Speech |

Dr Pécoul at the African Summit on HIV/AIDS, Tuberculosis and other related diseases

8 min

Speaker: Dr. Bernard Pécoul

Speech given in Abuja, Nigeria, on lack of access to affordable medicines, and use of old, ineffective medicines. Calls for African leadership to address these issues.

Mr Presidents, your Excellencies, and distinguished delegates.

Thank you for the opportunity to address this distinguished gathering. MEDECINS SANS FRONTIERES would like to thank the Nigerian government and the OAU for organising this important meeting. MEDECINS SANS FRONTIERES, for 30 years has provided healthcare in war torn areas, and has run programs assisting people that are facing epidemics, famines and natural disasters. We also are involved in long-term health projects. In all the places we work, we do so in collaboration with national partners.

It is in the spirit of partnership that I want to speak about some progress that has been made on improving access to treatment of infectious disease. This meeting is a symbol of the growing political will to put increased attention and resources towards improving access to prevention and care.

Let me tell you about our perspective on the challenge of access to essential medicines and vaccines. We speak as doctors who are witnessing, what we believe, are unnecessary deaths.

  • We are seeing people die because -- some of the drugs that are needed to treat them are no longer produced. Treatments are abandoned by drug makers when the vast majority of patients are not wealthy enough to represent a profitable market.
  • We are seeing people die because -- new life-saving drugs are priced beyond their reach.
  • We are seeing people die because -- the drugs that are available to treat them are no longer effective – the treatments have grown resistant to the bugs. And there is virtually no ongoing research to develop replacements for the drugs that are becoming obsolete. Research and development for new medicines for tropical diseases is at a standstill.

As you see in this pie chart, out of 1,223 new drugs that were approved between 1975 – 1997, only 1% -- that is 11 drugs -- were indicated for tropical disease. Out of these 11, 6 were actually developed for treating animals and then later tested for humans.

Let’s take the first case of life-saving treatments that have been abandoned by their producers. In practical terms this means that effective medicines or vaccines for meningitis, yellow fever or sleeping sickness suddenly are no longer available. Sleeping sickness treatments are the perfect case study. Two years ago, four of the five drugs to treat this fatal disease had either been abandoned or were being inconsistently produced. The most striking example has been the drug eflornithine, which was introduced more than 11 years ago. It was called the “resurrection drug” because of its ability to bring people back from near death.

But today first-line therapy for second stage sleeping sickness is a toxic arsenic-based drug that kills up to 5 percent of patients with its side effects. Why are physician rationing the “resurrection drug”? Because it hasn’t been produced since 1995, it was abandoned by its producer because it was not profitable.

In 2001, under growing international pressure, all of the producers of sleeping sickness medicines have agreed to restart or continue production of these critical medicines. They have also agreed either to offer treatments at affordable prices or to donate them. Now that these medicines are available, there is an urgent need for leaders of affected countries to quickly ensure that these drugs are used.

The second category is life-saving drugs that are priced out of the reach of people who need them. This the case with new antibiotics and AIDS drugs. Lets take the example of antiviral drugs or “AIDS cocktails” as they are sometimes called. But first, let me say a word about MSF’s position on HIV/AIDS prevention versus treatment. We believe that the two are inherently linked and prevention does not work well without treatment. People don’t want to get tested if there is no treatment available and when people don’t get tested prevention efforts falter. There is an urgent need to scale up both prevention and treatment efforts, we do not believe it is possible to choose between the two. Vaccine development is also a priority.

Regarding access to drug cocktails, until recently there could be no serious discussion because prices were just too high, at US 10,000 – US 15,000 per year per patient. Treatment was not an option. This reality has fundamentally changed. The change has come partly because of growing awareness of the lack of access to life-saving drugs. Many world-leaders have realised that for some diseases, the patients are in the South and the medicines are in the North. As you can see from this pie chart , 85% of the world population lives in developing countries but only represents 23% of the world-wide drug market. Africa alone represents only one percent of world-wide drug sales.

Combined with growing international awareness has been intense competition from generic companies. This chart shows the dramatic fall of prices, for a common three drug cocktail, once competition was introduced. The price for this cocktail has fallen 98 % -- or 30 fold. This has happened in just 8 months. We think it is very significant that each reduction by the multinational drugs companies, came after generic companies offered discounts. The price of the brand products track along with the generic discounts.

Making medicines like ARVs or antibiotics affordable, will take direct action on your part. We encourage you to support all means at your disposal to maintain affordable drug prices.

There are several promising strategies that you can use simultaneously:

  • stimulating generic competition – through local production and/or importation
  • demanding differential pricing, that is to say, dramatically lower prices in your countries
  • developing regional, and international procurement and distribution schemes with the support of WHO, UNICEF and UNAIDS

To implement the generic and/or local production strategies, over the long-term, it will be necessary to take full advantage of the safeguards in TRIPS, the international agreement that governs patents. For example you can write national laws that include 1) compulsory licensing rules that allow governments to override patents when necessary and 2) parallel imports, which means getting the best price on the world market for patented medicines.

Application of these safeguards are not consistently being implemented. For example, the recent revision of the Bangui agreement, a trade agreement between 16 African Francophone countries, makes implementation of safeguards difficult.

We support the leaders of Africa in their call for a special session at the World Trade Organisation’s TRIPS Council that will look at how trade rules can be implemented while ensuring public health. The upcoming June session will be an opportunity for you to ask if the TRIPS agreement needs to be reinterpreted or changed to ensure access to medicines.

The third category is old medicines that continue to be used even when they no longer work. I am speaking about common diseases that in principle should be treatable, such as malaria, severe diarrhoea caused by infections like shigellosis, and sexually treated diseases.

The case of malaria is instructive. For instance, we at MSF are concerned about the fact that the current practice of using drugs, which no longer work, verges on medical malpractice. We should all take collective responsibility for this. We have an ethical responsibility to provide the most effective life-saving therapies available. National malaria protocols need to be changed when they stop working. In addition to stepping up prevention efforts, health ministers and political leaders should make the decision to begin introducing combination therapies including artesunate derivatives when necessary. Your attention to this issue is a matter of life and death for children, and adults without natural immunity.

The challenge as we see it, is to translate the limited successes in improving access to sleeping sickness and AIDS medicines -- into a durable system to improve access to medicines.

As physicians who are working with our African colleagues on a daily basis we have some ideas for change. But it is you, the leaders of Africa that ultimately have the responsibility to take definitive action.

- Only your leadership -- can make sure that shortage of drugs and vaccines – such those for yellow fellow or meningitis are relegated to history.
- Only your leadership -- can ensure that drugs are affordable, your national laws and your role as members in the WTO are determining factors.
- Only your leadership -- can ensure that people will not die from using chloroquine when it no longer works.
- Only your leadership - - will make more funds available for prevention and care

We believe that the international community can play a significant role in helping you to realise your health objectives. International support will need to include funding from donors, technical and advocacy support from the UN agencies such as WHO, UNICEF, UNAIDS and constructive participation from pharmaceutical companies.

MSF, through caring for individual people in many of your countries and through our ability to advocate internationally, will try to lend our support.

Thank you for your attention.