MSF: Access to medicines must be preserved and improved at the World Health Assembly

Guest blog by Dr. Tido von Schoen-Angerer, Executive Director, Access to Essential Medicines Campaign, Médecins Sans Frontières/Doctors Without Borders (MSF), Geneva, Switzerland

On May 17-21, the World Health Organization (WHO) will convene the 63^rd World Health Assembly (WHA) in Geneva. This annual gathering of country health ministries is the supreme policymaking forum for international health, setting global medical priorities and defining the work of WHO. As an international humanitarian medical aid organization, MSF and its field teams deal first hand with the practical effects of WHA resolutions.

This year, MSF’s Access to Essential Medicines Campaign highlights three key issues on the WHA agenda: treating childhood malnutrition, innovative financing for medical research and development (R&D), and conflation of drug safety with intellectual property (IP). In addition, MSF raises concerns regarding multidrug-resistant tuberculosis (MDR-TB), Chagas disease, and achievement of the health-related Millennium Development Goals (MDGs).

An important health matter on the WHA agenda is infant and young children nutrition. MSF treated more than 300,000 malnourished children in 2008, mainly with nutrient-rich ready-to-use food. A resolution will be before the WHA to develop a comprehensive implementation plan on childhood nutrition. This plan will be synergistic with a framework of action already set forth by the World Bank. However, this framework does not provide safeguards against potential conflicts of interest with the food industry. Nor does it prioritize access to treatment and early interventions, which have shown success in reducing undernutrition in children. A “window of opportunity” in a child’s life up to 24 months is recognized as crucial for preventing irreversible physiological and cognitive damage caused by malnutrition. Early interventions and treatment, in the form of complementary foods and therapeutic feeding, must therefore play a much more central role in any response to acute child malnutrition in high-burden areas.

Another important WHA agenda item is on the global plan for public health, innovation and IP, featuring the report of the Expert Working Group (EWG) on R&D financing. Innovative financing for global health R&D is critical because new drugs and diagnostics are desperately needed for diseases for which traditional, profit-driven markets do not exist, such as TB, Chagas disease, and sleeping sickness. As a pediatrician, I have been unable time and again to diagnose TB because current tests are not good enough. Unfortunately, the EWG report is flawed in several aspects and ignores the important principle of delinking the cost of R&D from the commercial price of the new product, despite the inclusion of this strategy in resolutions, such as for MDR-TB last year. Delinking R&D cost from resultant product price must guide innovative financing mechanisms to assure that global health R&D is driven by medical priorities, not profits, and that new medicines are affordable and accessible.

Regarding fake medicines (or “counterfeits”), everybody agrees they must be stopped. But recent interventions have applied an IP framework, specifically that of trademarks and patents, to fake medicines. By conflating IP issues with what is essentially a public health concern, the European Union has stopped legitimate generics in transit, and Kenya has adopted an anticounterfeit law that confuses fakes with generic medicines. Therefore, a public health-driven definition and approach, rather than an IP enforcement agenda, should be adopted to fight fake as well as substandard drugs, without hindering access to legitimate generic medicines.

Other important medical issues will be discussed at the WHA. For TB control, MSF is concerned with the very slow progress in scaling up care for MDR-TB, where still <3% of patients receive treatment. MSF has tried to show that scale-up of MDR-TB treatment is possible in high-burden countries. High-burden countries must prioritize treatment scale-up, and WHO and other agencies must provide better adapted support, including increasing the availability of quality-assured second-line drugs. New drugs for TB must be tested in MDR-TB, and proposed MDR-TB clinical trials need to be funded.

A resolution on Chagas disease this year (dropped from last year’s WHA agenda) presents an opportunity to address the medical needs of the 8-15 million people with Chagas. However, the resolution lacks a clear commitment to increasing diagnosis and treatment of infected patients. For the Chagas resolution, we urge the emphasis of integrating diagnosis and treatment at the primary health care level, reinforcing supply chains, and increasing R&D, especially for safer, more effective drugs and a test for cure.

Finally, for the health-related MDGs, these goals will not be reached due to major gaps in universal access to HIV and TB treatment, acute childhood malnutrition, and vaccination, among others. Uncertain funding plays a predominant role in this, and we call on the WHA to support raising additional funds for achieving the health-related MDGs, such as creation of a financial transaction tax.

Of course, all of the world’s health problems cannot be solved in one week at the WHA. But this gathering presents a chance to make concrete commitments now to the urgent, life-threatening medical concerns of people most in need.