A/HRC/23/42 to essential medicines.14 During the period 2001-2009, the average availability of essential medicines in public health facilities was only 42 per cent and in private sector facilities was 64 per cent.15 For chronic conditions, most of which require life-long access to medicines, the availability in public and private sectors was even poorer, at 36 per cent and 55 per cent respectively.16 Despite momentous gains in the past decade, only 8 million out of 14.8 million people living with HIV globally receive necessary treatment.17 12. Inadequate prioritization of health, insufficient resources and poor governance has increased the inability of governments to finance efficient health systems that enhance access to medicines, consequently increasing their dependence on out-of-pocket payments and international donor funding.18 Even where international donors like the United States President’s Emergency Plan for AIDS Relief (PEPFAR) and the Global Fund to fight AIDS, Tuberculosis and Malaria have stepped in to fill this gap, they have only managed to reach a portion, though significant, of those who need these medicines due to limited budgets. 13. There are wide disparities between the global burden of disease and the global consumption of medicines. For example, in 2004, South-East Asia and Africa accounted for 54 per cent of the global burden of disease predominantly caused by communicable diseases.19 However the geographical breakdown (by main markets) of sales of new medicines launched during the period 2004-2008 indicates that North America, Europe and Japan accounted for 95 per cent of the sales, while Africa and Asia, representing more than two-thirds of the world population, only accounted for 5 per cent of the market.20 During this period 90 per cent of the global production of medicines was also concentrated in the developed regions of the world.21 14. Manufacturing capacities in developing countries are limited to countries such as China, India, Brazil, South Africa, Thailand, Kenya, the Syrian Arab Republic and Egypt. Even in the developed world, large innovator multinational companies are concentrated in a small number of countries such as Switzerland, the United Kingdom, the United States, Germany, France and Japan. The Special Rapporteur recognizes that while factors such as inefficient procurement and poor distribution practices22 do determine the availability of medicines in a country, it may still be politically and strategically important for developing countries to ensure the security of access to medicines for their populations through local production. 15. Investing in local production as a long-term strategy holds the promise of improving medicines security in developing countries. Fulfilling this goal would require, inter alia, a coherent policy framework that explicitly links local production to improved access to 14 15 16 17 18 19 20 21 22 6 WHO, The World Medicines Situation 2011: Access to Essential Medicines as part of the right to health (Geneva, 2011), p. 1. United Nations, Milennium Development Goal 8, The Global Partnership for Development: Time to Deliver, MDG Gap Task Force Report 2011, p. 51. Ibid., p. 52. UNAIDS World AIDS Day Report 2012, p. 6. A/67/302, para. 2. WHO, WIPO and WTO, Promoting Access to Medical Technologies and Innovation: Intersections between public health, intellectual property and trade (2012), p. 25. European Federation of Pharmaceutical Industries and Associations, “The Pharmaceutical Industry in Figures”, Key data, 2009 update,p. 3. Available at http://www.efpia.eu/sites/www.efpia.eu/files/EFPIA%20in%20Figures%202009-20080612-009-ENv1%20(1)_0.pdf WHO, The World Medicines Situation (2004), p. 3. MDG Gap Task Force Report 2011 (see Note 16 above), p. 51.