In developing and least developed countries, millions of people today do not have access to adequate health care, including safe and high-quality pharmaceutical products. Ten million children, aged no more than 5 years, are dying every year because of infectious diseases, while treatments for their condition exist. Three million young children are dying each year. Their lives could have been saved, had they been vaccinated.

The dramatic expansion of the HIV pandemic, which is particularly affecting populations in sub-Saharan Africa, parts of Asia and Latin America, emphasises the significant inequality gap in health and life quality standards between rich and poor. Whereas treatments targeting HIV/AIDS exist and are available for patients in developed countries with established marked economies, the virus often remains a death sentence in less developed countries.

The pharmaceutical industry is acutely aware of this tragic disparity and deeply concerned by the global threats posed by infectious communicable killer diseases such as HIV/AIDS, malaria and tuberculosis (TB), which are still killing, crippling and devastating too many populations of the world.

As UN Secretary-General Kofi Annan acknowledged: "The fight of the international community against such global aggressors is as much a peace and security issue as a humanitarian crisis".

Underlying the link between health care and economic development, Gro Harlem Brundtland, WHO Director General, emphasised: "Since the fight against poverty and its alleviation has a strong health component, we must invest in health as one way of reducing poverty".

No doubt, lack of access to healthcare in poor and developing countries is primarily a poverty and development issue, which as any global problem - must be tackled from a global perspective. Main obstacles restricting access to health care in the developing world range from financial barriers (insufficient public and privatefunding in general, and for health in particular) to physical barriers (infrastructure, roads, transportation, healthcare facilities, staff and equipment, distribution channels, sanitation, water supply, etc.).

Moreover, wrong political priorities (health care services have often taken a back seat to defence spending even worse, available health funds can be left unspent due to bureaucracy), dubious economic policy options (protectionism, poor intellectual property protection leading to risky sub-standard and counterfeit medicines), political instability and corruption constitute the additional elements of a cocktail recipe for discouraging foreign investment.

In remote rural areas, equal access to health care is also restricted by more fundamental educational and social obstacles. Ignorance, neglect and selfmedication by poorly informed patients perpetuating risky behaviours may lead to ineffective medicine use and to the growth of drug resistance. Language, ethnic and religious considerations must also be taken into consideration and form part of this very complex equation.

Under these conditions, complex treatments that require regular doctor visits, close medical supervision, and combinations of products (e.g. combination therapy for HIV/AIDS) cannot be readily administered even if such treatments were made available at no cost.

Nevertheless, because of its role in the world community the pharmaceutical industry is contributing to and further committed to increase its efforts to respond to this critical challenge.

Pharmaceutical companies contribute directly and indirectly to world health. Their efforts encompass a multitude of approaches. They are taking part in collaborative efforts to help find effective and sustainable solutions, hence paving the way for Better Global Public Health.

Often overlooked is the fact that virtually all medicines and vaccines which are currently used to fight diseases anywhere in the world, including tropical diseases, originate from the pharmaceutical industry. Even those few products not discovered by the pharmaceutical industry are only available because research based pharmaceutical companies tested and developed them. This important R&D work is still going on, even though it is true that - for many different reasons - treating diseases that are prevalent in the least developed countries remains a tremendous challenge.

Pharmaceutical companies have for quite some time developed initiatives that make significant contributions to national public health efforts in many developing countries around the world. A wide range of concrete voluntary actions is underway in the field of healthcare capacity development, education and awareness, medicines'' donations and subsidies, vaccines development and donation, as well as enhanced R&D in neglected diseases. Key targets include HIV/AIDS as well as other diseases prevalent in tropical countries, such as malaria, onchocerciasis, vitamin A deficiency, lymphatic filariasis and trachoma.

Here are just a few examples:

A - Since 1987, one company has donated, free of charge, more than 250 million tablets of its patented medicinal product for the treatment of onchocerciasis (river blindness). As a result, 25 million people were treated through continuing treatment programmes in 31 countries in Africa, Latin America and the Middle East.

B - Another company has developed a 20-year programme to eliminate lymphatic filariasis (one of the world''s most disfiguring and disabling tropical diseases); its product is donated free of charge and for use in every country that needs it until the disease is eliminated as a public health problem.

C- Since 1992, a pharmaceutical company has cosponsored a programme of community care, support and education in Senegal, Burkina Faso, Zambia, Ecuador, SriLanka, Bangladesh and Cambodia.

D - A vaccine company has donated 50 million doses of polio vaccine to five African countries ravaged by war. In order to eradicate leprosy, a company has made a donation to train local health workers in the Amazon area of Brazil.

E - And still another company pledged to donate medication worth about $30 million over the next six years to the public/private sector initiative "The Global Alliance", treated by the WHO to eliminate leprosy worldwide by 2005.

To meet and overcome the complexity and enormity of the "access to better healthcare in the developing world"challenge, time has come to mobilize the entire world community. Partnerships between all potential partners, governments, official international organisations, non-profits and pharmaceutical companies, each providing its own expertise, are seen as the best and most viable solution in the search for improved health care.

A practical response to the call for concerted action in the face of the global health challenge is the recent initiative taken by five pharmaceutical companies to accelerate access to HIV/AIDS-related care and treatment in developing countries. Elaborated in co-operation with the United Nations, this programme presents a comprehensive approach, focusing not only on medicines supply, but also on political commitment, support to healthcare infrastructure, reliable distribution, supply of resources from international organisations and continued R&D. So far, several developing countries have expressed an interest in this programme and hopefully many more will follow.

The Medicines for Malaria Venture (MMV) is another unique public/private sector joint venture set up as part of the WHO Roll Back Malaria programme that intends to develop new, registered, and affordable drugs for malaria at the rate of one every five years. As of today, three new products are already being developed by collaborations between major pharmaceutical companies and academia.

Such examples illustrate that far from having neglected debilitating or fatal diseases that are prevalent the developing world, the pharmaceutical industry is devoting considerable effort to research and develop new life-saving medicines and making them widely available.

Pharmaceutical companies have gained considerable experience through the voluntary actions they have initiated and from partnerships projects to implement treatment access programmes. They are further committed to enhance their efforts and play a willing role in the international mobilisation to improve access to care of women, men and children in greatest need.

The speed of change is accelerating with a clearly set objective: halving the number of people living in poverty by the year 2015. While change is coming and change is needed, we should be very cautious not to weaken intellectual property rights which allow to drive research, foster innovation, and to deliver cheap medicines through unrestricted, competitive production of generics drugs after patents have expired.

The resources which the pharmaceutical industry can make available are only due to the protection provided by strong patent and other intellectual property rights. As developing pharmaceutical products is a very high-risk endeavour, with very uncertain returns, it is imperative that intellectual property rights are protected so that the revenues from these products can be used for supporting research in new and better products for diseases, including those which particularly affect the developing world.

Indeed, only one in 5,000 new chemical compounds discovered in the laboratory makes it to market. In part because of the increasing complexity of chronic and degenerative diseases and because of extensive regulatory testing, it now takes an average of 10-12 years to bring a new medicine from the laboratory to the pharmacy shelf, at an estimated cost of over ?500-600 million. Without intellectual property protection, the needed resources for such research will be greatly diminished, ruining the hopes of millions in the developing world who look to the industry to find new and more effective cures, vaccines and treatments for conditions which affect them.