[Ip-health] PCB39: Address of Justice Michael Kirby - HIV/AIDS & Solidarity - 30 Years On

Thiru Balasubramaniam thiru at keionline.org
Wed Dec 14 00:58:10 PST 2016


http://keionline.org/node/2700

PCB39: Address of Justice Michael Kirby - HIV/AIDS & Solidarity - 30 Years
On
Submitted by thiru <http://keionline.org/user/6> on 14. December 2016 -
10:54

On 7 December 2016, Justice Michael Kirby
<https://en.wikipedia.org/wiki/Michael_Kirby_(judge)> delivered the
following keynote speech at the 39th Meeting of the UNAIDS Programme
Coordinating Board during discussions on intellectual property and access
to medicines. Justice Kirby served as a member of the United Nations
Secretary-General's High-Level Panel on Access to Medicines.

UNAIDS
PROGRAMME COORDINATING BOARD
39TH MEETING, WHO, GENEVA
AGENDA ITEM 6, 7 DECEMBER 2016

HIV/AIDS & SOLIDARITY - 30 YEARS ON*

Michael Kirby**

30 YEARS OF SOLIDARITY

I am proud to be invited to contribute to the Programme Coordinating Board
(PCB) of UNAIDS in this 39th Session. For over nearly 30 years I have
witnessed the extraordinary journey of the global response to the epidemic
of HIV and AIDS.

I am particularly moved to be making these remarks in this chamber at the
World Health Organisation. Coming back to this room summons up powerful
images and memories of the beginning of this journey.

In 1988, almost 30 years ago, I was appointed to the inaugural Global
Commission on AIDS of the World Health Organisation. The Commission met for
the first time in this very room. Our hopes were mixed with fear. There
were no specific treatments for this mysterious new health threat. Yet
fifteen of us were summoned together to confront and hopefully to overcome,
an existential threat to the human species. There was no assurance of
success.

In this room sat Luc Montagnier who was later to be recognised as co-winner
of the Nobel Prize for isolating the causative agent: the human
immunodeficiency virus (HIV). Here, on this side, sat Robert Gallo. His
skills contributed to the earliest tests developed to identify the presence
of the virus. Close by was June Osborn. It was she who insisted on an
evidence-based approach in everything that we did. Next to Robert Gallo sat
Daniel Défert. I sat near him. From every continent we came. We were
chaired by Lars Olof Kallings of the Karolinska Institutet of Sweden. And
at the main table sat Jonathan Mann. A brilliant American epidemiologist,
working in Zaire, he had sounded the alarm and attracted the attention of
Halfdan Mahler, Director-General of WHO. It was Jonathan Mann who demanded
a human rights-based approach that would quickly become the signature of
the global response to this epidemic.

I recall how Robert Gallo predicted that we would have a cure and a vaccine
in less than 20 years. Thirty years on, we have neither cure nor vaccine.
Yet remarkable scientific, medical and social changes have certainly been
achieved.

How fortunate the world was in the inspiring leadership of Jonathan Mann.
And since those days, how fortunate we have been in the leadership of Peter
Piot and of Michel Sidibé, continuing this heroic global work.

Before he lays down his mandate as UN Secretary-General, it is also right
to honour Ban Ki-moon for his close engagement with HIV and with the
lessons that it teaches us. Also his predecessors, Boutros Boutros-Ghali
and Kofi Annan for their perception of the special challenges presented by
HIV and the need for a response and a coordination of efforts that gave
birth to UNAIDS. AIDS is not over. The challenge has not gone away.
However, the achievements in the 30 years since that meeting in this room
have been extraordinary. We have learned to extrapolate from the lessons
for healthcare generally. We have learned about ourselves: the noble side
of solidarity and the side of fear, indifference and greed.

