MSF Accessmed : Press releases

MSF statement at the close of UN health R&D summit

Sat, 03 May 2008 17:26:00 +0200

A UN health research and development (R&D) summit concluded in Geneva on May 4th 2008 has failed to...

Two-Year Process to Overhaul Health R&D System Reaches Critical Stage at UN Summit

Mon, 28 Apr 2008 16:34:00 +0200

28 April 2008 Geneva – This week, more than 150 countries at a UN health R&D summit in Geneva have...

Food Aid Basket Missing Critical Ingredients

Wed, 23 Apr 2008 15:22:00 +0200

MSF response to The Lancet series on malnutrition

Thu, 17 Jan 2008 16:58:00 +0100

London, 16 January 2008 – A series on maternal and child undernutrition in the medical journal, The...

People in Southeast Asia needlessly becoming blind due to a neglected virus

Sat, 01 Dec 2007 14:34:00 +0100

Geneva/Bangkok 1st December 2007 – Failure to diagnose and treat cytomegalovirus retinitis (CMV) in people with AIDS is leading to unnecessary blindness, according to a paper published today in the journal PLoS Medicine. The authors found in pilot studies that CMV retinitis, which has been dramatically reduced in wealthy countries since the advent of antiretroviral therapy, occurred in 23, 27 and 32% of patients with advanced AIDS in Cambodia, Myanmar and Thailand respectively. By training clinicians to screen and taking steps to make the best treatment affordable, the authors argue that CMV diagnosis and treatment can easily be integrated into existing AIDS treatment programmes.

“We can diagnose CMV retinitis fairly easily and reliably in less than two minutes, and there is an effective, practical treatment,” said one of the authors, Dr. David Wilson, former MSF Medical Coordinator, Thailand. “Instead of addressing the problem, it’s like the world is pretending the death and the blindness CMV causes are not happening, or worse, we’re just accepting them.”

Detecting and treating CMV retinitis early enough would stop the slow but relentless progress of a disease that leads to blindness within three to six months in patients whose immune systems are severely weakened with HIV. But because there are often no symptoms in the early stage of the disease, CMV can only be diagnosed through systematic screening of all at-risk patients.

“Routine retinal examination of high-risk HIV patients in Myanmar has allowed us to save patients from CMV-related blindness,” said Dr. Kalpana Sabapathy, HIV/AIDS advisor at MSF, citing recent studies in the Myanmar programme by an ophthalmologist and CMV specialist from SEVA Foundation, Dr. David Heiden.

But in many countries the best treatment option, oral valganciclovir, costs more than US$ 10,000 for a four-month treatment course. An alternative treatment using intravenous ganciclovir is cumbersome, requiring infusions twice a day for two or three weeks, and then daily infusions for another two or three months. A third method to treat CMV retinitis, with intraocular injections of ganciclovir - doctors have to repeatedly jab patients in one or both eyes - is all the more unsatisfactory. This invasive technique requires special training and does nothing to treat potentially fatal forms of CMV that occur outside the eye.

Integration of CMV retinitis into HIV programmes is therefore feasible, but dependent on systematic screening of at-risk patients and securing access to affordable oral valganciclovir, the authors argue. Until then, CMV retinitis will continue to be the neglected disease of the AIDS epidemic.

“This is a classic case of the vicious circle,” said Dr. Tido von Schoen-Angerer, Director of Médecins Sans Frontières’ Campaign for Access to Essential Medicines. “Because the price of the drug is so high, HIV programmes aren’t screening and therefore are not reporting large numbers of CMV patients. But since on paper there are so few patients, bringing down the price of this treatment and ensuring its availability has never been a priority.”

CMV retinitis is not mentioned in the current and pending WHO guidelines for HIV treatment in resource-poor settings.

While there has been some progress on the accessibility of valganciclovir, it remains limited. NGOs have been proposed a discounted price from Roche of € 1,281 (US$ 1,899) for a four-month course of therapy but this offer remains expensive and excludes many countries where the CMV retinitis problem is most acute.

