 Hi, good afternoon. My name's Mareth. I'm the executive director for a non-profit organization called University's Allied for Essential Medicines that began actually at Yale Law School in conjunction with Yokai who's here who also we have the privilege of his sitting on our advisory board. So I'm going to talk to you a little bit about a couple of case studies about how patents influence access to medicines and some examples of what we can do potentially if we are willing to think outside the box a little bit I hope. So some of you may have heard of this example, Xtandi. This is a prostate cancer drug that was developed at UCLA with publicly funded grants mostly from the NIH and Department of Defense and actually interestingly the University of California system does have some sort of global access licensing provisions that UAM had pushed for and campaigned for in previous years. So going back to our discussion about you know having something on your website and having a policy but whether or not a university implements it the implementation piece is going to be really key and what we've seen here is a drug that would develop with U.S. type of payer money and now has a price tag in the United States for $129,000 for one annual you know year of treatment basically. The same drug in Canada is being sold for $29,000 and there is a quote from a third party supplier that they can make these drugs for around three dollars. So we obviously recognize and part of the mission of UAM is really recognizing the role of universities to be leaders and obviously students within those universities to solve some of the access to medicine crisis that we have today and the 10 million people who don't have access to the life-saving drugs that they need who die annually as a result. So this is sort of an example of what could happen even if you do have these nice policies if they're not adhered to. This is the sort of thing that we're going to be looking at and typically for us we have looked at ensuring access provisions in lower middle income countries but as we were talking about as we were talking this morning this sort of problem has come home to roost here in the United States and in Europe where we're seeing exorbitant prices for life-saving drugs which are often publicly funded in the first place. And this goes back to sort of the story that started UAM back in 2001 at the height of the height of the HIV AIDS crisis. Doctors Without Borders or MSF were looking to treat people living with HIV for the first time in history and one of the drugs that they were looking at was Dauverdein D4T and they realized that it had been discovered by this chap here Professor Prusoff at Yale University and students basically went to their administration and said this is unacceptable that it's being priced at $10,000 a year which actually ironically in today's terms doesn't seem as much unfortunately and campaign that they needed the university to change the license with Bristol Myers Squibb. At the time initially Yale said no this is not possible but as we know even with patent law this isn't a law of nature and these things can be changed and eventually after some bad press in the New York Times in a few weeks believe it or not Yale agreed to change the license with Bristol Myers Squibb and it allowed for generic importation of the drug into South Africa and MSF were able to treat people living with HIV for the first time and that wouldn't have happened without the pressure of law students at Yale and sort of civil society there were some other actors as well but more broadly there is with this quote I think as well from Dr Prusoff it shows that you know people are not necessarily all going into science because they want to make a lot of money and not knowing potentially in this case that his invention his discovery had not in fact gone to treat the people he had hoped he would treat. Yes and then this came out this was 2005 it's a little old now but out of the horse's mouth Yale didn't actually lose any money in the process. This is a more recent case with Johns Hopkins, Citeslid, an antibiotic and it looks like it will be a promising treatment for MDRTB it was going to be licensed to Sequela Ali mentioned earlier which is a small biotech that didn't really have the capacity to really bring it quickly enough to to market potentially or to be able to do sort of a combination trials so UAM again in conjunction with MSF and a TB group called TAG worked in conjunction with JHU students and alumni to basically persuade the administration to not license to this group and to license to another organization the medicines pattern pool that would protect access and affordability and interestingly all the licenses for the MPP are available on their website you can take a look at them and they they're doing just fine so yeah so this happened this happened over a period of two years and and Johns Hopkins became the first university American University to license to the MPP when they opened up their mandate to include TB last year and this was finally signed in January and then already TB Alliance is sub licensing from from the MPP and it seems to be a potential win-win for access and affordability and Johns Hopkins has come out with some good press as a result so in terms of what we do and this has been you know UAM has been around for at least 10 years urging tech transfer offices to adopt policies around this global access licensing framework which Yokai knows a lot about and we've been urging universities to adopt what we mentioned earlier the SPS which Harvard helped launch back in 2009 I think most of you judging by our discussion today know a lot about global access licensing but this is a very quick overview in a nutshell but basically yeah I think it's self-explanatory just for the interest of time and I mentioned earlier today the university report card tool and the idea was when we realized that we were measuring sort of we were talking to tech transfer offices and they said yes we're doing all these great things we're licensing in a particular way we wanted to make sure that this was actually happening so this is that this report comes out every two years we should have another one in the US hopefully by the end of the year it's been replicated in Canada in the UK and Germany and as you can see here Harvard's come he's got a B I don't know if that's good for Harvard or not but the idea is we ask a lot of questions we talk we engage with the university's tech transfer offices to report self-report a lot of information and also a lot of that information is available online as well but the idea is to urge universities to actually implement the reforms that they're suggesting that they are adhering to and then sort of beyond this we've been working obviously the last 10 years working with lots of different universities urging them to to think about access and affordability of life-saving drugs in low- and middle-income countries but like I mentioned at the beginning we've seen these challenges now in Europe in the United States where drugs are eighty four thousand dollars over a hundred thousand dollars and people are unable obviously to afford even a medication that is nearly a hundred years old insulin has been around since 1922 the original patent was given to the University of Toronto and yet a hundred years later you've seen the press the the prices of insulin are going up and up and up and it is not by chance so what can we do rather than go university by university what we would like to do and what we're campaigning around now and I'd love to hear your thoughts is to target more strategically the funder directly so the NIH given that they give 31 billion dollars every year to universities we would like to ask them to strengthen the conditions they attach to university grants to ensure that access and affordability of life-saving medications technologies are are prioritized and that you you know Americans here in the United States can afford the drugs that they paid for with their taxpayer dollars it's not really a radical idea yet somehow it seems to be so this is this is what we're we're pushing for ironically it doesn't even require a change in the law this is within the NIH mandate yet there have been requests to directly to the director Francis Collins but he hasn't seemed to recognize affordability as something that is his problem so we are going to be organizing to remind him that it might be actually his problem and so just to sort of give a broader context here I'm sure many of you know this but last year one in five Americans couldn't afford to fill their prescriptions and I think part of the reason we're talking about patents certainly in biomedicine what we're really talking about is people and people's lives it's very different to patenting some other sort of technology and I think that's where we do need to recognize an important line and the fact that now today more than 70 percent of Americans believe that drug costs are unreasonable and amazingly there's a huge there's huge support according to polls if you believe polls today for government intervention around price controls or of drugs and you know universities will continue to be at the forefront of that so those are sort of the the key messages at least for the few minutes that I've had your attention but I do and what we do believe in is really that universities should and must be the leaders of ensuring access to and affordability of publicly funded medications here in the United States and around the world especially given that the 31 billion dollars even it is even if it is cut will still represent the biggest public funder of global health research in the world and I think there are reforms that don't require more than support from a handful of universities to be able to get them pushed through so that's it thank you