November 21, 2012
MSF International President, Dr. Unni Karunakara, in his keynote speech at the 2012 Universities Allied for Essential Medicines conference:
Good evening and thank you very much for welcoming me here tonight. I’d particularly like to thank Rachel Kiddell-Monroe and Bryan Collinsworth for the invitation.
It’s incredibly inspiring to look out and see a room full of students who choose to spend their spare time advocating on behalf of millions of people who lack access to lifesaving medicines. So thank you all for being here today, and for choosing to engage with UAEM, an organization whose work Médecins Sans Frontières—MSF—admires and supports.
Our two organizations have an important history together. In 2001, university students and MSF combined forces to lead a pivotal and successful campaign to pressure Yale University to adhere to its own patent licensing policy in relation to an important AIDS drug—a policy designed to ensure that its research benefited society in general.
That victory was a watershed moment in the fight against the AIDS epidemic in developing countries. It ultimately led Yale and its licensee, Bristol-Myers Squibb, to permit price-busting generic production of the AIDS drug. This, in turn, led other multinational pharmaceutical firms to make similar groundbreaking concessions.
That campaign gave rise to UAEM, the vibrant organization that you are a part of today.
If at times it may be difficult to see a tangible connection between the kind of work you do on your university campuses and the medical needs of patients on the ground in developing countries, you need only remember the story of Yale and Bristol-Myers Squibb bending to student activist and civil society pressure. The story that triggered massive price reductions in AIDS drugs, helping to bring them to 8 million people today.
Tonight I hope to further illustrate how vitally important your work with UAEM is to our patients.
As a medical humanitarian organization, MSF aims to deliver the best medical care possible to people whose very survival is threatened by armed conflict, epidemics, neglect, exclusion from health care, natural catastrophes, and man-made disasters.
Today, more than 30,000 MSFers—including doctors, nurses, logisticians, and support staff—work to assist populations in distress in more than 60 countries across the world.
But our teams are often hindered in delivering optimal—or even adequate—medical care. MSFers in the field grapple every day with the fact that the drugs, diagnostics, and vaccines needed to treat our patients are unavailable, unsuitable, or unaffordable.
When treating sleeping sickness in the Republic of Congo, I saw firsthand the hardships our patients have to endure. Without treatment, sleeping sickness is 100 percent fatal. But even those patients lucky enough to receive care suffer enormously. Diagnosing the advanced stage of sleeping sickness requires a spinal tap or lumbar puncture. Imagine performing this procedure in field conditions.
At the time, the only treatment option we had for the advanced stage of the disease was an arsenic-based drug, melarsoprol. Melarsoprol is so corrosive it is nicknamed “fire in the veins.” We had to struggle with the knowledge that the drug we were prescribing had a one in twenty chance of killing, instead of curing, our patient.
What was even more frustrating was that we knew a safer drug existed. It existed, but it wasn’t available. The manufacturer had discontinued production for lack of profits.
Thankfully, we no longer use melarsoprol. But the best treatment currently available is still complicated to administer. Patients must endure 14 injections over seven days. We still have to perform lumbar punctures.
We desperately need a diagnostic tool and treatment for sleeping sickness that is safe, effective, and easy to administer in remote areas, where there is no water on tap, no electricity, and trained medical staff are scarce.
Each year, millions of people die, and millions more suffer needlessly from diseases that can or should be prevented and treated.
This is unacceptable.
It is unacceptable that 90 percent of those afflicted with multi-drug resistant tuberculosis don’t have access to treatment, and the few that do must endure a highly toxic two-year treatment regimen that can cost almost nine thousand dollars.
It is unacceptable that 22 million of the world’s children fail to receive basic life-saving vaccinations every year.
I’ve no doubt you agree. It’s why you’re here today, it’s why UAEM has to exist, and it’s why MSF continues to devote significant resources to breaking down barriers to access, through treating patients, but also through research and advocacy.
Tonight, I want to talk about how changes in the global health landscape are affecting patients. I will discuss how access to health care can be—and has been—incrementally improved by implementing practical solutions. But it is not enough. We need a sea change in our approach to ensure that scientific advances are consistently translated into better care for patients.