UN LEADERSHIP

Embracing the AIDS paradox, for default of other tools, Jonathan Mann
established the Global Programme on AIDS within WHO. With the 1990s came
the antiretroviral drugs and their miraculous impact on life and health.
With that impact came the early lessons about intellectual property law
(IP) as it related to AIDS. In the Universal Declaration of Human Rights,
Eleanor Roosevelt and her colleagues included the concept of the gradual
attainment of a right to human health as basic to human existence. But also
the basic right for the enjoyment for the fruits of science and for authors
of scientific inventions to enjoy rewards for sharing the benefits of their
inventions with society. The reconciliation of a right to health and a
right to protection for inventions has never effectively been achieved.
They stand together; but often in competition. It is that unresolved
competition that, years ago, I predicted would need a “Luther of
jurisprudence” to reconcile.

In 2011, Helen Clark, Administrator of UNDP, established the Global
Commission on HIV and the Law. I was appointed to it and former President
Fernando Henrique Cardoso of Brazil became the Chair. That Commission
reported in 2012. Again, there were brilliant and knowledgeable colleagues
– pushing forward still further the lessons that Jonathan Mann had taught
us. In chapter 6 of that report we drew attention to the unresolved issues
of intellectual property as they impinged on access to essential
healthcare. We recommended that the UN Secretary-General establish a body
of appropriate membership to grapple with this topic. We recognised that
this was a sensitive and controversial proposal. In the nature of things,
we were not at all sure that it would be followed up.

It would have been easy for Secretary-General Ban to have left our proposal
to a successor. But that was not his approach at all. With the support of
Helen Clark for UNDP and of Michel Sidibé for UNAIDS, in October 2015, he
announced the establishment of his High Level Panel (HLP) on Access to
Essential Medicines. For the leadership of that Panel he appointed, as
Co-Chairs, two outstanding former heads of state, to bring practical wisdom
and leadership to the task: Mme Ruth Dreifuss (former President of the
Swiss Confederation) and Mr Festus Gontebanye Mogae (Botswana). They were a
formidable leadership team. In office, each had shown empathy for, and
knowledge about, the challenges of healthcare. They were to lead us through
our work.

With 15 members in the HLP and the input of an expert advisory group and
multiple agencies and institutions, of scientists and lawyers, of industry
and civil society, we worked under great pressure. We delivered our report
by September 2016, just as the Secretary-General had required of us. It is
not a lengthy report. It cuts to the bone of the issues with which we were
entrusted. It speaks to the United Nations and to this PCB on the essential
challenge presented by the reconciliation of the necessities of human
health and the essential requirements of intellectual property law.

A CONTEXT OF CHALLENGES

The HLP addressed its mandate aware of the realities of the HIV/AIDS
epidemic and of health care generally today. Those realities are well
known. But they deserve repetition:

We still have no cure for, and no effective vaccine against, HIV, despite
the early bold predictions.

The world has made astonishing advances in mobilising huge resources of
money and talent required to bring essential healthcare and messages of
prevention and protection to unprecedented numbers of persons infected or
at risk. The initiatives of PEPFAR and the Global Fund against AIDS,
Tuberculosis and Malaria have, with bilateral and multilateral assistance,
resulted in astonishing support and solidarity. More than 18 million people
living with HIV and AIDS (PLWHA) are receiving ARVs. However, in part from
fatigue; in part because of economic crises; and in part in consequence of
other challenges, the flow of funding is now under strain. This is most
clearly demonstrated by the fact that 30 million could benefit from access
to ARVs. Yet at least 12 million of these are presently left behind.

The early treatments, with first line therapies were largely achieved with
the aid of generic drugs: copies from originals but available at much lower
costs. Now, increasing numbers of patients require second, third and other
line therapies. Their numbers will increase. And with that increase so will
the cost of treatment grow, exactly at a time when global subventions are
in decline.

The immediate occasion for the Secretary-General’s action in establishing
the HLP was the adoption by the UN General Assembly in September 2015, of
the Sustainable Development Goals (SDGs). Specifically, SDG 3 affirms the
basic entitlement of people everywhere to “essential” healthcare by 2030.
The SDGs proclaim that no one will be left behind. “Essential” must mean
essential to life and basic care and support. Unless the world can do
better, millions will certainly be left behind. That grim possibility must
now be faced. And so must the risk that some, even in countries now
classified as middle or high income countries will fall outside global
support and sustainable care.

