[Ip-health] MSF Open Letter to TWG and TSS
Paul Davis
pdavis@critpath.org
Sun, 11 Nov 2001 11:03:33 -0500
MSF is submitting the following letter to all members of the Transitional
Working Group and Technical Support Secretariat of the Global Fund to Fight
AIDS, Tuberculosis and Malaria during the upcoming NGO consultation process
in Brussels. Referenced are three MSF documents/reports:
"Pills and Pocketbooks" available at
http://www.accessmed-msf.org/prod/publications.asp?scntid=3D318200146197&cont=
e
nttype=3DPARA&
"Fatal Imbalance" available at
http://www.msf.org/source/access/2001/fatal/fatal.pdf
"A Matter of Life and Death" available at
http://www.accessmed-msf.org/prod/publications.asp?scntid=3D291020011614133&c=
o
ntenttype=3DPARA&
Please contact Seco Gerard with MSF in Brussels with any questions at
+32 2 280 18 81.
Regards,
Rachel
Access to Essential Medicines Campaign
Doctors Without Borders/Medecins Sans Frontieres (MSF)
6 East 39th Street, 8th Floor
New York, NY 10016=20
http://www.doctorswithoutborders.org/
http://www.accessmed-msf.org/
Rachel M. Cohen Phone: (212) 655-3762
Mobile: (917) 331-9077 Fax: (212) 679-7016
U.S. Advocacy Liaison E-mail: rachel_cohen@newyork.msf.org
dr_________________________
Open Letter to Members of the Transitional Working Group and Technical
Support Secretariat of the Global Fund to Fight AIDS, Tuberculosis and
Malaria
9 November 2001
Dear Members of the TWG and TSS,
On behalf of M=E9decins Sans Fronti=E8res (MSF), I am pleased to submit this
letter to you and other members of the Transitional Working Group (TWG) and
Technical Support Secretariat (TSS) as part of the NGO consultation process
for the Global Fund to Fight AIDS, Tuberculosis and Malaria (Global Fund).
Rather than attempt to address all of the "key issues" identified for
discussion in Brussels on November 12-13, we have chosen to focus on
several core principles and knowledge gained from our experience working to
treat and prevent AIDS, tuberculosis and malaria in the field.
Treatment: a medical and ethical imperative
As a medical humanitarian organization, MSF believes that the Global Fund
must provide financing for treatment programmes for HIV/AIDS, TB, and
malaria. This is an ethical imperative. In its statement of underlying
principles for the Global Fund, the TWG commits to "pursu[ing] an
integrated and balanced approach covering prevention, treatment, and care
and support in dealing with the three diseases."1 MSF fully supports an
integrated approach to AIDS, TB, malaria and other infectious diseases ? in
fact MSF implements disease control programmes in a comprehensive,
integrated manner in the field. But we are deeply concerned that because
donors and some in the international health community traditionally favour
prevention at the expense of treatment, patients already infected will be
written off as not sufficiently "cost-effective" to treat.
Treatment and prevention are mutually dependent and both are essential
elements of any effective strategy to address HIV/AIDS, TB, malaria and
other infectious diseases. MSF medical teams working in Africa, Asia,
Eastern Europe and Latin America have witnessed this. Our field experience
has taught us, for example, that in addition to improving and extending the
lives of people living with HIV/AIDS, offering antiretroviral treatment
significantly enhances prevention activities; condoms and drugs for
opportunistic infections and sexually transmitted diseases are simply not
enough.
It is vital to improve treatment interventions, not expand use of
ineffective treatments
It is of vital importance that the Global Fund be used to support
improvement of treatment interventions, and that it does not inadvertently
facilitate the expanded use of ineffective treatments. For instance, in the
case of malaria treatment, it would be wrong to support programmes which
continue to use inexpensive treatments in areas where they have lost their
effectiveness due to resistance. Where resistance to traditional first-line
treatments ? especially chloroquine ? is high, malaria treatment must
include not only traditional antimalarials, but also regimens containing an
artemisinin derivative. Research and development is of course desperately
needed to produce more effective and easy to use medicines, vaccines and
diagnostic tools for the three diseases ? the enclosed report "Fatal
Imbalance" contains further details on this issue. Operational research
needs to be accelerated to increase knowledge on best practices for
implementing new combination treatments and diagnostic strategies in
resource-poor settings. Newer, more effective, field-relevant medicines and
medical technologies must be made available to poor countries at affordable
prices as soon as they are developed.