This has forced difficult compromises. In Thailand, along with local partners, MSF has decided to use the sub-optimal intravenous formulation of ganciclovir as well as intraocular injections. In China, MSF pays the full price for oral valganciclovir, which is € 6,930 (US$ 10,273). This is higher than the price of a Chinese economy car.

There is an urgent need for Roche to both extend their discounted prices to all developing countries and to lower this price further. Current prices in China and Thailand mimic wealthy country prices where the drug is almost exclusively used to prevent CMV for patients undergoing organ transplants. Roche is targeting a small but lucrative market, and protecting its position through patents, including in India, a significant source of generic drugs for developing countries.

The PLoS paper was authored by an international team of eye doctors and HIV specialists and is based the clinical experience from Médecins Sans Frontières and other programmes assessed by the lead author, Dr. David Heiden, a consultant from SEVA Foundation, based at the California Pacific Medical Center, San Francisco. The article Cytomegalovirus Retinitis: The Neglected Disease of the AIDS Pandemic is freely available from the open access journal PLoS Medicine at: medicine.plosjournals.org/perlserv/

UN health talks could lead to new ways of developing urgently needed drugs and diagnostics

Wed, 07 Nov 2007 12:09:00 +0100

Geneva- 5th November 2007 – Health talks opening today in Geneva have the potential to change the way medical research is conducted and ensure that urgently needed products are developed and made accessible, the international medical humanitarian organisation Médecins Sans Frontières (MSF) and Knowledge Ecology International said today.

Representatives from Ministries of Health are gathering today for the second round of negotiations of the Intergovernmental Working Group for Public Health, Innovation and Intellectual Property (IGWG). They are charged with coming up with a plan of action to ensure new medical products are developed, and existing ones are made affordable.

“The R&D system is broken. It is not delivering,” said Dr. Tido von Schoen-Angerer, Director of MSF’s Access to Essential Medicines Campaign. “Take tuberculosis, for example; because tests are either antiquated or too high-tech, we don’t have any practical tool to diagnose TB in people with HIV, who are precisely the ones most at risk of dying. And because drugs to treat resistant strains of TB are too weak, up to 20% of HIV uninfected and two-thirds of HIV infected patients with multidrug- resistant TB die during treatment.”

Governments at the World Health Organization in 2006 created the IGWG following the release of a WHO report that said that intellectual property is not a significant factor in contributing to innovation for diseases that disproportionately affect developing countries. Similarly, a Lancet study concluded that only 1% of the 1,556 drugs developed in the last twenty-five years targeted neglected diseases and tuberculosis, although these diseases account for over 10% of the disease burden.

The IGWG represents the first chance for countries to begin building a system for medical innovation and access to medicines that prioritises such diseases, develops needed health tools, and makes them affordable.

“This is an unprecedented opportunity to change the paradigm. The IGWG has been asked to de-link the cost of R&D from the price of medicines. This is enormously important," said James Love, Director of Knowledge Ecology International (KEI). "We need new mechanisms and institutional responses to move toward a paradigm of innovation plus access, rather than a set of poorly functioning trade-offs. The big ideas in the negotiation are patent pools, prizes and a treaty on medical R&D. They are also the most controversial."

Today’s model, where the cost of researching and developing medicines is paid for through drug prices, means that drug development is steered towards areas where the profit rewards are the greatest, so diseases which predominantly affect developing countries are neglected. At the same time, patents are used to sustain artificially high prices for medicines, so many in need are quite simply priced out of the market.

The UN talks risk being derailed by opposition from some governments. Although this meeting is based on a World Health Assembly Resolution which puts intellectual property on the agenda, the USA and the European Union countries are questioning an expanded role for the World Health Organization regarding intellectual property and health. Some governments are also trying to narrow the scope of the meeting to a restricted number of diseases, whereas developing countries seek comprehensive solutions.