Coinciding with these developments have been others in the field of IP.
They were known to the UNDP Global Commission. They were foremost in the
minds of the HLP. A proliferation of Free Trade Agreements (FTAs) since the
1990s has altered the landscape, sometimes in an aggressive way. Until the
establishment of the World Trade Organisation (WTO) in 1994 national
protection of IP in the context of pharmaceuticals, diagnostics and other
healthcare inventions was patchy and inconsistent. The WTO stamped the
obligations of the TRIPS Agreement of 1994 on countries rich and poor. Yet
that agreement contained particular protections allowing safeguarding of
the right to health and the entitlements of countries, especially middle
and lower income countries, to enjoy ‘flexibilities’ that they can invoke
when tackling health crises. The advent of many FTAs undermined these
flexibilities. In the result, the Doha Declaration of 2001 was agreed to
safeguard the ‘flexibilities’ and thereby to protect human health,
especially in poorer and more vulnerable communities. Unfortunately, FTAs
continued to impose on many such countries new obligations in respect of
intellectual property. They imposed new and additional duties, called
“TRIPS+”. To gain the advantages of freer trade, the poor and vulnerable
were commonly required to surrender the powers of self-protection. The
flexibilities in TRIPS and the protections in Doha proved inadequate to
resist the pressures. A crisis demanded new and urgent measures. The
specialised institutions of the global community (WHO, WTO and WIPO) talked
and debated for years. But over time, the protections for health were
disappearing in the face of the tide of FTAs.

This was a crucial problem called to notice by the UNDP Global Commission
of 2012. Could it be left to market forces to sort it out? In establishing
the HLP, the UN Secretary-General noted the “policy incoherence” that had
emerged. If SDG3 were to be attained by 2030, as promised, the policy
incoherences had to be addressed. This was the setting in which the HLP
took up its
challenge.

METHODOLOGY OF TRANSPARENCY

Whereas most FTAs and much else in trade law are negotiated, and the deals
struck, in circumstances of secrecy and negotiations private from civil
society and the poor and vulnerable communities most affected, the HLP
embarked upon its own methodology of total transparency.

On its establishment, it provided briefings in the United Nations, for the
nation states, the affected UN agencies and other institutions and for
international civil society. It reached out to the pharmaceutical industry
and the corporations closely involved in the manufacture of
pharmaceuticals, tests, vaccines and other health technologies. It
undertook public hearings to which industry, institutions and civil society
were invited. These hearings were conducted in London, Johannesburg and (by
video link) Bangkok. A large body of submissions was posted on the HLP
website. So were the proceedings of the public hearings. At every step of
its work, the HLP was transparent. We were determined to engage with as
many affected as was possible.

Moreover, led by our co-chairs, the HLP sought internal consensus and
explored multiple options. In the end, the members had a choice:

We could present an ‘aspirational’ report, identifying the policy
incoherences and advocating a completely new model to replace the IP market
model of the past;

We could embrace the current approach, leaving it stand on the basis of the
many scientific successes in health technologies that had undoubtedly been
achieved; or

We could seek to address the policy incoherences and provide a strategy for
innovation and access for the here and now that accepted the continuing
role for IP but in the context of basic rights to health recognised in the
SDGs.

In the end, the HLP opted for this third approach. It would seek the
highest measure of agreement that could be attained amongst the 15 members,
working by consensus. We would indicate any individual views of our
signatories, if they wished to record them. The report thus provides the
core agreement upon which the HLP members came together. But it also
records the views of those who advocated the strengths of the current model
alongside those whose conclusion was that the current model had basically
failed the people for whom SDG3 is mostly addressed. The consensus rejected
an approach that would have “torn up” the current model to start again. But
it equally acknowledged the urgent need to provide immediate solutions for
the demonstrated policy incoherencies which had occasioned the
establishment of the HLP.

This was a transparent but also prudent, practical and realistic consensus.
It can be placed before the international community as something more than
dreams. It proposes requirements urgently needed to assure access by all to
essential healthcare.

