In the field, MSF doctors are constantly frustrated by the lack of adequate medical tools to give quality care to the patients we treat. In response, Médecins Sans Frontières set up the MSF Access Campaign in 1999 to improve access to existing medical tools (medicines, diagnostics, vaccines) and to stimulate the development of urgently needed better tools for people in countries where MSF works.
From the start we faced two major challenges – the high cost of existing medicines and the absence of treatments for many of the diseases affecting our patients. Our response has been on the one hand to challenge the high costs of existing drugs or outdated treatment policies. On the other hand we have worked to stimulate research into new medicines for neglected diseases such as tuberculosis, sleeping sickness and malaria.
Key barriers blocking access to medical tools in poor countries:
- Many medicines, in particular those that are still relatively new such as HIV medicines are too expensive for use in poor countries. Patent protection has increased in developing countries and this pushes prices up because patents provide a monopoly for the originator company for up to 20 years, blocking competition.
- When new and better treatments exist it can take a long time until they are registered, treatment policies are changed and they become truly available to patients. This has been the case, for example, with the more effective malaria treatment, artemisin-based combination therapies that are replacing old, ineffective drugs.
- Research and development is not geared towards the needs of people in poor countries. Drugs and diagnostic tools are being developed on the basis of their future market potential rather than on patients’ needs. Only 1% of the drugs that have come to the market in the last 30 years were developed for tropical diseases or tuberculosis while the existing drugs for these diseases are often toxic and are becoming less and less effective due to resistance.
- Once medical tools are made available other barriers to access to care can become more apparent. One key problem delaying the further roll-out of HIV treatment is the chronic shortage of health staff, particular in Southern Africa, often due to inadequate salaries and poor working conditions.
Main improvements and changes in the access situation in the last 10 years
The work of the MSF Access Campaign and many other actors has brought about significant advances over the last few years although important problems persist.
- Treatment of HIV with antiretroviral (ARVs)drugs on a large scale has become a reality and international priority. This became possible thanks to massive price reductions from generic competition for the first generations of ARVs down from US$10 000 to under US$100 per patient per year and because it was possibly to show that treatment is practically possible in poor countries. Urgently needed newer HIV medicines remain much more expensive though.
- An effective malaria therapy, artemisin-based combination therapy (ACT) has been introduced in most African countries – although there are still delays in making it more widely available. The treatment was adopted after new recommendations from the WHO in 2001 following many resistance studies carried out by MSF and as well as the MSF’s “ACT Now” campaign.
- Awareness of the urgent need for new medical tools for the most neglected diseases such as sleeping sickness, leishmaniasis or Chagas disease increased, accompanied by increased activity in developing new tools. Production of some older medicines that had been taken out of production because of lack of profitability, such as eflornithine for sleeping sickness was restarted following international media attention.
- Restart of research and development (R&D) for neglected diseases following increasing international attention. Several not-for-profit product development partnerships (PDP) were founded with MSF being a co-founder of the Drugs for Neglected Diseases Initiative. The scope of R&D by PDPs and the funding available for neglected diseases remains however greatly inadequate.
- The negative impact of increasing intellectual property protection on public health in developing countries is today at least widely recognized. The Doha declaration on TRIPS and public health in 2001 and the use of flexibilities in trade agreements by countries such as India, Thailand or Brazil has helped to improve access for some drugs. This does not however take away from the fact that most new medicines will be patented in poor countries and that patents have not ensured innovation for diseases that mainly affect people in poor countries – simply because these patients do not present an attractive enough market for pharmaceutical companies.
- International recognition that the current system of research and development is deeply flawed and is particularly failing people in poor countries most in need of medical innovation. Governments have started to negotiate through an Intergovernmental Working Group at the WHO on how to change the way research and development is prioritised and supported.
What are the Access Campaign’s current priorities?
The Access Campaign continues to work both on improving access to existing treatments and stimulating the development of newer and better medical tools that take into account the needs of people in poor countries. We push for continued improvements in medical practice. We also continue to support efforts to reshape the way medical Research and Development is funded so that medical innovation serves those most in need and is not only market-driven as at present.
Key priority areas include:
- Malnutrition where there is a need to rapidly step up the production and use of ready-to-use foods to reduce child deaths from malnutrition.
- Tuberculosis where wider access to and accelerated development of better tests and drugs are urgently needed. This includes stimulating drug trials in patients with drug resistant forms of TB as well as enabling early, compassionate use of new drugs for patients suffering from drug resistant strains of the disease.
- The need for governments to establish a framework on essential health R&D to prioritize and support research and development for medical tools primarily needed by people in poor countries.
- Greater availability and affordability of HIV treatment options. Newer drugs are too expensive due to lack of competition and are insufficiently studied for use in the populations that need them most.
- Accelerate the roll-out of artemisin combination therapy for malaria.