It is the kind of change that can only be provoked by a strong grassroots movement that brings together frontline medical practitioners, patient groups, activists, researchers, and others with a common goal—ensuring access to lifesaving medicines. By sharing the experiences of our patients, I hope to show you what needs to happen on university campuses, in negotiating halls, in laboratories, and in conference rooms, if we are to make a long-term difference in the lives of our patients. Tonight is about the perspective from the ground, and how you can affect it.
Over the past two decades, a massive transformation has taken place in global health. Global health has claimed a bigger space on the international political agenda and received huge increases in financial resources.
Spending almost doubled from 1990 to 2000, from $6 billion to $11 billion. By 2011, it had leapt to $28 billion.
The past two decades have undeniably yielded incredible gains.
The strong focus on health indicators in the Millennium Development Goals certainly helped spur these achievements. In parallel, powerful new actors and radically different program approaches have emerged.
The World Health Organization, once the dominant global health actor that set technical norms and priorities for funding and research, now shares the stage with a host of other influential institutions. In the 1990s, the World Bank emerged as one of the largest global health funders. And the past decade has seen the Bill and Melinda Gates Foundation rise to become one of the largest donors in terms of expenditure, distributing $2 billion in global health grants last year.
Major global health initiatives, such as the Global Fund to Fight AIDS, Tuberculosis, and Malaria, GAVI—the Global Alliance for Vaccines and Immunization—and the US’s PEPFAR program, together pumped $8 billion into global health programming in 2011.
The so-called BRICS countries—the rising economic powers of Brazil, Russia, India, China, and South Africa—have increased the size and scope of their efforts in global health and development assistance. Their emergence is challenging the traditional North-South paradigm in no small way.
The mobilization of civil society actors means that organizations like MSF and UAEM have become even more relevant.
The gains we have seen, however, are fragile, and formidable tasks remain before us.
We have fallen into a period of financial crisis, and of donor retreat.
Moreover, the MDGs have almost run their course, and the Sustainable Development Goals that are likely to take the global agenda forward are putting the prioritization of health at risk.
We need to ask fundamental questions about the approaches, governance and longer-term impact of the transformation in global health.
We must scrutinize the trend of governments turning to a mix of public and private actors, including multinational corporations, private foundations, and civil society to confront major health challenges. For example, the Gates Foundation’s influence on global health extends well beyond the development of new technological solutions. It seeks to direct program implementation, priority-setting, public health policymaking, and medical and scientific norm-setting.
We must also look at how donor habits are changing. Donors are selecting the programs that they wish to fund, rather than funding core operating budgets decided by states. Earmarked voluntary contributions to the World Health Organization and the World Bank have spiked in recent years. These can be risky, because donor priorities change: major health initiatives funded through voluntary donations have been subject to dangerous fluctuations in funding flows.
In this new system of governance, scientific research and development priorities and access strategies are donor-driven more than they are patient-driven. The voices of our patients, who have some of the greatest and most urgent needs of all, are not being heard.
UAEM's new University Global Health Impact Report Card reveals that the top sixty US and Canadian research universities devote an average of just 3 percent of their total biomedical research funding to neglected diseases. These are ostensibly public interest institutions. Their research is funded primarily by government grants. They should be working in the fields of medicine that are being neglected by others. Three percent is a shockingly low number.
This neglect has a direct effect on hundreds of millions of people. Senzo is just one of them. Senzo is seven. He is one of our patients in southwestern Swaziland. He is HIV-positive and is being treated for multi-drug resistant tuberculosis, or MDR-TB, meaning that his infection is resistant to the two primary anti-TB drugs. MDR-TB treatment is therefore much harsher than regular TB treatment.
Every day, Senzo wakes up and walks to catch a bus to the clinic for his injection. He also takes 14 pills every day. Because there are no drugs specifically formulated for children, his caregivers have to adapt adult dosages by breaking up pills. Some of the drugs taste terrible, and some have unpleasant side effects, such as nausea, vomiting, and diarrhea. It will take two years of treatment, and cost thousands of dollars, before Senzo is cured.
But Senzo is one of the lucky ones. MDR-TB is on the increase, but treatment programs are scarce. New data from MSF projects show alarming numbers of MDR-TB cases around the world. These have come as a shock even to our doctors in the field.
In the north of the Central Asian country of Uzbekistan, 65 percent of TB patients treated by MSF in 2011 were diagnosed with MDR-TB. MSF data reveals that MDR-TB is not only developing due to incorrect treatment, but is also transmitting in its own right. In southern Africa and Southeast Asia, HIV and MDR-TB infections are combining to make a toxic brew of disease.