HLP’S CORE PROPOSALS

The consensus report of the HLP advances a number of core recommendations.
They require immediate action to tackle the demonstrated policy
incoherences:

Stopping retaliation: It recommends that the WTO take immediate steps to
halt the imposition of pressure targeted at member countries of WTO to
require surrender of their TRIPS flexibilities and to protect the
guarantees of the Doha Declaration. It urges the establishment by WTO
members of a register of complaints of conduct of this kind. It seeks to
bring about a change in the culture of WTO and a restoration of the
principles of TRIPS flexibilities and the Doha Declaration. It insists on
the protection of the right to establish compulsory licenses where this is
necessary for vulnerable countries in safeguarding the essential healthcare
of their populations.

Innovation: The HLP tackles directly the unsubstantiated exaggerated claims
that excess prices were indispensable for scientific innovation. Reasonable
and just rewards to not warrant excessive demands. Nor is the current model
shown to be effective in promoting research and development, particularly
for the diseases of poorer and vulnerable countries and regions. The HLP
urges delinking the costs of innovation from the end prices paid for
essential healthcare, vaccines and tests. It calls attention to the urgency
and variety of the world’s health needs and the inadequacy of the market
alone to achieve essential innovation.

Transparency: The HLP also recommends the radical enhancement of
transparency of data so as to make available to nation states, the market
and the international community the real costs of developing new health
technologies. In the place of unsubstantiated assertions should be accurate
data, including data that breaks down the actual investment on innovation
and segregates marketing, advertising and promotion costs from the costs of
novel scientific research.

Database of Products: In the age of the internet, the HLP recommends the
establishment of a database containing prices of patented, generic and
biosimilar products and the places of their availability. The market should
be given enhanced capacity to deliver products to the needy and poor.

Review Body: The HLP recommends that the UN Secretary-General should
establish an independent review body to report on the initiatives taken
following the HLP report. And to track both innovation of new products and
access to healthcare worldwide. Such a body should be created by 2018.

Special Session: The UN General Assembly should convene a Special Session
on Access and Innovation in 2018, both to examine follow-up to the HLP
report; to scrutinise the operation of TRIPS and Doha and to examine
critically and empirically the claims of innovation and the delivery of
products worldwide.

NEED FOR ACTION

But was there really a need to change in any significant way the current
model of intellectual property and healthcare? Have we not seen examples of
technological miracles these past 30 years? Has not the market delivered
these technological miracles on HIV so that we can be confident that it
will do so in the future in all areas of healthcare?

Market Failure: Unfortunately, it cannot be said that the market and
current IP protections provided access to the ARVs and others HIV
necessities. To the contrary, the advent of the original early
pharmaceuticals (mainly the outcome of public research in Universities not
by private corporations) were completely beyond the means of most PLWHAs.
The average ARV market price of $10,000 per patient per year in June 2000
was completely unattainable for countries where HIV was at its worst. Had
it been left to the global market, millions would have died. It was
resolute action and the development of generic copies that put ARVs within
a cost that allowed the global initiatives of the past decade.

In effect, India, Brazil and other countries, by their national initiatives
under their IP laws, became pharmacies for needy of the world. The costs of
patient treatment fell immediately. Suddenly the world could indeed dream
of essential HIV healthcare for millions. The first line therapies for a
patient could be secured for $100 and later less. The initiatives of WHO,
UNAIDS and other agencies rapidly scaled up the access of millions to HIV
treatment. Today 18 million are alive thanks to these initiatives. Yet the
figure should be 30 million. The increasing need for new lines of patented
drugs makes this still more difficult. Sustaining the miracle requires new
initiatives. More of the same will return the world to a policy incoherence
between desperate need and affordable care.

The problem becomes even more clear when consideration is given to
conditions beyond HIV. The present costs of treatment of Hepatitis C are
beyond the means of most natural health budgets. Yet the pharmaceutical
means exists to save lives, give care and even to cure millions who
presently live with this challenge to their very survival.

