There has been a collection of high quality posters designed specifically for the Access Campaign in the MSF offices worldwide over the past three years. This collection shows some of the range for the posters.
MSF convenes a workshop in Paris called "Drugs for communicable diseases: stimulating development and securing availability". This meeting leads to the creation of the Drugs for Neglected Diseases Working group whose 35 members include scientists, academics, health professionals and representatives from WHO, developing country governments and non-governmental organisations.
At the World Trade Organisation Ministerial meeting in Seattle, US president Bill Clinton announces that the US will begin considering the health implications of its trade policy.
After a long period of negotiations with MSF and the World Health Organization, the pharmaceutical company Aventis (based in France) agrees to produce 10,000 vials of the drug eflornithine - used to treat sleeping sickness - from existing eflornithine powder. Production of this drug had been stopped in 1995 because it was no longer profitable to its maker.
MSF supports the Treatment Action Campaign (TAC), a coalition of South African AIDS activists, in demanding that US-based company Pfizer, the exclusive marketer of fluconazole, either lowers the price of the drug or lets generic companies sell it at an affordable price. MSF sections in developed countries as well as many field countries communicate their support of the TAC demands directly to Pfizer headquarters and affiliates.
Following negotiations with MSF and WHO, Eli Lilly, a US-based drug company, agrees to sell two of its drugs used to treat multi-drug resistant tuberculosis (MDR-TB) at steeply discounted prices. Thanks to discounts on Lilly drugs cycloserine and capreomycin as well as tender prices for other drugs, the overall cost of treating one patient with MDR-TB drops from approximately $10,000-14,000 to $2,500-3,600. The drugs are distributed in the context of a newly set-up WHO greenlight committee to ensure appropriate use of the medications and reduce the risk of fostering further drug resistance.
Pfizer announces that it will provide free fluconazole to people with AIDS in South Africa.
UNAIDS announces a programme (later named the Accelerated Access Initiative) to improve access to AIDS care. The initiative, a cooperative agreement with five multinational drug companies that produce AIDS medicines, is in part an attempt to make medicines more affordable. Press reports mention potential price reductions of 85-90%, but MSF reacts with scepticism as discounts are not confirmed and no other details on the programme's substance are forthcoming.
MSF and Health Action International (HAI) host an East African Assess conference, attended by delegates from more than 21 countries. One presentation on drug prices shows that East Africans sometimes pay more than twice what Europeans pay for essential medicines. As a result, a coalition of Kenyan NGOs forms and develops a campaign to influence the rewriting of patent rules. This reform is mandated by the TRIPS Agreement, of which Kenya is a signatory.
Access is the buzzword at the XIII International AIDS conference in Durban, South Africa. MSF hosts a satellite meeting with the Treatment Action Campaign (TAC), a coalition of South African AIDS activists, and presents a study showing the dramatic effect competition can have on AIDS drug prices. The case study on fluconazole is later published in a letter to the Lancet.
The Thai law society announces it will prosecute the ddI case on behalf of MSF and people with AIDS. It will challenge Bristol Myers Squibb's (BMS) monopoly on the sale of the drug and seek to have BMS's patent revoked. Legal experts argue that the product sold by BMS does not meet two basic requirements for patents - novelty and an inventive step. (ddI, or didanosine, is an antiviral drug used as part of combination therapy to treat AIDS)
MSF announces that it will use $1 million Nobel Peace Prize money to create a Neglected Disease fund. The first projects to receive funds are designed to improve treatment for malaria, sleeping sickness, kala azar, and TB.
In Bangkok, Thailand, MSF begins treating AIDS patients with antiretroviral drugs.
MSF successfully lobbies manufacturer Novartis to reduce the price of their malaria drug Co-Artem for sale to the South African provincial government of KwaZulu-Natal. The reduced price of $3.79 per adult treatment means the medicine is now affordable for the province, and the government orders a stock to prepare for their seasonal epidemic.
