The Lilly MDR-TB Partnership Local Action, Global Impact World Bank Donor Forum Paris, France 20 May 2008 Patrizia Carl

1. The Lilly MDR-TB Partnership Local Action, Global Impact World Bank Donor Forum Paris, France 20 May 2008 Patrizia Carlevaro Head, International Aid Unit Eli Lilly and Company

2. Facts & Figures • TB kills close to two million people every year • TB kills one person every 20 seconds • 4600 people will die of TB by the end of today -- most of whom are in their most productive working years (ages 15 to 54) • 2 billion people are infected with TB worldwide -- 1 in 10 will become sick with active TB • 12 million people worldwide with HIV/AIDS-TB co-infection • One-third of AIDS patients die of TB, making TB the leading cause of death among AIDS patients • Nearly 500,000 of the 9.2 million new cases of TB every year are multidrug-resistant • China and India account for half the world’s MDR-TB cases • Highest MDR-TB incidences are in countries of the former Soviet Union

3. Global MDR-TB Challenge: Businesses & communities at risk • MDR-TB prolonged and complex treatment can result in poor patient compliance and development of drug resistance • Decline in worker productivity to the order of US$13 billion annually • Lilly has organized health professionals, businesses, academic institutions, and communities in a comprehensive US$135 million MDR-TB program

4. MISSION:to combat the growing MDR-TB pandemic and to support the Global Plan to Stop TB. Awareness and Prevention Since 2003, Lilly has lead a comprehensive approach to fighting MDR-TB through Community Support and Patient Advocacy Treatment, Training and Surveillance Research Transferring Technology Reaching patients throughout the world

5. The Partners • Results Educational Fund • Shasun Chemicals and Drugs, India • SIA International, Russia • Stop TB Partnership • TB Alert and TB Survival Project • U.S. Centers for Disease Control & Prevention • World Economic Forum • World Health Organization • World Medical Association • Aspen Pharmacare, South Africa • International Council of Nurses • International Federation of Red Cross & Red Crescent Societies • International Hospital Federation • Harvard Medical School & Partners in Health • Hisun Pharmaceutical, China • Purdue University, USA Reaching patients throughout the world

6. Share Lilly’s specific and general manufacturing knowledge Create self-sustaining centers of manufacturing excellence capable of providing additional products and employment Support reliable generic producers to ensure expanded multi-source availability of the two drugs Offer manufacturing firms in MDR-TB “hot spots” (China, India, Russia, South Africa) the technology to produce two second line TB drugs Technical training in manufacturing and Good Business Practices with the support from Purdue University Provide Lilly staff on-sitefor technical assistance/training Transfer of Technology

7. Transferring Technology

8. 360 degree approach: examples Healthcare Professional Education Program International Council of Nurses (ICN) Scope/reach: more than13 million nurses worldwide • Sample 1 activity: Training of Trainers • Sample 2 activity: Development of framework and advocacy for TB and MDR-TB curriculum in nursing schools World Medical Association (WMA) Scope/reach: 7 million physicians worldwide • Sample 1 activity: Develop distance learning course for physicians addressing the clinical aspects of MDR-TB • Sample 2 activity: Conduct in-country training with local medical associations International Hospital Federation (IHF) Scope/reach: 50,000 hospital facilities worldwide • Sample activity: Development of MDR-TB control manuals and disseminated to 40,000 public and private hospitals and clinics

9. 360 degree approach: examples Community Support and Patient Advocacy International Federation of Red Cross and Red Crescent (IFRC) • Sample activity: Community support to people living with MDR-TB to ensure better access to care and improved compliance Awareness and Prevention TB Survival Project and TB Alert • Sample activity: Patient-led initiative to raise awareness and engage patients and their families worldwide STOP TB Partnership • Sample activity: Advocacy and awareness campaign involving football star Luis Figo as goodwill ambassador Research and Development • Establishment of a not-for-profit early phase drug to integrate medicinal chemistry expertise from the pharmaceutical industry with academic expertise in chemistry, microbiology and TB (basic biology genetics and molecular biology) • Includes collaboration with the Infectious Disease Research Institute (Seattle, USA), National Institute of Allergy and Infectious Diseases (USA), Global Alliance for TB Drug Development, etc.

10. 360 degree approach: examples TB and MDR-TB in the workplace Partnership with the World Economic Forum (WEF) • Develop a Global Awareness Toolkit for Tuberculosis/MDR-TB in the Workplace and disseminate through WEF member companies • Provide educational material targeting employees and in-plant healthcare staff • Pilot-tested by the WEF in India and being adapted for other high-burden countries with large business communities Advocacy and awareness in the workplace Partnership with the Global Business Coalition (GBC) • GBC scope/reach: 220 cross-cutting multinational companies worldwide(e.g., Coca Cola Company, Citibank, General Motors, Deutsche Post World Net, L’Oréal, Siemens, etc.) • Distributed 400,000 card decks with TB awareness/advocacy messages in Beijing train stations (target: migrant workers)

11. Contact Information Dr Patrizia Carlevaro Head, International Aid Unit Eli Lilly and Company Geneva, Switzerland carlevaro_patrizia@lilly.com www.lilly.com www.lillymdr-tb.com