A/63/263 GlaxoSmithKline (see para. 2 above) did not specifically examine the draft Guidelines, the mission provided an excellent occasion to reflect very closely on the issues, and the Special Rapporteur is most grateful for that opportunity. A few companies sent helpful written comments on the draft. Some 40 stakeholders sent written comments, all of which were placed on the web, with a small handful of exceptions where confidentiality was requested. 39. In summary, extensive written and oral comments on the draft were received from a very wide range of stakeholders encompassing States, institutional investors, pharmaceutical companies, specialized agencies, national human rights institutions, non-governmental organizations, academics, and others. The Special Rapporteur takes this opportunity to warmly thank all of those who provided their invaluable comments, advice and information. A special thank you is due to Realizing Rights: The Ethical Globalization Initiative. The Special Rapporteur, however, has sole responsibility for the draft and final version of the Guidelines. 40. When the Special Rapporteur informed the General Assembly in October 2006 that he intended to prepare draft guidelines, he was encouraged to proceed with this challenging project. He updated the Human Rights Council in March 2007 and the General Assembly in October 2007. When reporting to the Human Rights Council in March 2008, he confirmed his intention to finalize the text before the end of July 2008. The Guidelines 41. The draft Guidelines were extensively revised in the light of the very numerous written and oral comments. The final version of the Guidelines is contained in the annex to the present report. Beginning with a preamble, the Guidelines are grouped by themes, such as transparency, management, monitoring and accountability, pricing and ethical marketing. Each theme is followed by a brief commentary. 42. The Guidelines should be read with the Special Rapporteur’s report to the General Assembly on access to medicines (A/61/338). That report includes a section on the responsibilities of States and another on the responsibilities of pharmaceutical companies. The discussion and analysis will not be repeated here. Instead, some interrelated points are briefly emphasized. Health systems 43. At the heart of the right to the highest attainable standard of health lies an effective and integrated health system, encompassing medical care and the underlying determinants of health, which is responsive to national and local priorities, and accessible to all. Medical care and access to medicines are vital elements of an effective, integrated, responsive and accessible health system. Their full realization crucially depends upon such a system being in place. In many countries, however, health systems are failing and collapsing (see A/HRC/7/11). There are, in many countries, extremely grave systemic obstacles to enhancing access to medicines, such as clinics without health workers and the most basic facilities. While immediate steps can be taken by a range of actors to enhance access to medicines, it is imperative that systemic obstacles are recognized and tackled as a matter of priority and urgency. 10 08-45647