30 June, 2003

Dear Sirs:

The World Health Organization estimates that there are 6 million people living with HIV/AIDS in the developing world and the former Soviet Union in acute need of antiretroviral therapy, yet only approximately 300,000 people are currently receiving treatment in these countries, with a majority of these people in one country, Brazil.

Although generic competition has been a critical factor in reducing the prices of antiretroviral drugs, most of the originator companies have responded by making significant price reductions for the developing world. However, the criteria and terms of these discounts vary from company to company. Some of these price reductions are limited to sub-Saharan Africa or the world's least developed countries (according to United Nations classification), while others depend on a formula that combines a nation's human development index score and its prevalence of HIV infection. Even if a country is eligible for a discount, the pharmaceutical manufacturers may put restrictions on the kinds of institutions that can take advantage of these prices. Furthermore, the terms and conditions of shipment, particularly the inclusion of transportation and customs costs, vary from company to company as well.

We are writing to ask for discounts and other concessionary offers to be extended to all countries, except those that are members of the Organization for Economic Co-Operation And Development (i.e. Australia, Austria, Belgium, Canada, Czech Republic, Denmark, Finland, France, Germany, Greece, Hungary, Iceland, Ireland, Italy, Japan, Korea, Luxembourg, Mexico, Netherlands, New Zealand, Norway, Poland, Portugal, Slovakia, Spain, Sweden, Switzerland, Turkey, United Kingdom, United States) and the exploration of further reductions in the prices of these life-saving medications to as close as possible to marginal cost of production. We are also asking that these price reductions be made available to all public and private institutions, including private clinics, pharmacies and employers that are committed to distributing these medications on a not-for-profit basis. Furthermore, standard international procurement procedures should be established for all discount and concessionary offers to allow rational drug supply management at the country level. Finally, all discounts and concessionary offers cannot be tied to the renouncement of countries' rights to parallel importing or compulsory licensing of generic medications as allowed under current trade regulations.

We would like to meet with you as soon as possible to discuss these requests. A more systematic, transparent approach to differential pricing would be an important step in facilitating wider access to antiretroviral therapy. With one price for all non-OECD countries, broad and uniform eligibility criteria for discounts and concessionary offers and standard international procurement procedures, it will be far easier for all countries and treatment initiatives, and importantly people living with HIV/AIDS, to obtain these drugs at a reasonable cost.

Yours truly,