"That’s really what this work is about—the patients. But even our most dedicated, skilled field workers can only do so much if they don’t have the right tools—the diagnostics, the medications, the vaccines—for the environments in which we work."

Dr. Deane MarchbeinPresident, MSF-USA
September 23, 2015

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My first mission was in Ivory Coast. My boss was a 28-year-old French nurse who was serving as project coordinator, hospital manager, and medical coordinator, all at the same time. Her quiet, gentle manner belied a steely resolve. She knew every employee and many patients by name. Above all else, she was pragmatic, always seeking to do what was best for our patients, who were caught in a civil war.

I’ve always remembered her practical, patient-centered approach, because that’s really what this work is about—the patients. But even our most dedicated, skilled field workers can only do so much if they don’t have the right tools—the diagnostics, the medications, the vaccines—for the environments in which we work.

MSF’s Access Campaign was founded to prod others to develop or provide these essential medical tools and to make sure they work in remote locations with few resources. The work the Access Campaign does is directly tied to our field experience and has profound consequences for the people with whom we work. It brings much-needed attention to pricing, policies, the research and development system, and other crucial elements of the process by which medicines and medical tools make it to the field—or don’t, as the case may be.

And that’s what this issue of Alert is about, the cost of medicine,and the processes that drive the development of some medicines over others. Our special report consists of four interrelated sections, three of which highlight a different challenge our field teams face, while the fourth looks at the root causes of the dynamics at play. The first, focused on the $1,000-per-pill price tag of a new hepatitis C treatment, covers medications that are unaffordable because of how and why they’ve been developed and marketed. The second shows what happens when too many vaccines are unadapted to the settings in which we work (and, in some cases, unaffordable as well). The third looks at how the Ebola outbreak showed the frustrations of trying to respond to a crisis where good treatment options are unavailable. And then,to bring it all together, we look at the prevailing research and development system, which neglects huge swathes of people and leaves them vulnerable to health issues and diseases for which they should have better options.

My boss back on my first mission could make decisions at the field level that improved the picture for patients, but other things were far beyond her control, like the funding and incentive mechanisms for research and development,and the lack of attention paid to neglected diseases that primarily affect poorer patients. That’s why we think it’s so important to highlight the work that the Access Campaign is doing and to understand the issues we are raising here.

And as we talk about innovation, pragmatism, and effectiveness, we dedicate this issue of Alert to Jacques Pinel, a longtime MSF staffer who recently passed away. In his distinguished career with MSF, Jacques helped develop some of the most innovative and effective tools our field teams have, kits and protocols still in use that demonstrate the spirit, ingenuity, and attention to the needs of patients to which we all aspire. You will be missed, Jacques, but your impact will be felt every day in MSF projects—and by patients—around the world.

—Deane Marchbein, President, MSF-USA

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