At an MSF meeting in Berlin, the drug company Bayer publicly announces its intention to keep producing nifurtimox and suramine, two drugs used in the treatment of African trypanosomiasis. The drugs had risked being taken out of production because they were no longer profitable for the company.
The landscape of AIDS drug pricing changes dramatically when Indian generic manufacturer Cipla offers a triple combination of antiretrovirals for a price of $350 per patient per year. This offer, made public by the New York Times, sparks a price war among generic and proprietary AIDS drug manufacturers, and significantly re-orientates the thinking of political leaders on the feasibility of treating AIDS in poor countries.
The 39 pharmaceutical companies' court case against the South African government becomes headline news. Beginning in 1998, the companies had begun blocking implementation of a law that aimed to make medicines more affordable to patients. Helping to move the case into the court of public opinion, MSF launches a world-wide "Drop the Case" Petition.
Bristol-Myers Squibb (BMS) announces that it will offer a "free license under the patent for Zerit (d4T) (rights to which are owned by Yale and Bristol-Myers Squibb) to treat AIDS in sub-Saharan Africa." Both BMS and Yale had been under pressure to grant the license from Yale students, the Consumer Project on Technology and MSF South Africa.
The 39 drug companies unconditionally drop the case they had been pursuing against the South African government. The end of the law suit means the 1997 Medicines Act can go into force, allowing parallel importation of patented drugs and generic substitution of off-patented medicines.
WHO announces an agreement outlining a donation of sleeping sickness drugs eflornithine, pentamidine and melarsoprol large enough to cover estimated global need for five years - the total value of the drug donation is around $12.5 million. The company agrees to donate another $12.5 million over the following five years for WHO's sleeping sickness programme, which includes both disease management and control and R&D. MSF had been advocating for a restart of eflornithine production and continuation of production of other sleeping sickness medicines since 1999 and was a member of the WHO technical team that was searching for a new producer.
The Kenyan IP Bill 2001 passed. The Kenyan parliament approves the Industrial Property Bill 2001, which allows the importation and production of cheaper medicines for HIV/AIDS and other diseases. The Bill includes most of the WHO recommended ‘safeguards' such as parallel importing and compulsory licensing. But it takes the Kenyan government almost another year to authorize import of generic drugs: In May 2002, MSF asks for official authorization to import a batch of generic ARVs to treat 150 patients for 4 months in Homa Bay hospital and the Nyumbani orphanage. The medicines arrive on 1st July 2002.
Health before profits at the 4th World Trade Organization (WTO) Ministerial Conference. After two and a half years of campaigning to put health before trade interests, the 142 WTO member countries support a declaration stating "the TRIPS Agreement does not and should not prevent Members (states) from taking measures to protect public health." Approved in the WTO Ministerial conference in Doha on November 14th, the declaration also gives an extra ten years to least developed countries during which they do not need to provide patents on pharmaceuticals. The most important result is that countries can issue compulsory licenses for government use without fear of legal repercussions.
The right of babies to be born HIV free endorsed in South Africa. Although around 180 babies are born HIV positive in South Africa every day, the government long refused to implement a nationwide prevention of mother-to-child transmission (PMTCT) programme. TAC had been pressuring the government since 1998 to implement a PMTCT policy without much success. Finally, TAC took the government to court over the issue and won. The victory was widely publicised and supported by the media. However, the government has since appealed the decision.
Drugs for neglected diseases: MSF and partners launch four pilot projects. MSF established an Immediate Drug Development Project (IDDP) fund to support the completion of four "targeted drug development projects" for three neglected diseases (leishmaniasis, Human African trypanosomiasis (HAT) and chloroquine-resistant malaria) in collaboration with WHO/TDR. These projects are to become part of the Drugs for Neglected Diseases Initiative (DNDi), a not-for-profit drug development unit which is being established by MSF and other founders to compensate for the lack of research and development into the diseases of the poor. The DNDi, which was approved by MSF's International Council in June 2002, will be officially launched in mid-2003.