“As a medical organisation we need medical innovation to happen. But we also need to ensure that new and existing medicines are made affordable for all those that need them,” said Michel Lotrowska, Campaigner with MSF. “Innovation is meaningless if newly developed products remain out of reach.”

MSF and TB experts call for new approach to test TB drugs

Tue, 06 Nov 2007 14:09:00 +0100

Geneva, 6th November 2207 - Drug developers can speed up the development of urgently needed new tuberculosis drugs by adopting a different strategy, the medical humanitarian organisation Médecins Sans Frontières (MSF) joins international experts in stating today. According to a report published today in the open-source medical journal PLoS Medicine, mimicking the approach used to test AIDS drugs would accelerate the research process, and get drugs to patients who most need them faster.

The authors call for testing new TB drugs in patients whose TB is resistant to standard treatment, making it easier to detect the anti-TB activity of new drugs. This strategy, adopted with success during the AIDS pandemic in the 1990s, means that clinical trials could be done quicker and in fewer patients, and ultimately newer and better drugs could be developed faster.

“This is quite simply the best hope we have of getting improved medicines to patients with multidrug-resistant TB faster,” said Dr. Eric Goemaere, Head of Mission, MSF South Africa. “We cannot afford to wait. MDR-TB is spreading rapidly, particularly in areas like South Africa where HIV is high. And with the current drugs, many patients on MDR-TB treatment give up half-way and the majority of patients co-infected with HIV will die before the end of treatment.”

The important long-term goal is to develop a complete new treatment that works for both drug resistant and drug-susceptible TB. But until this is achieved, which will take over a decade, the urgency is to improve treatment of drug-resistant TB.

Globally there are almost five hundred thousand new cases of multidrug-resistant TB every year. The current treatment relies on weak drugs with harsh side effects and lasts up to two years. Even in the best treatment conditions, some patients develop extensively drug-resistant TB (XDR) simply because the drugs are so ineffective.

“There is an imperative to speed up TB drug development and one way to do this is through innovative trials,” said Dr. Carole Mitnick, Harvard Medical School. “All new, promising compounds should be tested in patients with drug-resistant and drug-susceptible TB to accelerate access to improved treatments for those in need now. In light of recent improvements in the TB drug pipeline and growing evidence about the magnitude of the MDR problem, it is frustrating that this approach to improving treatment outcomes for all TB patients has not been widely adopted.”

Introducing a different strategy and testing new drugs in drug-resistant patients would not compete with trials in drug-susceptible patients as they could be done in parallel. Countries with high burden of TB need to actively support the set up of these trials to address the TB crisis. In addition, the overall number of compounds that are in the pharmaceutical pipeline needs to be increased dramatically.

“I don’t understand why this is not taken up by all drug developers,” said Dr. Tido von Schoen-Angerer, director of MSF’s Access to Essential Medicines Campaign. “On the one hand we have world-renowned experts and leading regulatory authorities such as the US FDA advising that clinical studies in multidrug-resistant patients would hasten the approval of new drugs, and on the other hand we have key funders such as the Gates Foundation, sticking to a one track traditional approach. Funders and drug developers need to respond to this challenge.”

The article “Randomized trials to optimize treatment of multi-drug resistant TB” appears in the current issue of PLoS Medicine and was authored by Carole D. Mitnick (Harvard Medical School), Kenneth G. Castro (Division of TB Elimination, US Centers for Disease Prevention and Control), Mark Harrington (Treatment Action Group) Leonard Sacks (US Food and Drug Administration), and William Burman (Denver Public Health and the University of Colorado Health Sciences Center). PloS can be accessed at: www.plosmedicine.org.

MSF Warns More Food will not save malnourished children

Wed, 10 Oct 2007 15:52:00 +0200

The international medical humanitarian organisation Médecins Sans Frontières (MSF) today called for increased and expanded use of nutrient dense ready-to-use food (RUF) to reduce the five million annual deaths worldwide related to malnutrition in children under five. Current food aid, which focuses on fighting hunger, not treating malnutrition, is not doing enough to address the needs of young children most at risk, MSF warned.