Worldwide, less than 5 percent of TB patients have access to proper diagnosis of drug resistance. But wherever we look for drug-resistance, we are finding it in alarming numbers. This suggests that the global scope of MDR-TB is far more vast than previously estimated. It is also estimated that only 10 percent of people with MDR-TB have access to treatment—and this figure is an average. It is far lower in low-resource settings, where prevalence is highest.
This is a global crisis, which is being exacerbated by diagnostic tools and medicines that are outdated and hugely expensive. The toxic two-year treatment regimen is dominated by drugs developed in the middle of the last century.
My first assignment with MSF was to set up a TB program in Jijiga, eastern Ethiopia, in 1995. It’s difficult to accept that almost 20 years later, this curable disease remains one of the developing world’s biggest killers, taking 1.4 million lives each year.
This persistent plague perfectly illustrates how today’s medical innovation system is failing our patients.
Today’s system incentivizes companies to develop drugs and other medical tools based on the return on investment that the product will offer. Medical R&D therefore depends on the size of the likely market and on pricing.
The TB drug market is small, and there is little incentive for competition. TB patients tend to be poor, and cannot pay high prices. There are few manufacturers, so drug prices remain prohibitively expensive. With little prospect of making a profit in such a small market, few companies are rushing to develop new products and join the competition.
As Senzo is only too aware, there is a lack of pediatric diagnostics and formulations.
There is some good news. A new rapid diagnostic tool has the potential to massively increase early detection of drug-resistant TB. But it is too expensive for resource-poor settings, exactly where the ability to detect TB within hours—as opposed to days or weeks—is most needed.
We are on the cusp of having two new drugs to fight TB. But we fear that, just as happened with the development of the first ARV drugs for HIV, these new medicines will be reserved only for those who can afford them.
The world cannot sit back and ignore the threat of MDR-TB.
This is one of the most pressing medical humanitarian crises in the world today.
We must push for more people to be tested, treated, and cured.
We must change the system of medical innovation.
Right now, the link between R&D and pricing means that patients are losing out. Because the best way to maximize returns in today’s system is to control the market. Patents and other exclusive rights enable companies to protect the market for their products. Patents give exclusive rights to sell a product at any price the market will bear for a defined period, usually 20 years.
This system creates two key problems.
First, the needs of people in wealthy countries trump the needs of people in poor countries. Companies are incentivized to develop products for lucrative markets; by contrast, they have no incentive to develop products that will only serve very small or very poor populations. No incentive exists to prioritize R&D according to disease burden or patient needs.
Thinjin Wal, in South Sudan, can tell you just how big this first problem is. MSF has treated three of Thinjin’s sons for kala azar, also known as visceral leishmaniasis. Kala azar is a parasitic disease that infects around 500,000 people each year, and kills 50,000. There are various treatment options, but none are what any patient would want: treatments are highly toxic, take a long time, and require numerous injections.
Thinjin’s sons had to go through a 17-day course of injections. She had to stay with them at an MSF treatment center for several weeks. It was a long way from their village, and the father was left to tend their fields alone. Thinjin recalls that “each day, we have to beg the children to accept the injections. They try to refuse, saying ‘No, it hurts, I don’t want it.’ So I have to take them in each day and make sure they get their injections and hold them when they cry.”
New, more effective diagnostics and treatments are desperately needed to address these neglected diseases and help people like Thinjin and her family.
The second problem in the system is that even the diagnostics and medicines that do exist—even the less-than-ideal ones, which we need today while we advocate for better options in the future—are often priced out of reach.
The current best treatment for kala azar is sourced from a single company. Even with discounts, its price is up to 45 times higher than what we need if we are to scale-up treatment to everyone who needs it.
Affordability and sustainability are intimately linked with market competition and the existence of multiple suppliers. If new drugs are protected by patents, and if older drugs have only one supplier, the competition that fosters innovation and brings prices down does not exist.
MSF routinely relies on affordable generic drugs to treat TB, malaria, and many other infectious diseases. More than 80 percent of the AIDS drugs that MSF uses worldwide are generics.
Increasing access to generics is therefore vital to scaling up access to health care. Without generic competition, new medications generally remain unaffordable. The most affordable second-line HIV regimen today is still twice as expensive as the recommended first-line regimen. The price of a third-line regimen is more than 14 times higher than the recommended first-line regimen.