New cancer drugs are likewise beyond the means of many desperate patients.
On the very day that the HLP held its first meeting in New York, the media
was full of reports of a hedge funder who had acquired a pharmaceutical
company and increased the costs of a cancer drug a thousand fold. This, in
his analysis, was in the ‘best interests of the shareholders’ of his
corporation. Pharmaceuticals, vaccines, tests and other healthcare products
are not just ordinary goods. They can make the difference between life and
death. Between dignity and abject suffering. A market model left entirely
to its own devices will often be neither just nor efficient in tackling the
needs of innovation and access of the healthcare needs for millions. How
should the world respond?

IMPRESSIVE TESTIMONY

Strong voices are now being raised calling for an end to the policy
incoherences. Such voices were heard by the HLP at its public hearings and
in other submissions.

In Johannesburg, a young woman gave testimony about her struggles with
Multi-Drug Resistant Tuberculosis (MDR TB). Her evidence demonstrated the
inadequacies of the current model to produce new antibiotics and other
drugs – especially where the patients in need are mostly poor and cannot
stimulate the market. The complex and inefficient therapies against MDR TB
had rendered this witness deaf and frightened. Hers was a story told many
times about the instances where the market model showed its unacceptable
limits and inadequacies.

An older woman gave evidence in Johannesburg that she had been diagnosed
with stage 4 breast cancer. She had earlier taken out health insurance. But
it was not sufficient for the price of treatment. Public health could not
afford her access to medicines that would control her cancer. Hers was a
desperate plea for a better arrangement that would address the inadequacies
of the market. This witness died after the HLP report was delivered. But
her voice remains with us demanding that we explore a better means of
access to essential drugs.

In London, powerful testimony came from an unexpected source. In the law
there is a saying that evidence is more believable if given by a witness,
apparently against interest. The most powerful testimony offered in London
was not by a patient but by an official. A senior representative of the
Netherlands Government intervened to make a point on behalf of a wealthy,
creative and scientifically inventive country: “Don’t think that this is a
problem only for poor and vulnerable countries”, he said. “Today, this is a
problem for all countries. It is a problem for hard pressed national
budgets, faced with the desperate needs of sick and dying citizens. This is
also a problem for the Government of the Netherlands. It is a problem for
the whole world.”

In the last month, similar words were expressed by two ministers in the
Government of the Netherlands, Lilianne Ploumen and Edith Schippers.
Published in The Lancet, the minsters made a powerful call to all civilised
people:

“Better life through medicine – let’s leave no one behind.”

They criticised the way the current “global patent rules are applied”:

“These rules provide for safeguards to make sure that all people have
access to the medicine they need. However, in practice, the governments are
often submitted to pressure not to use these safeguards. This situation
contradicts [TRIPS] and its explicit provisions for a flexible
implementation of patent rules in the interests of public health.”

The two ministers describe other challenges in countries, including the
Netherlands, for the cost of the available treatment for chronic Hepatitis
C:

“Patent and intellectual property exclusivities are the only cornerstone of
the current model. Companies can ask the price they like. This will no
longer do. We need to develop alternative business models. And if public
money is used for the development of new medicines, agreement up front is
needed about what this public investment will mean for the final price. We
believe that companies must provide full transparency regarding the cost of
research and development.”

Little wonder that the minsters expressed their support for the proposals
of the HLP. Little wonder that they should acknowledge the current system
is “broken, but change is on the way.”

FROM DUNGEONS TO THE LIGHT

Intellectual property law is complex and technical. Yet an understanding of
it is essential for real access to essential healthcare. It is vital to the
attainment to the SDGs. This is why the recommendations in the HLP report
must capture the attention and support of the PCB. The report should not
end up in the graveyard of UN reports.

I saw that graveyard again as I walked through the dungeons of the WHO
building to reach this meeting of the PCB. In the cages that line the
corridor can be seen the reports of long forgotten committees. No doubt I
contributed to some of the early reports, now neatly collected on the
shelves gathering dust. I suppose it could be said, as we hurry pass them,
that in a general sense, we “take note” of the reports. But is that enough?
Unless the HLP’s recommendations impinge on our hearts and minds, a vital
opportunity may be lost, perhaps forever.

