International Partnership for Microbicides (IPM)
Response to
UK Call for Evidence on Extreme Poverty and the Sustainable Development Goals
18 February 2022
UK Support to PDPs
The United Kingdom (UK) has been a long-standing supporter of Product Development Partnerships (PDPs), which are one of the most innovative nonprofit models designed to address poverty-related and neglected diseases (PRNDs)1. These public-private partnerships (PPPs) were first established in the 1990s to address the urgent need to advance research and development (R&D) for PRNDs such as HIV/AIDS, malaria, tuberculosis (TB), pneumonia, diarrheal disease, and others that lack a traditional market incentive. Since then, PDPs have made significant advances in developing PRND-specific products such as drugs, vaccines, microbicides, biologics, diagnostics, vector control products, devices, and multipurpose prevention technologies1.
UK Support to IPM
Poverty is a major contributing factor to the HIV/AIDS epidemic. In low-resource settings, many people who are living with HIV are not aware of their status. Those who are aware may not be able to afford the high cost of care and treatment services, which may prevent them from working and drive families to financial ruin, trapping them in a cycle of poverty and weakening economies. According to UNAIDS, “The relationship between AIDS, poverty and human development is circular: the impact of AIDS exacerbates poverty and social deprivation, while socioeconomic inequalities and food insecurity increase vulnerability to HIV infection.”
Women in developing countries bear the burden of HIV/AIDS. In fact, HIV/AIDS was the leading cause of death among women ages 15-49 in sub-Saharan Africa in 2019. Further, women and girls accounted for half of all new HIV infections globally and 63% of all new infections in sub-Saharan Africa in 2020. As such, women and girls urgently need additional HIV prevention methods that they can control themselves to help them protect their sexual and reproductive health.
To address this urgent need, IPM has developed a vaginal ring that slowly releases the ARV dapivirine over the course of a month to offer women a self-initiated and long-acting way to reduce their HIV risk. The dapivirine ring received a positive scientific opinion in 2020 from the European Medicines Agency (EMA) for use among women ages 18 and older in developing countries. The product was also prequalified by the World Health Organization (WHO) in 2020, and in 2021 received a WHO recommendation and was included in WHO’s HIV guidelines. The ring received regulatory approval in Zimbabwe and several other countries in eastern and southern Africa in 2021 with additional reviews in the region currently underway.
The UK is a founding donor of IPM, having provided support since IPM’s inception in 2002. The milestones reached to date for the dapivirine ring would not have been possible without IPM’s longstanding strategic partnership with the UK, previously through the Department for International Development (DFID) and currently through the Foreign, Commonwealth & Development Office (FCDO). Continued support is now needed to ensure the successful introduction of the monthly dapivirine ring in eastern and southern Africa, where HIV incidence among women is particularly high. This would in turn open the door to introducing follow-on products now in development like IPM’s three-month dapivirine ring, which could offer women greater convenience and lower annual costs to donors and procurers, as well as IPM’s three-month dapivirine-contraceptive ring, designed to simultaneously meet two major SRHR needs by reducing HIV risk and preventing unintended pregnancy.
Continued Support Needed to Reduce Extreme Poverty
Health is a prerequisite to development. The products that PDPs develop are essential to achieving universal health coverage (UHC) as defined by the WHO Constitution, and the United Nations’ 2030 Sustainable Development Goals, including ending poverty, ensuring lives and promoting well-being for all, achieving gender equality and empowering women and girls, promoting inclusive and sustainable economic growth and productive employment for all, and reducing inequality within and among countries.
Further, investing in microbicides is smart for economic growth, political stability and gender equality given:
Importantly, COVID-19 is a potent reminder that while pandemics upend lives and livelihoods for everyone, they magnify inequalities for women and girls, and can leave them at an elevated risk for HIV. Gender inequities such as uneven power dynamics in relationships, economic disparities that force some women to rely on men financially, and gender-based violence help fuel the HIV/AIDS epidemic among women—and have all been exacerbated by the pandemic.
In fact, the COVID-19 pandemic has made clear how fragile the progress made to date against HIV/AIDS actually is, with a 2021 report noting that the number of people reached with HIV prevention services fell by 11% in Global Fund countries, and with treatment services by 22%.11 These disruptions also highlight the need to continue advancing R&D against ever-evolving infectious diseases, including the importance of evidence-based research and a willingness to embrace innovation.
The UK is renowned for its global leadership in science, research and innovation. IPM strongly believes that it is imperative that the UK continue its global public health leadership, particularly as we must continue responding to COVID-19 without reversing hard-won gains against HIV/AIDS and other epidemics. The UK’s sustained investment is critical to achieving long-term global health security goals.
As the world faces immense health challenges, we urge the continued leadership of the UK in supporting innovative models like PDPs to advance R&D for PRNDs and other global health priorities. We also see a continued and vital need for programs centered on the needs of women and girls, whose health and well-being are vital to achieving poverty reduction goals and shaping productive economies and resilient societies.
Bulc B, Ramchandani R. Accelerating Global Health R&D: The Role of Product Development Partnerships. http://globaldevelopment-impact.org/wp-content/uploads/2020/07/Accelerating-global-health-RD_The-role-of-product-development-partnerships_BBulc_RRamchandani_March2021.pdf
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3https://www.unaids.org/en/resources/fact-sheet
5 Smith JA, Anderson S-J, Harris KL, McGillen JB, Lee E, Garnett GP, et al. Maximising HIV prevention by balancing the opportunities of today with the promises of tomorrow: a modelling study. Lancet HIV. 2016 Jul;3:e289-96.
6 Glaubius R, Ding Y, Penrose KJ, Hood G, Engguist E, Mellors JW, et al. Dapivirine vaginal ring for HIV prevention: modelling health outcomes, drug resistance and cost-effectiveness. J Int AIDS Soc. 2019 May;22(5):e25282.
7 Smith JA, Harris K, Van Damme L, Garnett G, Hallett T. Cost-effectiveness of the dapivirine ring: A modelling analysis [poster presentation]. Conference on Retroviruses and Opportunistic Infections 2016; Boston, Mass.: 22-25 February 2016.
8 Glaubius R, Penrose KJ, Hood G, Parikh UM, Abbas UL. Dapivirine Vaginal Ring Pre-exposure Prophylaxis for HIV Prevention in South Africa [poster presentation]. Conference on Retroviruses and Opportunistic Infections 2016; Boston, Mass.: 22-25 February 2016.
9 UNAIDS (2021). With the right investment, AIDS can be over — A US$29 billion investment to end AIDS by the end of the decade. https://www.unaids.org/en/resources/documents/2021/JC3019_InvestingintheAIDSresponse.
10 Lamontagne E, Over M, Stover J. The economic returns of ending the AIDS epidemic as a public health threat. Health Policy. 2019 Jan;123(1):104-108. doi: 10.1016/j.healthpol.2018.11.007. Epub 2018 Nov 22.
11 The Global Fund (September 2021). Global Fund Results Report Reveals COVID-19 Devastating Impact on HIV, TB and Malaria Programs. https://www.theglobalfund.org/en/news/2021-09-08-global-fund-results-report-reveals-covid-19-devastating-impact-on-hiv-tb-and-malaria-programs/