Thank you for the opportunity to speak and to all the panelists for their interventions. I represent Médecins Sans Frontières/Doctors Without Borders (MSF), an international medical humanitarian organization that over the last 50 years has been among the leading global frontline responders to infectious disease outbreaks, epidemics and pandemics. Today, as our teams respond to a fast expanding diphtheria outbreak in West Africa in the face of significant global shortage of DAT (Diphtheria AntiToxin), I aim to share from such experiences some of the key principles that we believe are critical to take forward for a more equitable, people-centered approach to PPR beyond the disappointing political declaration that has been adopted.
First more effort needs to be made to ensure that PPR negotiations and initiatives are transparent and inclusive. They should include adequate representation and full participation of developing countries, civil society organizations, and affected and marginalized communities. PPR programs and initiatives themselves should better engage communities and implement community-based approaches, as previous outbreaks have reinforced the essential role affected communities play in successful outbreak response.
Countries must also be careful to make sure that health is not politicized and that those who fall ill aren’t treated like security threats. In our experience, when health is politicized, it puts health workers at risk, and vulnerable communities, like people caught in humanitarian emergencies, suffer the most.
It is disappointing that the final declaration provides limited political commitment to end the overreliance on “market dynamics” and voluntary actions by the private sector that drive inequities in access and downplays state responsibility in addressing them. Governments must do more to include mandatory access conditions in agreements for products developed from public funding, ensure transparency and access to information, allow the use of all legal and policy options available to restrict monopolies on lifesaving medical products, address ongoing challenges around establishing and coordinating global stockpiles, and prioritize equitable allocation of scarce medical products for humanitarian contexts through global coordination.
Lastly, as we’ve learned, without adequate and sustainable financing, PPR efforts are bound to fall short. We are disappointed in the lack of specific and tangible commitments with respect to financing PPR in the declaration, in particular the lack of recognition that many developing countries face serious challenges in mobilizing domestic resources for health due to the current economic climate. All countries should do everything they can to resource their health systems, but wealthier governments have a responsibility to do more and increase their support. This financing, however, cannot come at the cost of other essential global health initiatives such as the Global Fund.
While the soon-to-be-adopted declaration makes some minor advances, on the whole it fails to make the concrete, actionable commitments necessary to address the failures of the past and does not do enough to advance an approach grounded in solidarity and equity, one which will be the most successful in the long run. The guiding principle for all of these discussions should be to reduce the suffering of people directly affected by any disease outbreak and not only for those that may affect rich countries. We hope that this and some of the lessons I’ve just mentioned will be taken up in Geneva and elsewhere where PPR negotiations are ongoing.
Mihir Mankad, Global Health Advocacy and Policy Senior Advisor, MSF USA