The prudent, necessary and minimal recommendations of the HLP deserve the
active engagement by the PCB. Such engagement may be given in the sure
knowledge that the price of maintaining the solidarity of the past 30 years
will be immediate action to ensure that essential medicines, vaccines,
tests and other healthcare technologies are not put beyond the means of
those who need them most. Physically and figuratively, it will be a tragedy
for the HIV response, and for human healthcare more generally, if those
with power simply “note” our report and its recommendations. If they
consign it to the dungeon to gather dust, then many will be left behind.
Now is the moment of decision. We can draw on the deep well of solidarity
that has been such an inspiring feature of the past 30 years of the
struggle against AIDS. Solidarity can nourish the human family as it
considers where the logic of HIV takes us for the broader challenge of
universal healthcare.

We must make this happen.

…

DÉNOUEMENT AT THE PCB

At the close of the interventions on this item of the agenda of the PCB, I
can offer a few final reflections. I start with thanks for the
interventions of many member states, and the constituencies for whom they
spoke.

Especially I acknowledge the interventions expressing support for the
report of the HLP or indicating appreciation of the importance and urgency
of our recommendations. For this I thank the representatives of Brazil,
Ecuador, India, Iran, Canada, the Russian Federation, Ghana, the
Netherlands, Namibia, Mexico, South Africa and Chile. I also thank the
organisations that spoke in the same vein: Médecins Sans Frontières,
Knowledge Ecology International, Medicines Patent Pool, the World Council
of Churches, Centre Publique d’Innovation; AIDS Fonds. It was not
surprising to hear of the support of civil society organisations who are
engaged with the problems of access to essential healthcare in the field of
HIV. They realise the significance of what we do now for what we will do in
the years to come to ensure that SDG3 springs to life and effectiveness.

I also thank the representatives of the United Nations agencies and bodies
who have spoken in appreciation of the importance of the work of the HLP.
Many of them have been important sources of ideas for action that
influenced the report of the HLP. UNAIDS itself was there at the beginning
of the HLP. It gave invaluable support throughout our work. UNDP provided
dedicated secretariat. I should single out Dr Mandeep Dhaliwal and Dr Tenu
Avafia. Also to be acknowledged are the recommendations of the UNAIDS
Reference Group on Human Rights and HIV. As a member of that group, I
association myself with the recommendations it has placed before the PCB.

I also acknowledge the thoughtful intervention before the PCB by the
representative of WHO. I honour that agency of the United Nations. I
remember how Director-General Mahler, so long ago, seized the challenge,
empowered Jonathan Mann and authorised initiatives that were so resolute
and bold. If I am a little more muted in my praise of the Trilateral Group
(comprising WHO, WIPO and WTO), it is out of a sense of disappointment that
this group talked and produced papers over many years, whilst the urgency
of the problems now addressed by the HLP accumulated. This is why action
beyond the Trilateral Group was essential. A long life in the law has
taught me that specialists can sometimes get too close to their specialty.
When that happens, they lose critical perspective that is necessary to see
faults as well as merits in the speciality. This is what has happened with
the Trilateral Group. Hopefully, the HLP has given voice to the critical
faculty that will now reinvigorate the response for the World Health
Organisation. The WHO is the primary global agency with responsibility for
healthcare worldwide. It cannot shirk that responsibility or surrender it
to others – Trilateral or otherwise. It thus has the primary responsibility
the lead for attainment of SDG3. WHO must find its own voice and powerfully
support action on the HLP.

I acknowledge the insistence of several member states that intervened in
the PCB urging that a balance must be struck between the individual right
to health and access to essential healthcare (on the one hand) and
innovation with IP protection and rewards (on the other). I am thinking
here of the interventions of Monaco, United States of America, United
Kingdom, Norway, Japan and the constituencies for which they respectively
spoke. Correctly, they asserted that a balance must be struck. I thank the
representative of the Holly See in reminding the PCB of the words of Pope
Francis in this respect.

