The international courier DHL is the latest multinational company to join the ranks of those providing services at no profit to assist in the roll-out of antiretroviral therapy with the announcement on May 5th that it is to provide non-profit courier services to deliver antiretrovirals. Products manufactured by Merck & Co will be delivered to treatment centres and distribution centres in Africa at a no-profit cost that will reflect the costs of shipping.
Merck's efavirenz (Stocrin) is one of the drugs recommended for first-line antiretroviral treatment in resource-limited settings.
However, getting the right drugs to the right place at the right time has emerged as a major issue in rolling out antiretroviral therapy in developing countries. Drugs may be lost, damaged, incorrectly stored, stolen or diverted to street traders or back to developed countries during their journey from factories in Europe and North America to hospitals in sub-Saharan Africa. Stock control is also emerging as a problem, with protests in Nigeria last year that the government had failed to manage antiretroviral stocks, leading to shortfalls in supply.
Under the terms of the agreement, DHL has made a commitment to deliver MSD’s medicines at cost by air express to designated treatment centres in two dozen countries throughout sub-Saharan Africa.
Jeff Sturchio, Merck & Co’s Vice President of External Affairs for Europe, Middle East and Africa told aidsmap that the supply of drugs by this route was dependent on licensing of the product in a specific country, but that he expected coverage to grow as funds came onstream from the Presidential Emergency Plan for AIDS Relief (PEPFAR) and the Global Fund to Fight AIDS, TB and Malaria.
The agreement formalises a system that has been developed by Merck and DHL over the past few years, driven in particular by a ramping up of orders during the past six months. Whilst Gilead Sciences is seeking non-profit pharmacy distributors in countries where its antiretroviral products are registered and where its no-profit prices apply, Merck has chosen to set up a distribution system that emphasises security and timely delivery over the development of local capacity on the grounds that it provides greater security.
A spokesperson for DHL was unavailable to comment on the likelihood that this agreement will be extended to cover other companies' products.