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

On 7 December 2016, Justice Michael Kirby 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.