No one doubts the need for balance. It is inherent for the provisions
traced back to the Universal Declaration for Human Rights. But when the HLP
report is examined, it will be clear that the balance we proposed was
essentially the one that is already provided by the TRIPS Agreement and the
Doha Declaration. However, that balance must be attained in actuality. If
it is expressed in print but evaded and undermined without sanction in
actuality the response is incoherent. The balance is destroyed.

The international community should acknowledge this conclusion and act upon
it. It would be a tragedy if the solidarity that has been substantially
maintained over 30 years in the HIV/AIDS response were now to erode as in a
consequence of new divisions between rich and poor nations; donors and
recipients; IP insistent and healthcare demanding. The message that the
HIV/AIDS response must send to the next generation, as it grapples with the
SDGs, must surely be that solidarity and common ground can be forged and
maintained. Continued beyond 30 years. Just rewards for innovation are not
incompatible with universal access to essential healthcare that leaves no
one behind. That is the message the PCB should send around the world.

Finally, I honour the individuals who have spoken at the PCB on behalf of
non-governmental organisations and civil society. They have spoken on their
own behalf, to personalise an intensely felt commitment evident throughout
the PCB discussion. I refer to the representatives of NGOs Europe; NGOs
North America; NGOs Eastern Europe and Asia; APN Plus Asia and others. Many
of them have made it clear that they would be dead but for the specialities
of the global AIDS response and of the organisational model that began as
GPA in WHO and continues as UNAIDS today. And beckons us to SDG3.

This PCB is not a typical governing board of a UN agency. Or indeed, of
anything else. It remains a reflection of the insistence, in those days 30
years ago, that people living with HIV and AIDS would always participate as
voices at the top table. Jonathan Mann used to say: “Not spoken about nor
spoken to; but speaking out and listened to.” This has been a special
feature of HIV and AIDS. It bears the seeds for lessons for healthcare more
generally. As a relic of those early days, I am proud to see that this
unusual feature is still maintained. So I honour those who have lifted
their voices now and before. I thank them for their courage and
persistence. They have spoken out loud and proud: with strength and
conviction. We must not allow a business model to eliminate this feature of
our endeavours.

Earlier in my remarks, I mentioned distinguished names that were present in
the early days of the original Global Commission on AIDS, in 1988. There
were many others. One name I did not mention was Richard Rector. He too was
sitting in this room, lifting his voice before the Commission in 1988. He
was here because of Jonathan Mann’s commitment to a rights-based approach
and to the essential dignity of all those who became infected with HIV in
those frightening early days.

Richard Rector was a gay man from the United States. He had found work in
civil society in Denmark. He was faithful in attending the meetings of the
Commission. It was his platform. There were no antiretroviral drugs in
those days. A diagnosis of HIV was usually a death sentence. But Richard
Rector never lost his resolve and commitment. At each succeeding meeting he
appeared, increasingly emaciated, from the ravages of HIV. He never became
the beneficiary of the drugs that would have saved his brave and insistent
life. He served others for whom he spoke out until he could speak no more.

We should not forget Richard Rector and all those like him. Nor should we
forget the genius of human invention and the advances of science and global
engagement that have saved so many lives. One day science will consign HIV
to a footnote in the human history of epidemiology. But a whole new chapter
will now be written in the history of global healthcare.

It will tell of how, in very dark times, we did not forget our commitment
to one another. Of how we responded as a human community. Of how the United
Nations was true to the commitment of fundamental human rights expressed in
its Charter and in Eleanor Roosevelt’s UNDHR. This PCB must do all in its
power to maintain that remarkable achievement. That is why SDG3 is so
important. And why solidarity, with justice and equity, remain the guiding
principles for access to essential healthcare.

If we believe this, then as a minimum we will ensure that the minimal
recommendations of the HLP of Secretary-General Ban Ki-moon are given
effect. Only then will solidarity be maintained and extended. Only then
will no one be left behind.



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