Attachment

improvements. To resolve this, donors such as the Gates Foundation will hire experts and fund the optimization work and the upfront costs of implementing a new process. In 2017, for example, the foundation and a number of partners helped create a generic form of a more effective version of an HIV drug cocktail. The pharmaceutical companies that invented the drugs provided a free license to enable this work. The generic firms were able to reduce the cost so much that today nearly 80 percent of people who get HIV treatment in low- or middle-income countries are receiving the improved cocktail. The new drug requires a much lower dose--and a smaller pill--to be effective than previous treatments did, which means it's a lot easier for people to take. It also causes fewer side effects and is less likely to cause drug resistance.. It's hard to overstate the impact of these low-cost, high-volume generic manufacturers. Months before studies proved that molnupiravir is an effective antiviral, Merck had already negotiated licensing deals with several generic manufacturers in India, allowing them to make and sell generic versions in India and more than 100 other low- and middle-income countries. Researchers funded by the Gates Foundation developed ways to drive down the cost of making it, and our grantees helped the generic companies get ready to make the drug and apply for approval from the WHO. Beginning in January 2022--just two months after molnupiravir's successful results had been announced--generic companies would make 11 million doses available to low- and middle-income countries, a first step to producing many more. Generic manufacturers such as Aurobindo, Cipla, and Sun (all based in India), Teva (based in Israel), and Mylan and Sandoz (in the U.S. and Europe) produce the large majority of medicines used by people in low- and middle-income countries.17 One WHO program that