Patents are the major barrier to increased generic competition. But they can be challenging to overcome.
In many industrialized countries, intellectual property rights are regarded as sacred. Hailed as drivers of innovation, economic growth, and entrepreneurship, they are vigorously and aggressively defended by powerful institutions like the US and European governments, and by multinational corporations.
However, despite being protected by the strongest intellectual property norms in the world, the R&D productivity of US and European pharmaceutical firms is actually declining.
One glaring example is the empty pipeline for antibiotics. This is widely regarded as a critical danger to public health in both industrialized and developing countries.
The pharmaceutical industry’s response to the so-called innovation crisis is to tighten its grip on intellectual property, and keep the prices of medical products high. But this approach does not stimulate innovation that actually meets patient needs, and must be challenged.
Meanwhile, the industry’s preferred response to problems of affordability is to establish limited, defined discount programs, also known as tiered pricing schemes. However, these schemes are insufficient to address large-scale health problems, they are unsustainable over the long term, and they often fail to address needs of patients in middle-income countries.
For example, the data from our latest report on antiretroviral pricing shows that several pharmaceutical companies have abandoned HIV drug discount programs for patients in middle-income countries. Yet today, more than 70 percent of the world’s poorest people—the new “bottom billion”—live in middle-income countries.
One alternative to tiered pricing is voluntary licensing.
Voluntary licensing enables a form of controlled competition. If it is well-negotiated and well-implemented, voluntary licensing has the potential to enable generic competition and increase access to medicines.
However, in practice voluntary licenses are often deeply flawed. Many voluntary licenses are negotiated in secret, and contain anti-competitive and restrictive terms. These licenses actually stifle access to medicines for many people.
The work of UAEM in promoting equitable and humanitarian licensing of publicly funded research is of vital importance. It is no small accomplishment that 40 major research universities have committed to openly license globally relevant biomedical research in low- and middle-income countries.
We welcome your successes in getting key universities, like the University of California system, to make public commitments to humanitarian licensing after years of advocacy by UAEM students.
This could allow producers in countries like Brazil, China, and India to manufacture affordable versions of new university-discovered medicines.
Congratulations on these very important achievements, and keep up the good work! We need more commitments from universities, and we also need to start measuring how these commitments are translating into benefits for patients.
MSF aggressively advocates for greater transparency and better licensing terms. We have supported the efforts of the Medicines Patent Pool and have called for all patent holders to join it. We must continue to call for the public release of licensing terms so that these deals can be monitored and evaluated by government and civil society.
But the ultimate step in making newer medications affordable is to remove unwarranted patent barriers altogether.
Under the WTO TRIPS agreement, the world’s most comprehensive multilateral agreement on intellectual property, countries are allowed to define some aspects of patent law and to determine when patent monopolies are warranted.
It’s a myth that every patent application that is filed is valid and represents true innovation.
Drug companies routinely apply for patents or are granted monopolies on medicines even when they aren’t actually deserved.
This is the issue at the heart of the case between the government of India and Novartis. Indian law explicitly requires that patents should only be granted on medicines that are truly new and innovative. When Novartis applied for a patent in India on its cancer medicine imatinib mesylate, the patent was rejected on the grounds that the medicine was merely a new form of an old medicine, and therefore not patentable under Indian patent law.
Novartis decided to challenge this decision, and the case is pending before the Indian Supreme Court.
There have been successful patent oppositions in India, for example when civil society groups contested GlaxoSmithKline's patent application regarding the HIV fixed-dose-combination zidovudine/lamivudine. The group’s success helped to make sure that this combination could be widely used in HIV treatment in developing countries.
Last month, MSF launched its online resource to help more people do the same. The Patent Opposition Database will support civil society groups that want to stop unwarranted patents from blocking people’s access to more affordable medicines.
Compulsory licensing is another tool that can promote competition and ensure access to medicines. Brazil and Thailand have both used compulsory licenses to deliver important price reductions. India and Indonesia each issued their first compulsory licenses this year. In India, the move brought down the price of a patented anti-cancer drug from more than 5,500 dollars per month to 175 dollars per month—a 97 percent reduction in price.
But these legal provisions are under threat. The governments that have used them have regularly suffered from retaliation in the form of threats of economic sanctions and other pressures by US and EU governments and companies.
