Pablo Alvares Herreira, 55 years old, is one of the patients in the MSF project in Aiquile, in Bolivia.
Photo:Vania Alves

GENEVAThe world’s health ministers, gathering in Geneva for the World Health Assembly this week, will decide whether or not to start the process for a binding agreement that would jumpstart research and development (R&D) for medical needs that are currently unmet. Today, the international humanitarian medical organisation Doctors Without Borders (MSF) urged health ministers to seize the unique opportunity and give the green light to a proposal that has been years in the making.  By passing a resolution at the WHA, governments can this week take the first step to making an R&D convention a reality.
 
“Medical innovation is not delivering for the needs of people in developing countries.  Governments have the power, the responsibility and, from today, the opportunity to change this,” said Michelle Childs, Director of Policy/Advocacy at MSF’s Access Campaign. “A clear and compelling case has been made for an R&D convention. WHO member states must get on with starting the process, and not look for excuses to delay.”


The centre provides psychosocial and medical care to a limited cohort of HIV patients.
Photo:Claudio Tommasini

 
Today’s system for medical R&D is flawed, in that it is predominantly driven by commercial rewards rather than health priorities.  This means that research is steered towards areas that are the most profitable, leaving fundamental medical needs – particularly those that disproportionately affect developing countries like tropical diseases or tuberculosis - unaddressed. 
 
MSF field teams see the consequences of this every day, and struggle to deliver quality care when appropriate medical tools do not exist. When drugs, diagnostics and vaccines do exist, they are often unsuitable for use in countries where MSF works, as they have been designed for resource-rich countries. Unmet needs include: more effective treatments for drug-resistant tuberculosis; paediatric versions of HIV drugs; a test to determine whether a patient with Chagas disease has been cured; new antibiotics to treat life-threatening infections in the face of increasing resistance; and vaccines that do not need to be refrigerated or can be given without an injection.
 
“Our field teams know where the medical needs are, but that knowledge isn’t enough to address the gaps,” said Dr. Tido von Schoen-Angerer, Executive Director of MSF’s Access Campaign. “We need to connect the research priorities with the money, to drive the money spent on medical research to where the needs are and to ensure that the fruits of innovation are affordable and accessible. This is where the R&D convention can bring about transformation.”
 
In April, a report was released by the Consultative Expert Working Group on Research and Development: Financing and Coordination (CEWG), a WHO-convened group of experts mandated to look at medical innovation.  They concluded that a binding convention “is needed to secure appropriate funding and coordination to promote R&D needed to address the diseases that disproportionately affect developing countries and which constitute a common global responsibility.”
 
A convention would bring significant advantages. It would create an evidence-based process to define priorities. Signatory countries would then be bound to invest towards addressing those priorities. Importantly, any research funded thanks to the convention would deliver accessible and affordable products; for example, by ensuring price and supply commitments, adopting flexible licensing policies for developers, and supporting open innovation that would make knowledge available to others. 
 
Over the past ten years, product development partnerships have been created to fill some of the innovation gaps and new funding from philanthropic foundations and governments has been forthcoming. But these efforts are piecemeal and vulnerable. 
 
“We need a more sustainable system, particularly now that donor funds are increasingly scarce,” said Childs. “The convention would encourage a fair contribution from all, but also shape how the money is spent. It should ensure that the money goes further and achieves more by supporting alternative models to stimulate R&D that cost less and deliver medical tools that are accessible and affordable to those that need them”.
 
The WHO Framework Convention on Tobacco Control provides a precedent of an internationally binding agreement negotiated and adhered to under the auspices of WHO.