The leadership of Médecins sans Frontières (MSF) is under significant global pressure to reverse its decision to close its Access Campaign, with indications that the issue may be raised at the organisation’s general assembly that begins in Geneva on Thursday (27th).

The decision has been described as a triumph for technocrats within MSF, who want the organisation to be more narrowly focused on humanitarian efforts and less on the wider political issues hampering patients’ access to medicines.

Over 100 civil society organisations and 250 individuals have signed a letter addressed to MSF’s leadership and board, urging them to reverse the decision to close the iconic unit, which they say will “cause catastrophic and irreparable damage to access to health technologies for communities served by MSF projects and beyond”.

Signatories include past MSF leaders Dr Unni Karunakara (former international president), Kris Torgeson (former international secretary general), Gorik Ooms (former general director) and Dr Tido von Schoen-Angerer (former executive director of the Access Campaign).

Dr Mariângela Simão, former World Health Organization (WHO) Assistant Director-General for Access to Medicines and former New Zealand Prime Minister Helen Clark also joined civil society organisations and health experts in their appeal to MSF.

“The planned dismantling of the Access Campaign’s core structure, capacities, expertise, and networks will reverberate across the access to medicines movement and beyond,” they write.

“It will be yet another setback to the already-shrinking patient activist and civil society space critical to holding pharmaceutical companies and governments accountable so that medicines are never a luxury.”

‘Longstanding power struggle’

Von Schoen-Angerer, who headed the Access Campaign from 2006 to 2012, told Health Policy Watch that the closure was the outcome of “a longstanding power struggle” between MSF’s international office and its five powerful operational centres – Paris, Amsterdam, Brussels, Geneva and Barcelona – and the strong global and somewhat independent Access Campaign.

“It’s also a clear move from some people in MSF who want to depoliticise [the organisation], with a stronger focus on a technocratic approach; on products alone, shying away from some of the underlying political issues that determine access,” he added. 

“They are no longer willing to take up the political battle to really fight these access battles for better prices, more research and development, greater equity. 

“We’re looking at a more inward, more technocratic MSF that wants to get health products for their patients alone, and is no longer wanting to fight the bigger political battles that need to be fought.”

However, an MSF spokesperson told Health Policy Watch that the letter’s concerns were based on “the misleading notion that MSF is halting or reducing its work on access to products for healthcare. 

“This is 100% wrong. MSF is redoubling its efforts to deliver tangible improvements in access to products for healthcare driven by our new collective vision to expand our efforts to improve access to products for healthcare.”

Access Campaign victories

The Access Campaign has advocated for lower prices and better access to a range of medicines for over 25 years and won some major victories – particularly for HIV and TB patients. 

It was launched in 1999, first campaigning for Thai drug companies to be able to produce affordable generic versions of Pfizer’s costly fluconazole, used to treat infections in people with HIV. Its latest triumph was earlier this year when it helped to secure affordable access to bedaquiline for people with multi-drug-resistant TB.

In 2003, it helped to launch the Drugs for Neglected Diseases initiative (DNDi), an independent, non-profit drug development organisation focused on developing new treatments for some of the world’s most neglected diseases.

The Access Campaign is unique as it has both a global view of issues blocking access to medicines –  such as Free Trade Agreements that prevent generic competition – and local knowledge of communities’ needs from MSF’s field offices. 

But the unit is the victim of a costly two-year restructuring exercise aimed at redirecting resources from global issues to MSF’s work on the ground, according to sources.

These sources told Health Policy Watch that around 50 staff are to be cut to 19 and housed in a new unit called “Access to Products for Healthcare”. Current staff will have to compete with one another for the posts. The new unit will advocate for access to specific products needed by MSF’s humanitarian efforts.

At present, there is no strategic plan for the new unit, and staff are to be dispersed between five regional offices – Kuala Lumpur in Malaysia; Nairobi, Kenya; Dakar, Senegal; Rio de Janeiro, Brazil; and Brussels, Belgium.

Von Schoen-Angerer described as “arrogant” the restructuring process which cost “hundreds of thousands (of Euros)” yet involved “MSF talking entirely to itself, completely ignoring the hundreds of allies in terms of organisations in the Global South, but also the North – the academics, the governments that the Access Campaign has worked with.”

