the life expectancy of entire nations, while facilitating their combinations, eradicating some infectious diseases and aggressively controlling others to a near total elimination,” he concludes.