Dr. Orbinski’s fight for access to medicine: the DNDi Initiative
Concordia University
In 1998, Dr. James Orbinski was at a Doctors Without Borders clinic in the slum settlement of Kibera outside Nairobi, Kenya. He was part of a team offering treatment for malaria and diarrhea, and was also setting up an HIV prevention program. He sat in the clinic examining a 5-year-old girl with malaria who, after three days of standard chloroquine treatment, was still vomiting and running a fever. “Her malaria was clearly resistant to the medicine. Drug resistance is a natural phenomenon, and all infectious diseases eventually develop resistance. New drugs must constantly be found,” Orbinski recounted in his book, "An Imperfect Offering." “Every year, worldwide, almost two million people die of malaria; 90 percent of these deaths occur in Africa, and because children have more delicate immune systems, 800,000 of those who die are children,” he wrote.
When Orbinski gave a lecture at Concordia University in Canada on “Global Health and Humanitarianism” on Sept. 25, 2008, he spoke about his experiences as president of DWB in Rwanda and about his work on HIV/AIDS, encouraging the audience to take action.
After DWB was awarded the Nobel Peace Prize in 1999, Orbinski dedicated the money toward the development of drugs for the "neglected" diseases. This was how the Drugs for Neglected Diseases initiative was born. He announced the release of two new anti-malaria drugs.
In an interview, he explained that because malaria develops drug resistance, it is not simply cured with one treatment. In 1999, a public-private partnership, the Medicines for Malaria Venture, was set up to develop new drugs for malaria, but the process could take up to 10 years. “In the short term, there is an enormous need for drugs,” he said. “500 million people can’t wait for what may come.”
In his book, he explained that the Neglected Diseases Working group thought that by combining two existing anti-malaria drugs into one tablet, they might be able to develop an effective treatment in the short term.
“The problem was real and immediate, but there seemed to be no way to get anyone to do anything about it,” he said. “With no viable alternatives on the landscape, we decided to do it ourselves.”
In Oslo, when he gave his Nobel Prize address in 1999, he spoke of injustice outside the context of war. “Ninety percent of all death and suffering from infectious diseases occurred in the developing world,” he wrote in his book. “Around the world, two billion people had no access to essential medicines. Poverty is a driving force behind poor health, and that was not a problem we could solve. But as doctors, the lack of access to medicines was an injustice we could do something about.”
The fight for essential medicines was DWB’s next challenge. A global campaign was launched, drawing in more than 100 different non-governmental organizations as well as the World Health Organization. It was led by Dr. Bernard Pecoul, former general director of DWB in Paris, and Daniel Berman, a former marketing executive in the pharmaceutical industry.
In 2001, when Orbinski finished his term as DWB president, he worked as chairman of the Neglected Diseases Working Group. The question was, why was there so little drug research for diseases that affect those in the developing world?
“Returns on investment are not good enough for pharmaceutical industry and they are driven by profit,” he wrote in his book. “Governments have failed to ensure that wealth created by patent monopolies is directed towards global health needs.”
Thus DNDi was born. It was launched in 2003 as a not-for-profit pharmaceutical research and development organization that focused on four neglected diseases: sleeping sickness, chagas disease, leishmaniasis and malaria, all of which are neglected because their manifestation occurs in developing countries, where patients are too poor to attract investment for drug research.
Neglected diseases can be cured. The DNDi Web site defines malaria as the single largest cause of death for children under 5 in Africa, killing one child every 30 seconds, or 3,000 children every day.
A group of 40 scientists, drug policy analysts and drug development specialists as well as the WHO got involved in the DNDi. They surveyed the top 20 pharmaceutical companies in the world with Harvard University, and found that among the 11 companies that responded, eight spent nothing on research and development for diseases like African sleeping sickness.
They also found that only 0.2 percent of the $60 billion spent globally every year on drug research and development went towards tuberculosis, malaria and other diseases, which account for 18 percent of global mortality from all diseases.
Over the course of two years, they established a network of 15 African research centers linked with DWB, the Pasteur Institute and medical research councils in India, Malaysia, Brazil and South Africa.
In May 2001, when Orbinski met with World Trade Organization Director General Mike Moore to ask him for funding opportunities for DNDi, Moore told him that he was committed to finding the "right balance" among other the issues.
But “there is no right balance between life and death when life is possible,” Orbinski reflects in his book. “There is no right balance between justice and injustice when justice is possible.”
At the Kananaskis G8 summit in 2002, as well as at meetings with other potential donor governments, Orbinski asked for money for the DNDi. He returned empty-handed.
“This is why the start-up money had to come in from DWB because if we didn’t, no one would,” Orbinski explained in his book. “It is the responsibility of governments to provide the means for public healthcare,” he said in an interview.
As Orbinski concludes in his book, “we acted not to assume responsibility for the problem but to practically demonstrate that effective change and just alternatives are possible.”
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