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

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

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

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

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

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

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

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