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The Clinton Foundation might be committed to doing good around the world, but Hillary Clinton’s critics see it as a ripe target to bring down the presumptive Democratic nominee. Republican Donald Trump recently charged that some countries who gave money to the foundation received favorable treatment in return.
For anyone who hasn’t heard about the Clinton Foundation, it’s the signature project to reduce poverty and improve global health created by former President Bill Clinton. It is part matchmaker, helping wealthy donors connect with doers, and part active participant, directly running programs, especially in health care.
In an interview with Hillary Clinton, CNN’s Anderson Cooper quoted Trump and asked if her husband would break all ties with the foundation, should she become president. Clinton said she would cross that bridge "if we come to it," and proceeded to give a full-throated defense of the foundation.
"I'm proud of the work that it has done," Clinton said in the June 8, 2016, interview. "Nine million people have lower-cost HIV/AIDS medicine because of the work of the Clinton Foundation and my husband. We have women across the country, from Latin America and Africa -- across the world, I mean -- getting good jobs, and being able to support themselves for the first time."
We’ll focus on the first part of that statement and explore if the Clinton Foundation actually had a hand in making HIV/AIDS drugs more affordable for 9 million people?
The foundation’s work on HIV/AIDS treatment dates back to 2002 with the creation of the Clinton Health Access Initiative. That was a time when some countries were paying $1,000 or more to treat each AIDS patient. The basic goal was to bring in bulk-buying to lower costs.
The program consolidated both the supply of raw materials to make the drugs and the bidding to supply the finished product. The result was lower production costs and lower drug prices. Today, the initiative tracks the going price for a menu of treatments and posts them to help health departments around the world as they negotiate with drug companies.
In 2014, the World Health Organization reported that by the end of 2013, more than 11.7 million people were on antiretroviral therapy in low- and middle-income countries. While the kinds of drugs have changed, the WHO said "in the past decade the price of individual antiretroviral formulations has decreased considerably."
The treatments used in the early days have fallen from a median cost of about $600 in 2003 to about $100 a decade later. A more advanced drug combination introduced in 2005 saw a similar decline.
Importantly, the WHO listed the Clinton Health Access Initiative as one of a handful of organizations collaborating on ensuring a steady supply of drugs. The partners in that effort include the biggest players, including several United Nations agencies, PEPFAR (the President’s Emergency Plan for AIDS Relief) and UNITAID, a project created by Brazil, Chile, France, Norway and the United Kingdom.
UNAIDS announced at the end of May that the number of people under treatment is now closer to 17 million.
Technically, the Clinton Health Access Initiative has been a separate nonprofit since 2010, but it is still integrated within the Clinton Foundation and the foundation press office still offers comments on its behalf.
Clinton Health Access Initiative spokeswoman Maura Daley told us that Clinton used an old figure for the people being served by the initiative. "The total number of patients benefitting is 11.8 million," she told us. Not everyone getting treatment is counted as benefiting from the initiative’s efforts. Beyond working to reduce drug costs, it also coordinates with nongovernmental organizations inside countries to distribute the drugs once they arrive.
Clearly, the Clinton Health Access Initiative did not accomplish all of this on its own, but Clinton didn’t say that.
Two experts in HIV/AIDS treatment, Jennifer Kates at the Kaiser Family Foundation, and Ellen ‘t Hoen call the initiative an important player. ‘t Hoen was the first executive director of the Medicines Patent Pool, a group that streamlines the production of generic antiretroviral drugs.
"Without the work of the MPP it would have been much harder for organizations like CHAI to access generic antiretrovirals," she said.
The initiative has been faulted for failing to fully report donations from foreign governments and has filed amended returns for 2012 and 2013.
Clinton said 9 million people have lower-cost HIV/AIDS medicine thanks to the efforts of the Clinton Foundation and her husband. Bill Clinton started the foundation and its first big project was the Clinton Health Access Initiative. The program focused on using market mechanisms to reduce treatment costs. Costs have fallen dramatically and the initiative remains a key global player in maintaining a steady supply of affordable drugs.
If anything, Clinton understated the number of people who have benefited from the program. We rate this claim True.
CNN, Anderson Cooper 360 Degrees, June 8, 2016
Clinton Health Access Initiative, About, accessed June 13, 2016
World Health Organization, Access to antiretroviral drugs in low- and middle income countries, July 2014
Clinton Health Access Initiative, Antiretroviral reference price list, 2015
AIDS-Free World, Open Letter: Promoting Access to Affordable Medicines in South Africa through Patent Law Reform, Oct. 17, 2014
UNAIDS, Access to antiretroviral therapy in Africa, Dec. 19, 2013
Clinton Health Access Initiative, ARV Market Report, November 2015
Clinton Health Access Initiative, Presentation at Johns Hopkins School of Public Health, Sept. 28, 2011
Medicines Patent Pool, website, accessed June 14, 2016
UNITAID, website, accessed June 14, 2016
Email interview, Maura Daley, spokeswoman, Clinton Health Access Initiative, June 14, 2016
Email interview, Jennifer Kates, director, Global Health Program, Kaiser Family Foundation, June 13, 2016
Email interview, Ellen ‘t Hoen, consultant, Medicines Law and Policy, University of Groningen, Holland, June 14, 2016
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