Clinton Health Access Initiative

#Flashback03 - By mid 2006, we had 10,000 children on anti-retroviral treatment in 11 countries in Africa, the Caribbean and SE Asia, a grand achievement so we told ourselves. Barely had the champagne bubbles fizzled out before we regrouped and told ourselves a couple of hard-faced truths: 1) treating HIV+ children with syrups was a nightmare for the mothers who needed to carry a bunch of bottles out of the HIV clinics, making an already inimical stigma issue acutely crippling. 2)DNA-PCR testing was still dancing around high level research labs; yet that was the indisputable entry point for getting more children onto treatment. As we were getting ourselves all wrinkled up, in came the Heads of State of Brazil, Chile, Norway, France and the UK with an unprecedented show of solidarity and a bold conviction that driving innovation in HIV, TB and Malaria needed a lean and fast moving entity that could intervene on early stage promising solutions that could scale. That bold show became Unitaid - and our worry lines became a silver lining of the possibilities that lay at the end of this rainbow. Unitaid threw the gauntlet at us: 100,000 children on treatment and a complete overhaul of adult 2nd line treatment, largely in the global south, in 12 months...!! - the line between foolishness and boldness is pretty thin; we said bring it on. Kanika Bahl - lived between a suitcase and a plane seat for an indescribable timespan to eventually sign up enough countries into a drive that looked and sounded like a pipe dream. Trevor Peter - wore down his 2 bags (one always carried drinking water) to junk, setting up DNA PCR testing solutions in the same unwieldy number of countries and somewhere in there, Roche Africa diagnostics folks answered the call of the wild to walk with us in redefining molecular science out of the benches of research, into a real public health solution. We still had to roundtable governments, USG and Global Fund to figure out what pieces of the HIV pie were going stale and needed a round of fresh baking with more innovative ingredients. Most folks look hesitatingly at innovation and either walk away in fear or get to love it unreservedly. We were in good company on the latter and got the playing field packed with enough syrup naysayers to find ample space for liquid dispersible tablets as a replacement. It is these maneuvers that singed the signature of Clinton Health Access Initiative, Inc. - on market shaping, as each step up on that innovation ladder brought prices crashing down and formulations better and more tolerable. The part of cracking the DNA result transmission riddle fell on Richard Freeman - who is a whole story by itself, and who came up with an SMS printer as a solution, which became a wild fire long before the internet became sine qua non. We got 70,000 children on treatment in 12 months in 33 countries and hit the 100,000 mark 4 months later. The HIV world was never the same after that...Ashe oleng.

#Flashback01 - It is July 2002, the 14th International AIDS Society (IAS) conference in Barcelona, Spain. There are several heads of state and former heads of state in attendance including recently retired President Clinton, who has the enviable task of giving the closing address to a gathering that has run a whole week of clanging alarm bells; one after another, about a pandemic spiraling wildly out of control. Next to him and nodding in full agreement was retired President Nelson Mandela whose son was to die 3 years later from HIV complications. President Clinton makes a passionate case for more health care workers to manage HIV, lower drug prices and greater urgency in raising the funding required to up the fight against the virus. He offers to traverse the world if needed, to continue making this case. At coffee break, the then Prime Minister Denzil Douglas of St. Kitts & Nevis walks up to both President Clinton and President Mandela and raises a question directly to President Clinton: "With lower priced HIV medicine, I have the money to treat every infected person in my country. With current drug prices, I can barely manage 20% of the infected population". With an elbow dig into President Clinton's ribs, President Mandela tells him: "You should help this man find cheaper medicine, then your closing speech at this conference will have meaning". That is how Clinton Health Access Initiative, Inc. was born. By October of 2002, prices had been negotiated with several generic manufacturers in India and lower priced ARVs were on their way to St. Kitts & Nevis and to the Bahamas as well. From an impossible $1,200 per patient per year on innovator molecules, the world was now staring at an astonishing $140 per patient per year, but sadly that was just the beginning, as price drops without solid treatment plans, infrastructure and skilled staff, would still remain a single step. Fast track to April 2005, President Clinton's advance team jets into Nairobi to prepare for his visit to Kenya in June of 2005. An MOU is signed between Ira Magaziner, CHAI's co-founder and Charity Ngilu, then the Minister for Health in President Kibaki's Government, ably facilitated by Dr. James Nyikal, then Director Medical Services, and that formally establishes CHAI in Kenya. President Clinton arrives in June and amongst the many issues discussed between him and President Kibaki, 2 of them become the opening salvo for CHAI in Kenya: Paediatric HIV care and treatment and additional nurses. As President Clinton departs, he commits to President Kibaki to donate enough Paediatric ARV formulations to put 1,500 children on treatment by December 2005. That was the KPI that landed on my desk as I was running around trying to set up the CHAI office in Nairobi. A KPI coming off 2 Presidents has many meanings behind it with one very clear one: there is no room for failure. Coming up next: where is the medicine, where are the children, who will treat them...???

Yesterday, I drew the curtain on 21 exhilarating years in global health and took my final bow out of the Clinton Health Access Initiative, Inc. office in Nairobi heading out to what I am calling retirement, but what most folks close to me are laughing off uproariously. Rest however I must; looking back at 21 years of a high octane swoosh, sometimes above the sound barrier, makes the years look like just a couple of weeks. While I will definitely suffer withdrawal symptoms from the high energy environment that I am guilty of building and was so used to, a break is good for the soul and the body too. While I have a whole bunch of things already queuing themselves up for my attention, I want to walk carefully amid the haste and preserve some good downtime away from the "seen it all". There are some parts of global health that will not miss me at all, and there are others furiously banging on my door. I will probably open the door but only let through those that can fit into my downtime and still give my mind that much needed high once in a while. Over the next few weeks I will try and take a looking glass back through the 21 years and pick some moments that I will post here; some hilarious and others more sombre with some names thrown in. If you find your name somewhere in there, it will be about something good. Take the slow ride with me, and like I was taught by my Maasai moran friend: "ashe oleng" - which is thank you very much...

It was terrific to meet the hard-working government team leading Guatemala's malaria elimination efforts in Alta Verapaz. Visiting the Cangüinic transmission focus — one of the highest incidence areas left in the country — and connecting with the volunteer community health workers, nurses, and vector control technicians who comprise the frontline workforce gave me an inspiring picture of the progress being made and the challenges that remain on the road to zero cases by 2030. Thanks to the Clinton Health Access Initiative, Inc. Guatemala team for their dedication to working alongside the most affected communities and the Ministry of Health to finish the job in the next few years.