Photo exhibition: Too poor to be treated

Thanks to medical advances and improved living conditions, life expectancy in wealthy countries increases by four months every year. But in poor countries, treatment for certain life-threatening diseases is not available to those who need it. One person in three in the world, and one in two in poor countries, is denied access to essential medicines.

Infectious diseases like tuberculosis, malaria, sleeping sickness, Chagas disease and leishmaniasis are making a forceful comeback. These killer diseases claim 14 million victims every year, 90% of them in developing countries. MSF's photo exhibit in Calgary will focus on sleeping sickness (Human African Trypanosomiasis) in Uganda and Sudan and TB in Abkhazia, Georgia, a former Soviet republic.

The development of new drugs for these diseases has ground to a virtual standstill. Many of the existing treatments, developed decades ago, cause serious side-effects and are proving increasingly ineffective against microbes which have developed resistance to the drugs. Sometimes, effective drugs are taken off the market: for example, the laboratory manufacturing an alternative drug of better quality for sleeping sickness stopped production for reasons of profitability.

Of 1,393 new drugs approved between 1975 and 1999, only 13 (less than 1%) were specifically indicated for a tropical disease. This is why diseases such as leishmaniasis and sleeping sickness are called neglected diseases: they affect relatively large numbers of people who have no purchasing power and no-one to advocate their cause.

The lack of political leadership by public authorities into drug research and development allows the private pharmaceutical industry to set priorities according to profitability criteria imposed by shareholders. The industry devotes huge resources to developing drugs to fight diseases prevalent in wealthy countries, such as cancer and cardiovascular diseases, as well as highly profitable "lifestyle drugs" targeted at non-life threatening conditions such as baldness or erectile dysfunction.

Meanwhile, millions of people in developing countries do not have access to the medicines that would, quite simply, save their lives. This fatal imbalance must be addressed.

Travelling on three continents during a year, Laurence Binet and Serge Sibert followed the medical teams of Médecins Sans Frontières (MSF) and the patients they care for. Binet and Sibert documented the daily struggle of individuals, families and communities overshadowed by five neglected diseases: sleeping sickness (Uganda and south Sudan), Chagas disease (Honduras), tuberculosis (Abkhazia), leishmaniasis (Peru) and malaria (Cambodia).

By sharing the experiences of patients and doctors in the field with a wider audience, MSF wishes to highlight the enormous human suffering these neglected diseases cause to millions of people in poor countries - people forgotten by the pharmaceutical industry and by Western political leaders.

Suffering from unprofitable market syndrome

In 1999, frustrated with having to tell patients that the medicines necessary to cure them were not available, MSF launched a campaign to increase access to essential medicines. This international initiative, based on MSF's field experience and medical expertise, aims to lower drug prices and stimulate research and development for drugs for neglected diseases.

There have been a number of successes in recent years. Yielding to both public pressure and competition from generic versions of the drugs, pharmaceutical companies have been forced to start lowering the prices of antiretroviral treatments. These drugs, known as AIDS cocktails, have been used successfully in the West since 1996 to extend and improve the quality of patients' lives.

The treatment of multi-drug resistant tuberculosis is very expensive. But thanks to a price reduction negotiated by MSF within a World Health Organization project, it has been possible to build up a limited stock of medicines. More research is still necessary to find simpler, cheaper and more effective first- and second-line treatments.

Public pressure and an initiative by the World Health Organization, MSF and pharmaceutical companies helped restart the production of three drugs for sleeping sickness in 2001. At the same time, an agreement was made for donation of these medicines and a commitment to finance research and contribute to an oral formulation for eflornithine. These drugs were desperately needed because treatment options for this fatal disease were running out. More research is still needed to find new, simpler-to-use medicines for this disease.

Price reductions have already been negotiated for newer and more effective treatments for malaria, but the cost is still too high for the health systems of most developing countries. Subsidies from wealthy countries will be necessary.

An active commitment by governments is the only way to effectively respond to the pharmaceutical industry's lack of interest in treatments for diseases affecting the poor. It is therefore essential that human and financial resources be mobilized to give a new impetus to research and ensure availability of treatments for those who need them.

The battle to boost research and development into neglected diseases is only just beginning. By exhibiting the stories of the individuals affected, you will be helping MSF to fight the indifference that can kill.

MSF Access to Essential Medicines Campaign

About the contributors:

Serge Sibert (49) is French and has been working as a professional photographer since 1981. Before that, he worked as a teacher for children with special needs. Sibert's main interest is people and their social environment. Awarded several prizes in photography, Sibert has published features for the GEO magazine since 1988, as well as a book on Mauritania's ancient cities.

Laurence Binet (45) is a journalist and writer who lives in Paris. She has reported on the work of Médecins Sans Frontières (MSF) for years, concentrating particularly on the organisation's Campaign for Essential Medicines, launched in 1999. Binet is also the author of non-fiction books for adolescents, one of them focussing on access to medicines for sleeping sickness in Uganda.

A feature story based on Sibert and Binet's work on MSF's projects was published in GEO magazine (France) in October 2001.

Médecins Sans Frontières (MSF) is an independent humanitarian medical relief agency aiding victims of armed conflict, epidemics, and natural and man-made disasters. Founded in 1971, MSF currently works in more than 80 countries around the world. The organisation was awarded the Nobel Peace Prize in 1999.