The international medical humanitarian organisation Médecins Sans Frontières (MSF) this year marks the 20th anniversary of founding its ‘Access Campaign,’ which has been working to secure access to affordable medicines, diagnostics and vaccines, including promoting their research and development, for people in MSF’s care and beyond. Marking this milestone provides an opportunity to reflect on what has been learned and accomplished – and what needs to be done going forward – in medical innovation and access for all people in need.
MSF launched the Access Campaign in 1999 against the backdrop of the HIV/AIDS epidemic that was raging in developing countries—while lifesaving HIV drug ‘cocktails’ transformed this deadly disease into a chronic and manageable condition in wealthy countries, they were priced out of reach for everyone else. At the same time, MSF medical staff lacked adequate treatments for neglected diseases such as tuberculosis, malaria and African sleeping sickness, because pharmaceutical corporations did not consider it profitable enough to develop drugs for people who could not afford to pay high prices.
Deciding we could not sit by idly and watch this injustice take the lives of so many people in front of us, MSF started the Access Campaign to overcome the many barriers that prevent people from getting the treatment they need to stay alive and healthy, focusing in particular on bringing down prices and ensuring medicines are available in countries that need them, and stimulating research into improved treatment options.
Over the last two decades, MSF and civil-society outrage and demands to put patient lives before patents and corporate profits have resulted in advancements in the affordability and availability of key lifesaving drugs and vaccines:
- For HIV medicines, the price ultimately came down by more than 99 percent, from over US$10,000 to treat one person for one year in 2000, to less than $100 per year today, by breaking down corporate monopolies to allow robust competition and the production of affordable generic drugs, primarily from India.
- In the early 2000s, MSF pushed for a switch to more effective treatment for malaria through its ‘ACT Now’ campaign, urging countries to switch to artemisinin-based combination therapy (ACT), which most countries in Africa did by 2008.
- In 2003, MSF co-founded the Drugs for Neglected Diseases initiative (DNDi), an innovative non-for-profit drug development model to develop treatments for neglected patients, which has delivered eight treatments for malaria, pediatric HIV, leishmaniasis, Chagas disease, and sleeping sickness, including the recently launched all-oral sleeping sickness treatment fexinidazole.
- In the late 2000s and early 2010s, MSF’s Access Campaign added nutrition and vaccines to its portfolio and achieved success in improving the quality of food aid provided to children facing malnutrition through its ‘Starved for Attention’ campaign, as well as achieving critical affordable access for humanitarian actors to the pneumonia vaccine for children in crisis through its ‘A Fair Shot’ campaign.
- With the introduction of new medicines to cure hepatitis C starting in 2013, the world was confronted with the $1,000 pill – a situation which, alongside the exorbitant and escalating prices of cancer drugs and insulin, put front and center the global crisis of high medicine prices. By supporting legal challenges to the monopoly held by corporations like Gilead Sciences in multiple countries, MSF, along with other civil society organisations, has contributed to price reductions of key hepatitis C medicines to roughly $1 per pill in selected countries. But tens of millions of people are still waiting for the cure.
“The medical innovation and access crisis is now becoming increasingly global, with people in developing and developed countries alike experiencing some of the same access challenges we have seen for decades in our work in over 70 countries,” said Dr. Els Torreele, Executive Director of MSF’s Access Campaign. “It’s time to acknowledge that the way drugs are developed and sold today is not delivering the treatments people around the world need at prices they can afford. We need to see governments and the research community standing up and proposing bold solutions to a problem that is truly global—simply put, business as usual will be deadly.
Bhakti's Story - Strength to survive Drug-Resistant TB
Bhakti Chavan, 24, is a graduate student from Mumbai, India. A young, bright mind, she recently completed her master’s degree in biotechnology. In 2017, she was diagnosed with extensively drug-resistant tuberculosis (XDRTB) and began treatment at MSF’s TB programme in Mumbai. She is being treated with a combination of TB drugs, including delamanid, one of the first new TB drugs in 50 years. Her experience with long treatment and difficult side effects exemplifies the need for access to shorter, safer treatments for people with TB. This is Bhakti’s story.
I was 23 and completing my final project for my Master’s degree in biotechnology when I started having stomach issues. My father took me to a gastroenterologist, who diagnosed me with irritable bowel syndrome. With medication, I managed to complete my project and exams. During this time, I started losing weight, but I thought it was all happening because of my stomach issues.
In June of 2017, I successfully completed my Master of Science degree with first class and was searching for a job when I observed swelling on the right side of my neck. I consulted my family doctor, and she prescribed me some antibiotics. Despite this, the swelling was not reducing. We went to a chest physician who examined me and told me to undergo a biopsy. He told me to send the samples for testing, including with GeneXpert [TB test]. Two days after my biopsy, my reports came back positive for multidrug-resistant TB (MDR-TB), with high resistance to rifampicin [TB drug].
I was so shocked. How could I get this dangerous form of TB? My doctor said I needed a second-line MDR TB treatment regimen [second-line drugs are used to treat disease that is resistant to standard first-line treatments]. He told me I have to take daily injections for at least six months. [Treatment also requires taking many different pills for up to two years.] My family and I were so depressed after hearing about this rigorous treatment. Still, being a person with a science background, I knew in the back of my mind that this is the only treatment option I have.
Then, the drug-susceptibility testing report came with the most horrible results: I had not MDR-TB, it was XDR-TB [XDR-TB is a type of MDR-TB that is resistant to even more drugs]. I clearly remember the day when I was sitting in my doctor’s cabin with my dad, and he told me that I have XDRTB. He gave me the phone number of another doctor and asked me to visit there. It was the number of MSF’s clinic in Mumbai. My doctor wanted me to start treatment with the new medicine bedaquiline or delamanid, which were provided by MSF free of cost.
The first day I visited MSF was so depressing for me. The doctor at MSF saw my reports and explained the side effects of the medicines, including one that can affect the heart, with risk of sudden death. But with the counselling and support of the MSF team, I gathered all my courage and decided to undergo treatment.
Starting from August 2017, I was put on delamanid, cycloserine, ethionamide, clofazimine, moxifloxacin and linezolid, and daily injections of capreomycin. The side effects of the medicines started to appear soon – lots of vomiting, weakness, and neuropathy [nerve] issues. Due to the side effects of ethionamide, I was admitted to the hospital for seven days due to dehydration from severe vomiting. I used to cry while receiving the painful daily injections, which I took for eight months [requiring daily visits to the health centre, disrupting normal life]. But I feel proud of myself that, without missing even a single injection, I managed to complete that course of injectables.
As a young career-oriented person, it is so difficult to accept a situation like this. But I am so lucky that I have huge family support from my mom, dad and sister. They gave me confidence that whatever will happen, they will always be there for me, which also gives me a lot of strength. Also, talking with other survivors helps a lot. After a one-year break from my studies, I decided to take a postgraduate diploma course to keep my mind busy with something. Now I have completed 18 months of my treatment and have two to three more months to go.
I am very happy today that due to the support of MSF, I can be cured. I wish for people who are suffering with drug-resistant TB to be diagnosed in a timely manner. New medicines are required to be available for larger numbers of patients with drug-resistant TB. Only then will we achieve our TB-free target in India by 2025.