“That’s why they have come out with this letter because they’ve never been consulted,” he added.

MSF International stands its ground

An MSF spokesperson told Health Policy Watch on Wednesday that they were not aware of the issue being on the agenda of the general assembly, MSF’s highest decision-making body, or when it would be discussed by the MSF board.

Asked what the motivation was for closing the Access Campaign, the spokesperson said that “the new structure will be closer to our medical humanitarian operations, to better support the needs of the communities we assist. Five regional offices will work together with our operational teams and patients as well as with our partners and networks.”  

They added that populations’ access to healthcare were being affected by new developments including “technological breakthroughs, new political players, and new legal and commercial realities and regulations”. 

“For our patients and also our networks, we have a duty to ensure that we remain optimally organised to leverage our unique positions for improving access to products for healthcare for those deprived of them.”

MSF’s International Office said in statement  this week that the organsation’s “focus is on directly addressing the problems our patients and our operational teams face.

“We will also continue to work globally to address systemic barriers causing or amplifying these problems. This includes advocating for changes to policies and practices that determine who can or cannot access lifesaving health care products in many of the more than 70 countries around the world where we work.” 

Loss of global advocacy?

Many access activists fears that MSF will no longer advocate around HIV, neglected tropical diseases, intellectual property, research and development, trade agreements, transparency, and other cross-cutting access issues

However, when asked directly whether MSF would cease its global work on issues such as the pandemic agreement negotiations and global trade agreements, the spokesperson simply responded: “In 2025, MSF’s new structure dedicated to our work with improving access to products for healthcare will continue the work of the Access Campaign that aligns with our new collective access to products for healthcare priorities, including dossiers on vaccines, diabetes, [anti-microbial resistance], TB, and diagnostic tools. Next year will also be dedicated to dedicated to finalising the new structure’s longer-term strategic plan.”

The spokesperson added that “around 35 staff are contracted to the Access Campaign” as well as “a number of others with temporary contracts”.  

“At least 19 of them have the immediate opportunity to work for the new structure. Others may also be absorbed (due to their expertise) by other MSF sections, operational directorates or projects.”

But Von Schoen-Angerer expressed concern that there is no strategy in place for the new unit “beyond vague priorities” and  it will take at least a year to develop a strategic plan.

Loss of unique skills

“They are firing all the fantastic staff or humiliating them by making them reapply if they want to be part of the new structure. Allies will be lost, battles will be lost and it will take years before this will become effective.” he added.

Fatima Hassan, director of the South African Health Justice Initiative (HJI), described the skills of Access Campaign staff as “unique, unprecedented, and multi-disciplinary.”

“There are no other groups right now in the world that can replicate its work or fill its large shoes,” said Hassan, urging MSF not to “dilute” it.

Ellen ‘t Hoen, director of Medicines Law & Policy and former policy and research director of the  Access Campaign, has also expressed her alarm at the move, describing the campaign as “a pillar of global access to medicines work”.

“Access issues have never been more front and centre in global health, as the recent lack of progress in the negotiations of the WHO pandemic accord – and the desperate scramble to access COVID-19 countermeasures that preceded the launching of the accord process – have underlined,” noted ‘t Hoen’s Medicines Law & Policy this week.

“If MSF proceeds with this decision, it will leave a significant void in the access movement. Particularly, groups in low and middle-income countries will bear the brunt of this loss. There are no apparent players who can take over the role of the MSF Campaign because most lack the multidisciplinary expertise and resources MSF has.”

This week, Unitaid’s executive director, Philippe Duneton, also added his voice to appeals for MSF to continue its access work in an open letter to MSF’s president, Dr Christos Christou.

“MSF’s voice and work in access remains more needed than ever, addressing the grassroots causes of inequities whether in HIV or global health emergencies, neglected diseases, and neglected populations that the market keeps failing,” noted Duneton, whose organisation works to ensure low- and middle-income countries have access to treatment and tools to combat major health challenges.

Image Credits: MSF, MSF Access Campaign.