The way Global Fund financing will be used is critical
To ensure that international funding mechanisms, including the Global Fund,
offer treatment to the highest number of people possible, it is essential
that funds be available for bulk purchases of medicines and medical
technologies at the lowest possible cost, through international tender. In
its statement of underlying principles, the TWG states that "[i]n making
its funding decisions, the Fund will support proposals which...[a]re
consistent with international law and agreements, respect intellectual
property rights, such as Trade-Related Aspects of Intellectual Property
Rights (TRIPS), and encourage efforts to make quality drugs and products
available at the lowest possible prices for those in need." This statement
could easily be misinterpreted and must be clarified.
The TRIPS Agreement can and does have negative consequences for public
health in poor countries. However, it also has safeguards to balance public
and private interests and ensure that patents do not pose a barrier to
access to medicines. The Global Fund should make clear that applicants have
the option of purchasing generics with Global Fund money. The Global Fund
should make clear in its principles that, where patents constitute a
barrier to access, the use of legal safeguards (such as compulsory
licensing) to override patents is compliant with TRIPS. Without a
deliberate strategy to ensure that funding can be used to purchase quality
drugs from both generic and proprietary producers ? including those
located in developing countries ? funds will be squandered. To secure drug
quality, the Fund should explicitly support the World Health Organization's
project to pre-qualify manufacturers of drugs and diagnostics related to
HIV/AIDS, and encourage its expansion to other diseases, including malaria
and TB.
These principles related to procurement of drugs and diagnostics are
crucial because prices of medicines and other essential health care goods
will have a profound impact on the reach and effectiveness of the Global
Fund. Antiretroviral drugs for the treatment of HIV/AIDS provide a good
illustration: the cost of ARVs from proprietary companies ? even at deeply
discounted prices ? are, for certain regimens, three times more expensive
than ARVs from generic manufacturers.2 Using the lowest cost suppliers
will increase by as much as three times the number of patients who can be
treated with the same amount of money, and will allow for greater
investments in other important components of care and prevention. To
ensure the widest possible access to life-saving medicines, the Global Fund
must operate in a broader policy framework ? what MSF calls a global system
of "equity pricing" ? that affirms several mutually supportive strategies
for ensuring access to the lowest cost health-related goods in poor
countries (please see the enclosed paper entitled "Pill and Pocketbooks"
for a more in-depth explanation of these strategies). In addition to
utilizing existing resources wisely, donor countries must also urgently
allocate additional funds ? financial commitments to the Fund are to date
woefully inadequate.
Conclusion
It is essential that a long-term, sustainable solution to the access to
medicines crisis be developed and supported by governments and multilateral
agencies, which are responsible for responding to global public health
needs. Your leadership in the design and launch of the Global Fund will be
a key to its success and reach, and, ultimately, a crucial part of a
successful global response to HIV/AIDS, TB, and malaria. We urge you to
strongly support the recommendations presented in this letter and the
enclosed reports to guarantee access to effective and affordable medicines
and medical technologies at the best possible price. For millions of people
in developing countries, this is a matter of life and death.
Sincerely,
Bernard Pecoul, MD, MPH
Director, Access to Essential Medicines Campaign
(superscript: 1) (superscript:
http://www.globalfundatm.org/principles.html )- Accessed November 5, 2001
(superscript: 2) See, for example, "Accessing ARVs: Untangling the Web of
Price Reductions for Developing Countries," Perez-Casas, Carmen et al
available at
http://www.accessmed-msf.org/upload/ReportsandPublications/21120011652134/w=
e
beng.pdf
--
Paul Davis
pdavis@critpath.org
Health GAP Coalition
ACT UP Philadelphia
+1.215.474.6886 direct tel.
+1.215.474.4793 fax
+1.215.731.1844 ACT UP