MSF Secretary General Jerome Oberreit on the increasing threat to affordable health care worldwide.

Médecins Sans Frontières (MSF) or Doctors without Borders, the international humanitarian medical aid organisation that is active in 69 countries, serves populations affected by epidemics, armed conflicts, natural calamities and manmade disasters. MSF has relied heavily on generic drugs, much of which has been sourced from India, to deliver health care to some of the most deprived peoples on the planet. Addressing healthcare exclusion has been a major part of its work, and this has often meant locking horns with big pharmaceutical companies. MSF was in the news recently for its decision not to take any more funds from the European Union and member countries in protest against their tough refugee policies. Jerome Oberreit, Secretary General of MSF, tells A. Rangarajan why the organisation is the doughty fighter it is. Excerpts:

Tell us a bit about the role that generic drugs — which MSF sources from India — play in your work globally.

Generic drugs play a vital part in our programmes. These generics that we source from India are used by us in 60 countries and constitute nearly two-thirds of the drugs we use for HIV, TB and malaria. We have limited resources and we are committed to delivering health care to as many as possible. It is imperative that we keep costs low. Take the case of AIDS treatment; it is on account of the competition largely from Indian generic drugs that the annual cost of the HIV cocktail needed has been brought down 99 per cent from about $10,000 in 2000 to about $100 today. This has made another 16 million people possible to have the treatment. These statistics speak for themselves. The role generics play in affordable health care hardly needs emphasis. In many cases they are a lifeline.

MSF has expressed concern over the ongoing Regional Comprehensive Economic Partnership (RCEP) talks. Are you apprehensive that these could impact the generic drugs production in India?

India has always maintained the right balance between awarding patents to drugs and its commitment to the interests of public health. Since 2005 India has been obligated to issue patents under the WTO but it has wisely used the provisions of TRIPS flexibilities to maintain this fine balance and the poor of the world have benefitted from that. It is not just MSF alone but several ministries of health and other aid organisations have been able to deliver affordable health care to the needy, relying on generics. We are particularly concerned about two provisions that are being discussed in RCEP, Data Exclusivity and Patent term extensions. Data exclusivity is a backdoor route to awarding monopoly status to drugs. And Patent term extension will extend the monopoly hold of a pharmaceutical company on a drug beyond the current 20 years. Both these provisions go beyond the mandates of International Law. We gather that Japan and South Korea are brining pressure on India on both these counts. We feel it is imperative that the current status quo is preserved in the interests of the public health needs of some of the most marginaliaed and vulnerable peoples. And to that extent we would appeal to the Indian IP negotiators.

You have been campaigning against TPP — the U.S.-led Trans Pacific Partnership as well. MSF has made an oral testimony to the U.S. House of Representatives Committee and has written to President Barack Obama. What are your concerns there?

TPP introduces far-reaching monopoly protection for pharmaceutical companies that would unnecessarily strengthen, lengthen and broaden patents much to the detriment of public health safeguards, enshrined in international law. This will push drug prices up and make access to affordable drugs difficult. It will seek to impose the same conditions on all signatory countries regardless of their public health needs or affordability of governments and patients. We have also pointed out the flaws in the current bio-medical innovation paradigm that seeks to reward R&D through monopolies and high drug prices. That this is affecting the richer countries as well is demonstrated in the case of antibiotic resistance. Cash-rich pharmaceutical companies have not taken up R&D in antibiotic development because they must be affordable and should be used sparingly. Instead they focus on drugs that are necessitated by life-long treatments like cancer cure and other conditions. They spend more on sales and marketing than R&D. Bio medical innovation should be responsive to needs.

Seeking to demonstrate an alternative approach is feasible and viable, MSF has been a part of the Drugs for Neglected Diseases Initiative (DNDi) programme. How does it counter the ills of the current paradigm you point put?

The Drugs for Neglected Diseases Initiative (DNDi) was actually started in 2003 with the Nobel Prize money providing the seed funding. In 10 years we have developed six new therapies. Based on DNDi’s estimates we reckon that the cost to develop a new chemical entity to be between €100 to €150 million. Whereas estimating costs involved in developing a drug by the industry is a difficult exercise as there is hardly any transparency. Current studies however place that cost anywhere between $802 million to $2.6 billion. That is the staggering difference we are talking about. Pharmaceutical industry has been afflicted by excessive financialisition. Shareholder accountability becomes paramount, over and above public health needs. DNDi is about supporting both innovation and access.

It is a momentous decision indeed that MSF will be no longer taking funds from EU or member countries, foregoing nearly €68 million. Why did you decide to shame the EU?

The EU has been pursuing policies of damaging deterrence that are aimed at pushing people and suffering away from the shores of Europe. These refugees are fleeing some of the most dangerous and violent war-torn regions like Syria, Iraq and Afghanistan. The EU-Turkey deal goes even beyond deterrence and it places the very concept of a “refugee” and the entitled protection in danger. In Azaz, where 100,000 people are stuck between closed borders and frontlines, the situation is dangerously precarious. Further, to be talking about safe zones with in Syria is misleading and irresponsible. No security can be ensured in these so called safe zones. When Lebanon can take refugees almost equalling half its population and when Turkey can accommodate nearly three million refugees, indeed it is shameful that Europe with about a 400-500 thousand people should be turning its back on a proportionally much smaller number. These closure of borders is leading to more disasters at sea. Europe is abrogating its responsibilities towards refugees under agreed international conventions and this cannot become the norm and has to be challenged.

Has MSF started assuming a larger political profile?

MSF was founded by both doctors and journalists. Much of our work happens in places farthest from the presence of media. We also speak out publicly on what we see. We are impartial and neutral when it comes to conflicts. Bearing witness to acts of violence and suffering does not mean we remain silent. Taking a position on these vital issues does not make us political.