Letter from the Director: 20 Years On, the Access-to-Medicines Battle is Going Global 

Dr Els Torreele
Executive Director
MSF Access Campaign
4 min

Els Torreele - Executive Director, MSF Access Campaign 

What were you doing in 1999?

In 1999, MSF launched the Access Campaign out of medical necessity and frustration. MSF staff in the  field were facing multiple challenges – unable to provide adequate treatment to people dying from HIV/AIDS, tuberculosis, malaria, and neglected tropical diseases because new or existing drugs were priced out of reach; were ineffective, toxic, or ill-adapted for use in the places we work; or simply did not exist at all.

These deficiencies were not due to scientific or technical limitations. They were the result of conscious political choices about how medical innovation and access to health tools are organised and financed globally. Rooted in an economic and political system put forth by wealthy governments, the multinational pharmaceutical industry has wielded unchecked pricing power through patents and other monopolies, imposed globally through trade laws that prioritise profits over people’s health. “Medicines Shouldn’t Be a Luxury” has been, and remains the Campaign’s most poignant rallying cry.

The Campaign’s initial priority was on overcoming barriers to accessing lifesaving HIV antiretroviral drugs, then sold at more than US$10,000 per person per year. Together with patient activists, MSF spoke out about the fundamental injustice of letting people with HIV/AIDS die because they cannot afford the deliberately high prices companies charged for medicines. An emerging access-to-medicines movement put pressure on pharmaceutical corporations, governments and other ‘powers that be’ to crack this deadly gridlock and obtain lower drug prices to increase access to HIV treatment. 

It worked. By overcoming the companies’ monopolies and fostering generic production and competition, the price of antiretroviral drugs dropped 99% over the next decade, paving the way towards scaling up treatment for people living with HIV/AIDS to over 22 million at the end of 2018.

Other successes followed, from increasing access to rapid diagnostic tests and artemisinin-based combination treatments for malaria, to decreasing the prices of the pneumococcal conjugate vaccine and hepatitis C drugs, and fostering research and development (R&D) for the most neglected diseases – including the creation of the Drugs for Neglected Diseases initiative (DNDi), who are now celebrating the launch of fexinidazole, a new all-oral cure for African sleeping sickness.

Each advancement reflects the unique multidisciplinary nature of the Campaign. Our staff combine technical and political analysis based on MSF medical data and operational experience together with strategic advocacy in partnership with allies worldwide – all to get adequate health tools to people who need them most, as well as catalyse broader systemic change so we do not need to keep fighting the same access battles over and over again.

But where do we stand today, 20 years on?

Unfortunately, despite winning some battles, the access-to-medicines challenges are larger than ever, with many new drugs, diagnostics, and vaccines marketed at increasingly high prices, monopolies more entrenched, and pharmaceutical corporate powers more globalised. At the same time, we are missing the tools we need to control rising antimicrobial resistance and outbreaks of epidemic diseases such as Ebola.

Access to health, including medicines, is a matter of justice, not charity

Dr Els Torreele
Executive Director
MSF Access Campaign

But herein lies an opportunity. The crisis of access to medicines and innovation is no longer one of only ‘poor people’ in developing countries, but a truly global one. Our slogan “Medicines Shouldn’t Be a Luxury” is valid for people all over the world, and finding solutions is a topic of public and political debate in wealthy and developing countries alike.

In this ever-changing world, we are advocating for needs-driven medical R&D and access as a collective responsibility, with the results of this concerted effort considered as a public health commons, with a collective right of use. Given that medical R&D is largely financed by public funds, it is unacceptable that unchecked monopolies are privatising and financialising this common scientific progress, while health systems collapse under the financial burden and people die for lack of medicines. Access to health, including medicines, is a matter of justice, not charity. 

Marking the 20th anniversary of the Access Campaign provides an opportunity to look back on what we’ve learned, reflect on this new reality, and carve out new ways for MSF to engage in transforming the medical innovation and access ecosystem to better address the health needs of people in our care. 

What will you be doing in 2019 and beyond to help us achieve this shared goal?