Furthermore, some governments, including the United States, want to change the rules of the game. They want to incorporate stipulations into regional trade agreements that overturn the public health safeguards in the TRIPS agreement.
On your agenda earlier today was a session that covered the Trans-Pacific Partnership agreement and the harmful provisions that the US government is proposing—in secret.
One of the most harmful would make it impossible to challenge the validity of a patent before it has been granted.
Another would lower patent requirements, so that minor alterations of existing medicines could be given additional protected monopoly status, even if the alteration offers no therapeutic benefit to patients.
The US government is also demanding that diagnostic, therapeutic, and surgical methods be eligible for patenting. This could increase liability for doctors and medical professionals, including MSF doctors working in developing countries. Similar provisions have already been denounced by the World Medical Association, the American Medical Association, and the American Orthopedic Surgeons as unethical.
MSF has been actively advocating against including these provisions in the TPP, as well as similar provisions slated for inclusion in other trade agreements such as the one between India and the EU.
MSF and UAEM must build a bulwark against the erosion of fundamental rights to health care.
We must work to ensure technology transfer and access to publicly-funded research are not thwarted by commercial interests looking to protect monopolies.
We must encourage governments to exercise their rights under the TRIPS agreement to ensure their populations’ health is not compromised by unwarranted patents.
Today, the patient bears the burden of the cost of R&D: if patients can’t afford to pay high prices, the medicines and other medical interventions they need won’t be developed or properly adapted for resource-poor settings.
Listen to Aguil Bol Mallien. Aguil is an MSF patient whose twins were born at Aweil Civil Hospital, in South Sudan. The twins received their first vaccinations before leaving the hospital. Their next inoculations were due in six weeks. But Aguil lives more than an hour’s walk from the hospital, and she was unable to get back on time. Aguil explains, “it's hard for me to carry my twins over the long distance.” She managed to get help from her family and bring her twins in at ten weeks. But she will have to bring them three more times before they turn one to ensure they get the full basic vaccination package.
Five visits to a health facility before a baby’s first birthday is prohibitive for caregivers who have to walk for hours or pay for transportation, take time off work, and leave their families for extended periods in order to get to the clinic.
Delivering vaccines to people living in remote areas is incredibly difficult as well. Today, vaccines typically need to be maintained at between 35 and 45 degrees Fahrenheit from the time they leave a factory to when they are administered to a child. Maintaining this cold chain when the outside temperature is 113 degrees Fahrenheit is a challenge. Most developing country governments don’t have the means at their disposal to manage the logistics.
We need more flexible dosing schedules so fewer medical visits are required. We need alternative technologies—heat-stable vaccines, microneedles, inhalation, oral administration—that will allow community health workers to easily vaccinate children, rather than highly trained medical staff in clinics or hospitals.
We’ve seen the success of the oral polio vaccine, which can be administered without any medical training. We need more of the same.
In recent years, there has been a renewed focus on vaccines, which is good. But the focus has been on adding new vaccines to the basic package, not on adapting vaccines and vaccine regimens to the daily reality of patients like Thinjin.
Adding new vaccines means that a full course for a child in a country eligible for GAVI funding now costs $38.80 per child, up from just $1.37 in 2001. That’s a 28-fold increase in ten years.
Countries are trying to do more with their own resources, but the cost of the newer vaccines is often more than they can finance themselves. A Kenyan ministry of health official equated adding multiple new vaccines to a national immunization program as “taking out multiple mortgages.” When Honduras “graduates” from GAVI support in 2015, it will cost $25.50 just for the rotavirus and pneumococcal conjugate vaccines for one child. Today, with GAVI subsidies, the cost is $1.09.
We have established that the system isn’t working for our patients.
MSF has been and is trying to remove barriers to access. In 1999 we launched the Access Campaign to stimulate medical innovation for neglected populations and push in other ways to improve access. The Campaign has enabled us to intensify our advocacy, and our efforts to bring about greater transparency, robust generic competition, and better access to licenses and key technologies.
We are also going further. There is an urgent need for a new global framework to drive and fund medical innovation in a different way. MSF is advocating for an R&D system that is driven by patient needs.
In April this year, an independent expert group at the World Health Organization issued a landmark report.
The group recommended the creation of a new R&D framework to ensure that the benefits of innovation are accessible and affordable to patients.
One of the key conclusions of the report, and one that MSF supports, is the need to cut the link between the cost of research and the price of medical products.