“It’s not only about how much food children get, it’s what’s in the food that counts,” said Dr. Christophe Fournier, President of MSF’s International Council. “Without the right amounts of vitamins and essential nutrients in their diet, young kids become vulnerable to disease that they would normally be able to fight off easily. Calls for increased food aid ignore the special needs of young children who are at the greatest risk of dying.”

RUF, which come in individually wrapped rations, contain all the necessary nutrients, vitamins, and minerals that a young child needs. This dense therapeutic food which has milk powder, sugars and vegetable fats can be produced and stored locally and transported easily even in hot climates. It allows a child to recover from being malnourished and catch up on lost growth. Being easy-to-use, mothers—not doctors and nurses—are the main caregivers, meaning far more children at risk can be reached.

“In Somalia we are giving acutely malnourished kids packets of ready-to-use food and we see them gain weight and begin thriving within a couple of weeks,” said Dr Gustavo Fernandez, MSF Head of Mission in Somalia. “RUFs are practical to use in places like Somalia where security is very bad. General food distribution is also needed, but it is not going to be very effective to treat kids under three years old.”

Severe acute malnutrition in early childhood is common in large areas of the Horn of Africa, the Sahel, and South Asia -- the world’s “malnutrition hotspots.” The World Health Organization (WHO) estimates that there are 20 million young children suffering from severe acute malnutrition at any given moment and MSF estimates that only three percent of these will receive RUF in 2007.

Therapeutic RUF for only severely malnourished children, as current WHO, World Food Programme, and UNICEF guidelines recommend, is too restrictive. Given its nutritional benefits, RUF has the potential to address malnutrition at earlier stages and is far more effective than fortified blended flour, which is normally distributed. MSF is piloting a programme using a modified RUF as a supplement to prevent children from becoming acutely malnourished.

“Instead of waiting for kids to get gravely ill we decided to act earlier,” said Dr. Susan Shepherd, MSF Medical Coordinator, Maradi, Niger. “We are piloting a programme that gives RUF to all children under three in at risk communities so that they get the nutrients that are missing in their normal diet.”

Through this early treatment or prevention approach in Niger, MSF is providing mothers with small containers of RUF as a supplement to their normal diet. Early results from this ongoing project, which is reaching more than 62,000 children, indicate that RUF is significantly more effective than the traditional approach of supplying fortified flours and cooking oil to mothers of young children.

MSF is calling for donors and UN agencies to urgently speed up the introduction and expand the use of RUF. This is going to take a new allocation of funds to cover the cost of €750 million to reach the most vulnerable. But it will also take a realigning of food aid strategies with existing and newly developed products that have the nutrition needed to cure malnourished children.

MSF has been treating malnutrition with therapeutic RUF since the first products became available in the late 1990s, and in 2006 treated more than 150,000 children with acute malnutrition in 22 countries.

After Indian court ruling, MSF hands over petition with 420,000 signatures to Novartis

Wed, 08 Aug 2007 09:41:00 +0200

Basel, 8 August 2007 - The international medical humanitarian organisation Médecins Sans Frontières (MSF) delivered a petition with over 420,000 names to Novartis corporate headquarters in Basel today. Novartis lost a legal challenge against India’s patent law on Monday.

“Monday’s court decision in India is critical for us as doctors, who now feel confident that we will be able to continue to rely on India as a source of affordable medicines for our patients,” said Dr. Christophe Fournier, International President of MSF. “We are pleased to hear that Novartis does not intend to appeal this decision. And we call on the company to refrain from pushing for a challenge of the Indian Patents Act at the World Trade Organization or otherwise.”

Novartis challenged a provision in India’s Patents Act that makes it more difficult for companies to receive patents on changes to existing drugs or combinations of drugs, claiming that this was not compliant with WTO rules and with the Indian constitution. The court rejected all of Novartis’s claims. If the company had won, drug patents would have likely been granted far more widely in India, restricting generic competition.