MSF begins using Brazilian-made AIDS drugs in South Africa. MSF-South Africa announced, in conjunction with Treatment Action Campaign (TAC), the Congress of South African Trade Unions (COSATU), and Oxfam, that it had imported generic antiretroviral drugs from Brazil for patients in the MSF pilot project in Khayelitsha. This enabled MSF to treat twice as many patients as before. The groups also demanded that the government begin pilot projects to assess the operational constraints to ARV use as part of a process to make HIV/AIDS treatment widely available.
India registers new drug for kala-azar. The first oral drug to treat kala-azar, or visceral leishmaniasis, miltefosine was registered in India. Originally a spin-off from more lucrative pharmaceutical activity, miltefosine was registered for breast cancer metastasis seven years ago. MSF welcomed the news and hopes the drug can be registered in Africa. The possibilities of using a shorter course of miltefosine, possibly combined with another potent drug such as the intravenous liposomal amphotericin B, also need to be examined.
WHO releases first list of pre-qualified HIV/AIDS drugs. The first list of pre-qualified HIV/AIDS drugs was released by WHO. It included some generic drugs and manufacturers. However, some essential drugs (such as fluconazole) to treat HIV/AIDS and/or opportunistic diseases were missing altogether. MSF recommended that the project be expanded to include drugs for other diseases such as malaria and TB. NB: The "pre-qualification process" initiative was begun by WHO in November 2000. The idea is to offer information about the quality of HIV/AIDS medicines to countries that do not have their own quality assurance procedures.
WHO adds ten antiretrovirals and one new anti-malarial on the new Essential Medicines List. The WHO Essential Medicines Committee added ten anti-retrovirals and one new anti-malarial (lumefantrine artemether, also known as CoartemÃ?®) to the core essential medicines list (EML). The new EML contains 325 active substances, including 12 anti-retrovirals and over 60 other essential medicines for HIV-related care. If used appropriately, the EML is a key tool for health professionals and governments in developing countries. The committee also promoted the concept of fixed-dose combinations (FDCs) for malaria, TB and AIDS. As competing research-based pharmaceutical companies are unlikely to make FDCs, this provides an opportunity for generic companies to contribute to combating these diseases.
U-turn in South Africa's AIDS policy. The South African government made a dramatic turn-around in its AIDS policy: the Cabinet released a statement on HIV/AIDS in which, for the first time, it acknowledges the efficacy of antiretroviral drugs and their benefit in advanced stages of the disease, and commits to providing post-exposure prophylaxis (PEP) for rape survivors in public health facilities, with immediate effect. It also promised to roll out the prevention of mother-to-child transmission (MTCT) programme, targeting universal availability of nevirapine in all public facilities by the end of 2002.
WHO urging countries to switch to ACT on Africa Malaria Day. WHO went on record urging countries where traditional antimalarials no longer work to switch to the more effective artemisinin-based combination therapy (ACT). MSF welcomed this new policy as the beginning of the battle to improve malaria treatment, and called on WHO to build on it by clarifying how it plans to support rapid introduction of ACT. The focus switched to the governments of endemic countries, who will need to show strong political will by increasing their funding for malaria, and solicit additional financial support from donor countries as necessary. NB: ACTs are still 10 to 20 times more expensive than currently used antimalarials. The only fixed dose combination with an artemisinin derivative is CoartemÃ?® (Novartis) which, even at the reduced public price, costs US$2.40 per adult dose.
New hope for malaria patients in Burundi. In response to increasing resistance to the classical antimalarial sulphadoxine-pyrimethamine (SP), the Burundi Ministry of Health and WHO published excellent preliminary results of efficacy studies for two artemisinin-based combination therapies (ACT): artesunate amodiaquine and artemether-lumefantrine (Coartem), resulting in clear recommendations in favour of a change of protocol using artesunate amodiaquine as first-line treatment and in the case of malaria epidemics. Quinine is still to be used as second line treatment and for the management of severe malaria cases. The new protocol should be implemented country-wide by July 2003.