Saving lives through Doha: A medical humanitarian perspective
In our final blog to mark the 20th anniversary of the signing of the Doha Declaration, we asked Dr. Bernard Pecoul, then head of MSF’s Access Campaign in 2001, to reflect on MSF’s role in the process, and the impact of the Doha Declaration on MSF’s medical humanitarian work. As well, with his current hat on as Executive Director of the Drugs for Neglected Diseases initiative (DNDi), we asked him to reflect on how the twin challenges of access and innovation can be best met today.
Bernard, why was MSF, a medical humanitarian organisation, involved in discussions over international trade?
The trigger was the devastation we were seeing on the ground, caused by the AIDS pandemic. People in developing countries and in our projects were dying because they could not access affordable antiretrovirals. But this wasn’t the sole challenge we faced on the availability of medicines for people in our care. That’s why we had just set up the Access Campaign and together we made an assessment of what is influencing the price of drugs on one hand, and the lack of innovation for new medicines to meet the needs of people that MSF serves on the other. That’s when I started to discover the TRIPS Agreement and how intellectual property could impact on the price and availability of medicines.
The Campaign called its first public meeting where we spent a day talking about nothing but compulsory licensing. Carlos Correa, the leading legal mind on these matters, was there alongside many others, including trade policy negotiators and also people whose lives were directly affected, people living with HIV/AIDS and other patient groups.
What I understood from that meeting was that the TRIPS Agreement was a direct threat to our ability to carry out our medical work. My understanding, as a doctor, was that, without being able to exercise flexibility in the trade rules as set down in the TRIPS Agreement, we would be facing these kinds of obstacles to accessing affordable medicines again and again in our work. For HIV first — because HIV was the driver — but the same story would be repeated for many other diseases in our field of activity. And something had to be done.
How did things evolve from that first meeting called by the Access Campaign?
We continued, alongside others, to investigate how we could work to mitigate the impact of the TRIPS Agreement so that we in MSF and others could access affordable medicines. I did not lead the final MSF delegation to WTO meeting in Doha where the declaration was finally signed — that fell to Ellen ‘t Hoen, with her formidable legal experience and intellect.
We built a strong movement together. Civil society was very important and in particular the powerful testimonies of people affected by HIV/AIDS.
There was opposition of course to the creation of the Declaration, coordinated by pharma, but the opposition also was orchestrated a little bit by some of the UN agencies that began to enter into negotiations on the side with drug companies, some donations here, some price drops there. This was frustrating because it wasn’t the sort of fundamental changes we wanted to see that gave power to governments to decide for the health of their populations, a rebalancing of the power between public and private interests.
What happened at Doha and why was it important?
It was a victory. The political message it sent out was that governments should have the power to decide on issues affecting the health of their populations, and not pharmaceutical companies.
On the ground, after 2001 we were able to move from very limited access to treatment for people living with HIV, to something much bigger. While we cannot directly link the impact of Doha to this success in scaling up treatment for people living with HIV because there were other factors too, such as the creation of the Global Fund and PEPFAR, the Doha Declaration undoubtably contributed to this change of dynamic.
In the years that followed, many peoples’ lives were saved through the use of the TRIPS flexibilities set out in the declaration. I’m thinking for example of how the Malaysian government issued a compulsory licence on the hepatitis C drug, sofosbuvir, some 15 years after Doha, in order to make treatment for people with hepatitis C more affordable. The originator drug was priced by the drug company Gilead at US$14,000 for a 12-week treatment course.
And I would say also that there was a powerful impact in terms of the creation of the Medicines Patent Pool (MPP). The MPP rests on the purely voluntary licensing of medicines by pharmaceutical companies — but with the real threat of compulsory licensing on their products hanging over them as a result of Doha, many companies have chosen to sign up for a voluntary licence arrangement with the MPP — as the ‘lesser of two evils’ in their view. Many more lives have been saved through the more affordable medicines made available as a result of the MPP.
What about Doha’s legacy today? We face another global health crisis, and another global movement for change at the WTO around the TRIPS Agreement — the TRIPS IP Waiver campaign.
I think the big difference is that although the Doha Declaration was a battle that took place over two years, the WTO did finally achieve a concrete result with the Declaration that was able to improve the situation. Today, up to this point at least, even faced by another huge crisis, the role and the achievement of the WTO has been nothing or very little.
Why do you think that is the case — why have we seen so little progress in the face of this global pandemic?
As I see it, the WTO is less powerful today than it was 20 years ago. I think the WTO has less and less power. They set up the rules of the game, they monitor the rules of the game, but they’re not the same influencing power as the WTO of 2001.
We are again in the same situation that we were 20 years ago, where the power of a few drug companies compared with the power of a community of countries was totally unbalanced. But things have got much worse now. In my view, we now have a few large companies that are totally driving the policy, not just of the US, but of the whole world.
We’re operating in a very different geopolitical environment now. Do not forget that 20 years ago, we were in a period where we were expecting that we will have a new management of the world, after the end of the Cold War. We thought that multilateralism, and international organisations, could manage the affairs of the world. But in 2021, this is not the case. Particularly, there is a big battle between the US and China.
Do you think the proposed waiver to deal with this pandemic is irrelevant? Outdated even?
No, I have always supported this waiver initiative, but I’m also convinced that this should be part of a multiple strategy. Not to put all the eggs in one basket.
Today, we are not making so much progress because there is a lot of energy being spent on trying to get the waiver, and meanwhile, the other options are not getting the attention they deserve. Voluntary measures such as the MPP are only part of the solution. The transfer of technology — it’s all been long delayed. And then the price negotiations — that is another tactic that has not been very well-conducted by a lack of coordination. You need to employ a full set of tools in this kind of situation. And you need to move faster.
Do you think the waiver could be a catalyst for more radical transformation?
At the beginning of the crisis, I was expecting that COVID-19 could provide the opportunity for a big change. But almost 20 months later, nothing fundamental has happened. In any case, the waiver is presented only as a way to respond to a crisis for a short-term period. So, yes, while the waiver could be extremely useful, we could argue the need for a more systematic change — and by the way, the Doha Declaration was much more systematic, because it could be implemented in a variety of crises and was not pinned on just the one crisis.
It’s a fairly bleak assessment of the options before us, how would you now, as head of DNDi, like to see us move forward to address both the immediate crisis of the pandemic and the longer-term challenges of access and innovation?
DNDi never claims it has the solutions. It doesn’t. But we are trying to develop a different model of collaboration in the development of new treatments — along the principle of creating a ‘public good’.
This is something that we really need to revisit. Fifty years ago, when Salk and Sabin discovered the polio vaccine, it was obvious for them that the vaccine was a ‘public good’. They received financial support from the government, and they had been able to attract pharmaceutical companies to produce the polio vaccine. They did not patent the vaccine.
We are only talking a few decades back, so we are not talking about the Middle Ages! So I think it is still possible to dream or think about going back to this sort of objective, in the ways we respond to a public health crisis.
Today, we have been approached by several academic and biotech companies to set up an open source model for a new response to the situation we find ourselves in. This could be for COVID-19, or it could be for the next public health crisis. There is a perception that DNDi is able to manage innovation differently. I’d like to be optimistic about the way forward.
This is the final blog in our mini-series about Doha@20. If you’ve enjoyed it and would like to stay in touch with our work, sign up here on Medium.