“We would like to express sincere gratitude to everyone who contributed to the global mobilization against Novartis’s legal challenge in India,” said Dr. Fournier. “Hundreds of thousands of people on six continents made this happen and were a part of helping maintain India’s role as pharmacy of the developing world.”

Developing countries and international agencies like UNICEF and the Clinton Foundation rely heavily on importing affordable drugs from India, and 84% of the AIDS drugs MSF prescribes to its patients worldwide come from Indian generic companies.

“Novartis has expressed concern that this ruling will have a negative impact on innovation,” said Pere-Joan Pons, Campaigner with MSF in Switzerland. “But the reality is that stronger patent regimes have not lead to the development of drugs and medical tools desperately needed by people in poor countries.”

A World Health Organization report released in April 2006 found that increased intellectual property protection in developing countries had not led to higher levels of research and development (R&D) for diseases that primarily affect the developing world. It is crucial that there is support for international discussions on new ways to foster R&D that responds to health needs and at the same time ensures that medical innovations are affordable.

“We hope that the ruling upholding India’s patent law sets a precedent, and that other countries decide to enact rules that increase both access to needed medicines and the development of new treatments so desperately needed in the developing world,” said Pons.

Indian court ruling in Novartis case protects India as the 'Pharmacy of the Developing World'

Mon, 06 Aug 2007 09:47:00 +0200

New Delhi/Geneva, August 6, 2007 – The landmark decision by the High Court in Chennai to uphold India's Patents Act in the face of the challenge by Swiss pharmaceutical company Novartis is a major victory for patients' access to affordable medicines in developing countries, the international medical humanitarian organization Doctors Without Borders/Médecins Sans Frontières (MSF) stated today.

"This is a huge relief for millions of patients and doctors in developing countries who depend on affordable medicines from India," said Dr. Tido von Schoen-Angerer, Director of the MSF Campaign for Access to Essential Medicines. "The Court's decision now makes Indian patents on the medicines that we desperately need less likely. We call upon multinational drug companies and wealthy countries to leave the Indian Patents Act alone and stop pushing for ever stricter patent regimes in developing countries."

Novartis took the Indian government to court over its 2005 Patents Act because it wanted a more extensive granting of patent protection for its products than offered by the law. Novartis claimed that India's Patents Act did not meet rules set down by the World Trade Organization and was in violation of the Indian constitution. Apparently all of Novartis's claims have been rejected by the High Court today.

India only began giving patents on medicines to comply with WTO rules, but it designed its law with safeguards so that patents can only be granted for real innovations. This means that companies seeking a patent for modifications to a molecule already invented, in order to extend ever further their monopolies on existing drugs, would be unsuccessful in India. It is this aspect of the law that Novartis was seeking to have removed. A ruling in favor of the company would have drastically restricted the production of affordable medicines in India that are crucial for the treatment of diseases throughout the developing world.

Developing country governments and international agencies like UNICEF and the Clinton Foundation rely heavily on importing affordable drugs from India, and 84% of the antiretrovirals that MSF prescribes to its patients worldwide come from Indian generic companies. India must be allowed to remain the 'pharmacy of the developing world.'

Nearly half a million people worldwide voiced their concern about the impact Novartis's case could have on access to medicines in the developing world. Among them were the Indian Health Minister Anbumani Ramadoss, Archbishop Desmond Tutu, Global Fund Director Michel Kazatchkine, members from the European Parliament and the US Congress, former Swiss President Ruth Dreifuss, former UN Special Envoy for AIDS in Africa Stephen Lewis, German Development Minister Heidemarie Wieczorek-Zeul, Norwegian Development Minister Erik Solheim, as well as authors John Le Carré and Naomi Klein. An MSF petition urging Novartis to drop the case gathered over 420,000 signatures.