As an international medical humanitarian organisation, Médecins Sans Frontières/Doctors Without Borders (MSF) witnesses daily the gaps in access to lifesaving medical products, such as vaccines, therapeutics, and diagnostics, that are needed to address the health needs of people suffering in humanitarian and medical crises. These gaps have deadly consequences.
Each time a medical product is out of reach, there are significant barriers in accessing critical information that determines the availability, affordability and accessibility of these products. For decades, MSF has witnessed astonishing levels of opacity in the biomedical research and development (R&D) system, and in subsequent supply and procurement processes. The lack of access to information has therefore itself become a barrier to equitable access to medical products.
The web of secrecy surrounding biomedical R&D, supply and procurement, has been systematically created and imposed by the biomedical industry, including pharmaceutical and diagnostics corporations. It is in their interest not to disclose this information as secrecy is the bedrock of monopolies they hold on medical products and the high prices they charge. This secrecy exists despite the majority of biomedical R&D initiatives receiving extensive amounts of public funding at one or more stages of their development, and despite multiple international reports, agreements and resolutions recognising the importance of transparency for sustainable access to medical products. This information asymmetry between pharmaceutical corporations that hold this information, and everyone else that does not – including governments, treatment providers like MSF and patients – undermines efforts to ensure equitable access to lifesaving medical products, and ultimately costs lives.
This report focuses on the need for transparency in 10 areas: seven specific areas in the product development supply and procurement processes, and three cross-cutting areas where decisive action can ensure transparency and access to information more broadly:
1. Cost of R&D, including clinical trial costs;
2. Clinical trial information and data;
3. Cost of goods sold;
4. Prices;
5. Non-disclosure agreements and confidential information in procurement contracts;
6. Status of patents, other IP, licensing and technology transfer agreements;
7. Registration and supply information;
8. Governance and decision-making processes of global health entities;
9. Transparency conditions on public funding and resources; and
10. National transparency laws
This is not an exhaustive list, but it aims to capture the information that, in MSF’s experience of responding to multiple outbreaks, epidemics and pandemics, is most critical for access. These areas span across the lifecycle of medical products, from the early development stages to when they are supplied. The report also recommends actions for governments, pharmaceutical corporations and other stakeholders, and includes the steps MSF is taking, to reject secrecy as the status quo and ensure timely, equitable access. These actions are needed urgently if we are to overcome the overwhelming information asymmetry in the biomedical R&D processes that undermines efforts to save lives.