April 30, 2008

My name is Dr. Tido von Schoen-Angerer and I am speaking on behalf of Médecins Sans Frontières. Thank you for the opportunity to address this important gathering.

In 2000, I was working in one of MSF’s AIDS projects. Our response to the pandemic was one based on a simple medical decision: faced with the urgency of patients dying, the only acceptable response was to treat. This was an ethical imperative, to treat, regardless of the difficulties.

A treatment that then cost over ten thousand dollars for each patient for one year has now plummeted to under one hundred dollars. This 99% drop – which opened up the possibility of life-saving treatment to millions – happened only thanks to competition between manufacturers, which put an end to monopolies.

But we cannot hope for this to happen again for newer drugs in the future. With TRIPS implementation causing the source of generic medicines to dry up, governments now have to resort to deliberate, complex strategies to keep the price of medicines down.

These strategies are a source of conflict, both between governments, and between governments and drug developers. That such conflicts have multiplied in recent years across the globe, from South Africa to Brazil to Thailand, shows that something is wrong.

I have also seen time and again incontestable evidence of a second failure of the medical research and development system: that it fails to respond to diseases that affect people in developing countries. Tuberculosis provides a perfect example for this.

Treating standard TB was difficult already: the most common test to detect TB misses more patients than it actually detects, and the treatment regimen is lengthy and cumbersome.

What was a difficult disease to treat then, has now become a public health emergency through the effect of the HIV pandemic, and the spread of resistant strains.

The problem lies squarely with the lack of tools at our disposal: no simple, rapid test to better detect TB in field clinics; second-line drugs that must be taken for up to 24 months and that cause the most terrible side effects; and practically no treatment options at all for XDR-TB.

The current R&D system has the wrong priorities: it is unable to respond to the health needs of millions of people across the developing world. The scale of the problem is so immense, that putting all our faith in philanthropic organisations alone would be foolish. The likelihood of having a novel TB regimen with at least two new drugs by 2015 is less than 1%.

What we need from you, governments here at the IGWG, is to address these fundamental problems with both medical R&D and access to the products of innovation. You are tasked with changing the current situation and you need to have the courage to do so. This is, and must remain, a government-led process.

I understand that rich countries objected to an R&D fund without putting alternatives on the table. The IGWG is a historic opportunity and this should not become an historic failure for lack of response.

Governments, and the WHO, must not abdicate from their responsibilities, or pass the buck to others. We are asking you to strengthen WHO role in intellectual property and health, to change the way R&D is prioritised and financed so that paying for the research does not equal prohibitive prices, and to take measures to increase generic competition.

We are asking you, then, to rise to the challenge and change the rules to ensure access and innovation. Because we need both.

Thank you.