A laboratory technician carries out analyses for tuberculosis on a microscope for patients at the general referral hospital of Mweso, North-Kivu. DRC, 2023. © Laora Vigourt/MSF

Equitable access to lifesaving medical products must be prioritized

MSF calls on negotiators of WHO’s pandemic agreement to establish legally binding norms to ensure just and equitable response to global public health emergencies

Ahead of 7th meeting of the Intergovernmental Negotiating Body (INB) for the World Health Organization’s (WHO) agreement on pandemic prevention, preparedness and response (PPR), Doctors Without Borders/Médecins Sans Frontières (MSF) urged all countries to guarantee that the principles of equity, solidarity, transparency, inclusivity and accountability are at the centre of all future PPR negotiations and decisions. Leaders must move beyond treating PPR as merely a health security issue and focus on creating binding norms for establishing coordinated international stockpiles, and for overcoming intellectual property (IP) barriers to facilitate more independent, globally distributed production and supplies, particularly in and for developing countries. Only this will ensure equitable access to quality, affordable medicines, vaccines and diagnostics for people everywhere.

“The world witnessed glaring inequity during the COVID pandemic, with wealthy nations hoarding the scarce supply of COVID vaccines, therapeutics and other medical tools for their own use,” said Dr. Christos Christou, International President of MSF. “Well-coordinated global strategic stockpiling remains crucial to ensuring equitable allocation of lifesaving medical tools, especially for people in resource-limited areas and humanitarian crisis in all developing countries. Relying on voluntary partnerships is not enough, so binding rules need to be established that can guarantee a reliable supply of global strategic stockpiles in advance for people in future pandemics, while at the same time ensuring that immediate needs can be met when there are regional outbreaks, such as Ebola and diphtheria. Leaders must not forget that success in overcoming future pandemics hinges on global solidarity, transparency and accountability and not on reserving supplies exclusively for their own national security purposes.”

During the pandemic, access to COVID vaccines and treatments for people in humanitarian crisis was considered an afterthought. Eventually, when attempts at setting aside specific quantities of COVID vaccines for humanitarian contexts were made through the establishment of the COVAX Humanitarian Buffer, MSF’s experience with this instrument made clear that it was not fit for the purpose of providing rapid supply in an emergency situation. MSF continues to face similar disparities, for example with Ebola, where almost the entire supply of two recently approved treatments has been reserved by the US government for national security purposes. This has left people in countries in West Africa, among the most susceptible to future outbreaks, in an unacceptable situation in which they must rely on ad hoc donations and the goodwill of other governments.

Countries negotiating the PPR agreement must explicitly include people living in humanitarian contexts as part of the definition of vulnerable populations in the latest INB text. Exclusion of people in humanitarian crisis* may lead to further marginalisation of their health needs during the establishment and management of global stockpiles and allocation. Additionally, negotiations on the PPR agreement should stop overly focusing on emergencies in the future, while ignoring how to best address regional and present epidemics affecting countries with limited resources — such as measles or the re-emerging infectious disease diphtheria — which is currently raging in West Africa because of a significant global shortage of the diphtheria antitoxin treatment (DAT).

Time and again, equitable access to lifesaving medical products has been obstructed by IP monopolies which delay, limit or altogether prohibit additional independent suppliers from making available medical products, restrict the geographic scope of production, and foster high prices. While the most recent INB negotiation text highlights the need for time-bound IP waivers and the use of public health safeguards, the overall approach still excessively relies on voluntary mechanisms and “mutually agreed terms” with the private sector to pursue more diversified production, transfer of technology and know-how, that were ineffective during the COVID-19 pandemic.

“Over the span of 50 years, our struggle to treat people affected with infectious diseases such as HIV/AIDS, tuberculosis, hepatitis C, Ebola, and more recently, COVID, has often been exacerbated by the limited access to essential medicines, vaccines, and diagnostics caused by high prices or because needed medical tools simply don’t exist or are unavailable in lower-resource and humanitarian settings,” said Yuanqiong Hu, Senior Legal and Policy Advisor for MSF’s Access Campaign.

“Leaders now have a unique opportunity to establish new international norms of equity for pandemic preparedness, prevention and response by prioritising people’s right to health over commercial monopolies. It is critical to address intellectual property barriers and ensure technology transfer that will allow increased production and supply of essential medical tools within and from developing countries. Medicines and medical tools shouldn’t be a luxury for anyone, anywhere.”

To achieve more just and equitable access to medical tools in future pandemics, governments need to proactively demand technology transfer to facilitate diverse and independent production capabilities and ensure supply of essential medical products in and for developing countries. Every government should also use all legal and policy options, public health safeguards and flexibilities, including compulsory licenses, in order to facilitate rapid production, supply, export and import of lifesaving medical tools for all people.

*As recognized in UNSC resolution 2565 (2021), pandemics can exacerbate the negative humanitarian impact of armed conflicts and exacerbate inequalities.