Dr Bernard Pécoul was a leading founder and the first director of the then-called Campaign for Access to Essential Medicines, launched by MSF in 1999. Prior to the Campaign, he was the Executive Director of MSF France. Currently, he is Executive Director of the Drugs for Neglected Diseases initiative (DNDi). Here he speaks about the beginnings of the Campaign.
What led MSF to start the Access Campaign?
Unaddressed medical needs from the field led to the start, and the need to understand how to overcome the problems that stood in the way of better treatment for patients.
One example – in the 1980s-90s, MSF was confronted with sleeping sickness in Uganda. We knew existing treatments were terribly toxic, based on arsenic, even killing 5% of people treated. But we had no choice as the disease is otherwise 100% fatal! A much better option existed, but the drug was no longer being produced so our field programmes couldn’t access it.
For other diseases like kala azar, meningitis, shigella – we were confronted with a lack of products, or a lack of access to products, or both. After the 25th anniversary of MSF in 1996, we created a working group to understand the causes for this.
We knew we had to do something. But what? And how?
The first step was to understand exactly where the problems were, and gather the expertise so that the access and R&D [research and development] barriers could be confronted and overcome – that was the role for the Campaign.
What kind of shift did the creation of the Campaign mean for MSF?
As a medical organisation, MSF was not assessing the political and legal environment that governed access to medicine. We were logistically oriented and had made great progress in bringing medicines and vaccines to the field – we knew how to purchase and deliver. But we needed to address the situations when we had nothing to purchase, and nothing to deliver!
Take HIV – it was obvious that intellectual property [IP] was a major challenge, pricing treatments out of reach. Addressing IP barriers was a priority. But for sleeping sickness or leishmaniasis, the issue was a lack of R&D. You cannot address both IP and R&D with the same tools and response. The Campaign was the structure that developed a deep understanding of the problems, and then proposed solutions.
In this we are all indebted to Jacques Pinel. He was my mentor, he is why I was asking a lot of questions on this.
What were the first achievements of the Access Campaign?
Getting rid of toxic sleeping sickness treatment was a first success. On a trip to the US, I suddenly saw on TV an advertisement for a hair reduction cream containing eflornithine, the drug we had tried and failed to access for many years.
So this lifesaving drug wasn’t available for people at risk of dying, but could be bought as a cosmetic product! We took the story to The New York Times, and to [US TV news programme] 60 Minutes. This was the beginning of a long process which led to massive improvement in sleeping sickness treatment.
The Campaign also led on malaria. In the 1990s, field programmes were starting to observe that chloroquine was not doing the job. But there was reluctance to change the status quo. MSF and Epicentre [research arm of MSF] conducted a series of studies to document resistance, and on that basis the Campaign came up with a strong message: “ACT NOW” to change treatment, make artemisinin-based combination therapy [ACT] available, and do it everywhere. This campaign put pressure on the World Health Organization and led to the adoption of ACTs.
For HIV, the Campaign also had a role in challenging the status quo. Externally, the drive to reduce the price from $12,000 for a year’s treatment, down to $1 a day was driven by the Campaign. And internally, this contributed massively to unblock the hesitancy in MSF to treat HIV, as it was now seen as something feasible. And as convener of an expert group of idealists that thought we can do things better, the Campaign also led to the creation of DNDi. After investigating the problems on the R&D side, we realised that to develop solutions we needed to create a separate initiative, one that could demonstrate a different model, a different way of doing R&D, and that could deliver. DNDi’s achievements are also the Campaign’s!
Jacques Pinel, who passed away in 2015, was a pillar for MSF since 1979. Trained as a pharmacist, he was instrumental in the set-up of MSF’s logistics, pharmacy, and medicines policies, including guidelines and emergency kits. In the 1990s, he played a leading role in the movement that would become the MSF Access Campaign.