The report recommends including the principle of de-linkage in the design of new innovation incentive mechanisms. MSF agrees. We need mechanisms that stimulate research and development even where there is no profitable market, and that allow the product price to be set according to access needs.
There have been some steps in this direction already. MSF helped set up the DNDi, the Drugs for Neglected Diseases Initiative, in 2003. DNDi is a non-profit drug research and development organization focused on delivering new treatments for neglected diseases. It has already delivered improved treatments for malaria, sleeping sickness, kala azar, and Chagas disease. It currently has two promising drugs in the pipeline that could eventually deliver what we need for sleeping sickness: a medicine that can be taken orally and handed out at a simple community health post.
In partnership with Sanofi-Aventis, DNDi has developed a patent-free malaria treatment called ASAQ that costs just one dollar and has been used by tens of millions of people. ASAQ illustrates how separating R&D costs from product pricing can bring tangible benefits to patients the world over.
MSF is also looking into mechanisms such as prize funds. Prizes can be designed to encourage potential innovators to compete to address patient needs, accelerating innovation in a way that separates the cost of R&D from the price of the product.
We need a new system to deal with the neglected diseases. We will also need this system to deal with non-communicable diseases. This is the new frontier in global health. Sixty-three percent of all deaths worldwide in 2008 were due to non-communicable diseases. Nearly 80 percent of these deaths—that’s 29 million people—were in low- and middle-income countries. Many of the medicines for cancer, diabetes, and heart disease are currently completely unaffordable for patients living in developing countries.
The WHO expert group’s keystone proposal was for member states to start negotiating a global R&D convention that would put in place systems to steer funding and innovation towards the most urgent patient needs.
I know that important contributions from UAEM relating to university licensing were included in the final report. Both UAEM and MSF have roles to play as discussions on new frameworks for R&D continue.
Public investment represents the lion’s share of investment in innovative approaches to global health. Public research plays a huge role in drug and vaccine development, and has a particularly huge impact on global health.
Pharmaceutical firms have long relied on government and academic institutions for basic research. Faced with high R&D costs and dwindling product pipelines, pharmaceutical firms are increasingly relying on academia to conduct not only basic research, but early-stage translational research as well.
UAEM has a key role to play in ensuring that the institutions that are conducting important early stage global health research are pushing the values of equity and access outward to industry and through the development pipeline, all the way to the patient.
As the value of public research increases, the role of UAEM in defining how this research is used becomes even more compelling and influential.
Your voices are influential and represent a large and powerful constituency, and I encourage you to be loud and unrelenting in the name of patients like Senzo, Aguil, and Thinjin.
You represent the next generation of leaders in global health: you have the opportunity to help solve some of the world’s most intractable health problems.
We need to raise the alarm about the dangers of inflexible IP regimes. Let us make sure that the TPP doesn’t set dangerous precedents that will stifle access to medicines and harm millions of patients.
We must continue to advocate for more profound changes to the R&D system—to place patient needs at the forefront, and to separate the costs of R&D from product prices. Let us make sure that discussions for an R&D convention are not thwarted before they even start.
New lifesaving drugs and medical tools must not be priced out of reach of the poorest populations. UAEM is already breaking new ground in setting standards for equitable licensing. Let us ensure that products developed based on university research translate into medical benefits for all patients—not just wealthy patients.
We need more attention and resources focused on the needs of patients suffering from neglected diseases. The UAEM project to benchmark universities’ contributions to neglected disease research will provide a strong evidence-based foundation for advocacy in this area.
And we need to expand the breadth and diversity of voices with meaningful participation in the access to medicines conversation. In particular, I applaud your work in building the UAEM network in Brazil, and your efforts to expand UAEM’s reach into other regions of the world.
We cannot lose sight of the fact that vast numbers of people have failed to benefit from the medical and scientific progress that we have witnessed in recent decades.
Together, UAEM and MSF can bring about a better system for global innovation and access to medicines—a system that puts the needs of patients at the heart of the engine driving medical innovation into the next century.
It is a challenge that we can only overcome together—a force for change that unites the collective efforts of doctors, patients, researchers, and student activists around the world.
The stakes are unbelievably high: the lives and well-being of millions worldwide. But the payoff is a more equitable, healthier world.
© 2013 Doctors Without Borders/Médecins Sans Frontières (MSF)