In 1999, in the wake of Médecins Sans Frontières (MSF) being awarded the Nobel Peace Prize, MSF launched the Access Campaign. Its purpose has been to push for access to, and the development of life-saving and life prolonging medicines, diagnostic tests and vaccines for patients in MSF programmes and beyond.
Kenya 2011 © F. Zizola/NOOR An MSF nurse measures a babys weight as part of a medical assessment during a mobile clinic visit to Nalemsokon village in Turkana district, northwestern Kenya.
“Some of the reasons that people die from diseases like AIDS, TB, Sleeping Sickness and other tropical diseases is that life saving essential medicines are either too expensive, are not available because they are not seen as financially viable, or because there is virtually no new research and development for priority tropical diseases. This market failure is our next challenge. The challenge however, is not ours alone. It is also for governments, International Government Institutions, the Pharmaceutical Industry and other NGOs to confront this injustice. What we as a civil society movement demand is change, not charity." -- Dr. James Orbinski, president of MSF’s International Council 1999, acceptance speech for Nobel Peace prize
Deficient medicines, tests and vaccines obstruct MSF’s humanitarian work
MSF aims to bring the best medical care possible to some of the most disadvantaged people on earth. But our medical teams are often hindered in delivering that optimised care. There are many reasons for this but the Access Campaign’s key focus is on the difficulties people face in getting hold of adequate and effective diagnostic tests, drugs and vaccines for those diseases that predominantly affect people in the places where we work.
In response, therefore, in 1999, Médecins Sans Frontières launched the Access Campaign to alert the world about the desperate need to improve the medical tools at our and others' disposal.
Major obstacles include high drug costs and lack of R&D
Niger 2009 © Olivier Asselin. MSF logisticians prepare insulated carriers used by vaccination teams to carry meningitis vaccines as they prepare for another day of vaccination in Maradi, Niger.
From the start we faced two major challenges: the high cost of medicines current available and the absence of appropriate treatments for many of the diseases that affect patients in the areas where we work. That’s why we adopted a two track solution to the problem. On the one hand, we challenged the high costs of existing drugs - such as those to treat HIV/AIDS - and worked to bring prices down. On the other hand, we focused on stimulating research into new medicines for neglected diseases such as tuberculosis, sleeping sickness, kala azar and Chagas disease.
It turns out that solving the problems of both access and innovation are intertwined. And while there have been remarkable advances on both fronts, formidable tasks remain ahead, both to address existing challenges and to meet new ones. That’s why MSF is pursuing its campaign as vigorously as ever.
High prices caused by company monopolies Many medicines are too expensive for patients or governments in developing countries to afford – newer treatments used for HIV are an illustration of this. One reason is that the growth in patent protection in developing countries has pushed up prices and stifled competition, because a patent can give the originator company a market monopoly for 20 years.
Research and development agenda doesn’t target medical needs Another problem is that research and development is not geared towards the needs of people in poor countries. Drugs and diagnostic tests 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 past 30 years were developed for tropical diseases or tuberculosis, yet the existing drugs for these diseases are often toxic and are becoming less and less effective due to resistance.
Working to develop newer simpler models of care Even when better medicines and tests become available, there are other barriers to be overcome. For example, one key problem delaying the further roll-out of HIV treatment is the chronic shortage of health staff, particularly in Southern Africa. MSF is working also to provide field research that will support the development of more simplified models of care to deliver treatment and that will benefit both patient and health care workers. MSF closely follows the developments in the world of access to medicines, vaccines and diagnostics.
Highlights of what we have achieved in the past 10 years
Uganda 2009 © Brendan Bannon. Isaac, 8 at the time of this photograph, was constantly sick before being tested for HIV. After testing positive, he was started on HIV treatment immediately and now cannot even remember a time when he felt sick. He attends school now and likes to draw and play football in the evening after doing his chores.
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.
Large-scale treatment of HIV with antiretroviral (ARVs) drugs has become a reality and an international priority. This became possible thanks to massive price reductions triggered by generic competition for the first generations of ARVs that we promoted. Treatments that cost more than US$10,000 per patient per year are now less than $70. We also called for WHO to assess the quality of these medicines which WHO does today through the WHO pre-qualification system. However, urgently-needed newer HIV medicines remain much more expensive and large scale expansion of treatment will rely on the continuing flow of quality, affordable medicines. Learn more with our publication, Untangling the Web of ARV Price Reductions
An effective malaria therapy, known as artemisin-based combination therapy (ACT), has been introduced in most African countries. This treatment, recommended by WHO, was adopted following many MSF studies into drug resistance and its “ACT Now” campaign. Today we are working to effect a further change by calling for a switch from quinine to artesunate injection for the treatment of severe malaria.
Treatment of people with multi-drug resistant tuberculosis (MDR-TB) has become an international public health priority following the work by several organizations, including MSF. We negotiated lower drug prices for MDR TB for MSF and others before WHO then took this task on. However, drugs for MDR-TB remain still too high today and the supply is insecure.
The Campaign has raised awareness of the urgent need for new ways to tackle the most neglected diseases, such as sleeping sickness, leishmaniasis or Chagas disease. As well as increased activity in developing new treatments, one medicine for sleeping sickness, eflornithine, has been put back into production having been stopped due to lack of profitably. MSF co-founded the Drugs for Neglected Diseases Initiative which already has delivered new treatments. While the scope of R&D and the funding available for diseases that primarily affect people in developing countries remains hugely inadequate, a few new health technologies are finally reaching the market such as new TB drugs and diagnostics and a new vaccine against meningitis A. The challenge is to now implement these tools rapidly and at affordable prices.
The right to balance public health needs with intellectual property rights was affirmed in the Doha Declaration on TRIPS and Public Health in 2001 - and some countries such as India, Thailand or Brazil have used international trade rules to prevent inappropriate patenting or to overcome patents and improve access for key medicines. MSF has been closely involved in these developments. The Access Campaign also proposed the creation of a patent pool (which was officially established in 2010), and is at the forefront of alternative proposals to stimulate and reward needs-driven innovation that does not lead to high prices of the final products.
Based on our operational experience with nutrition projects in the African Sahel region, MSF has been able to pioneer a new approach to tackling acute malnutrition in children through ambulatory treatment with ready-to-use-therapeutic foods and the distribution of supplemental foods to young children at a point before they run the risk of becoming acutely malnourished. We have raised awareness internationally that young children have specific nutritional needs that were not met by food aid programmes and as a result are seeing significant improvements in the policies and practice of international organisations.