Humanitarian aid has come a long way in the last 40 years, says the international president of Médecins Sans Frontières (MSF), Dr. Unni Karunakara, but he warns that important health care gains made in the last decade may be reversed if funding is not maintained.
In a wide-ranging interview with allAfrica.com, Karunakara spoke about the values that underpin the work of MSF, the organisation's culture and its passion for principled humanitarian action.
It was MSF's work in Khayelitsha township on the outskirts of Cape Town 12 years ago that shifted the organisation's perspective. When conventional wisdom said it wasn't possible to provide antiretroviral therapy to poor people in a poor community, MSF helped pioneer treatment, bringing new life and hope to patients and healthcare workers.
"Khayelitsha was a transformative experience for MSF," says Karunakara.
"For the first 20 or 30 years we focused on refugee situations, but through engagement in this epidemic we realised that a crisis is not just about wars and guns, it's also about disease and quality of life."
One of the reasons that people with HIV/Aids have been able to enjoy a renewed quality of life is because of access to antiretroviral medicines (ARVs), which have dropped dramatically in price due to competition from generic manufacturers.
"In 1999/2000 the cost of treatment for a person per year for ARVs was between U.S.$10,000 and $12,000. Today it's around $75, that's a remarkable decrease," says Karunakara.
It is these cheaper, but equally effective, generic drugs that have enabled programmes such as the Global Fund, Pepfar (the U.S. President's Emergency Plan for Aids Relief), the Clinton Foundation and Unicef to buy affordable medicines, says Karunakara, and to put so many more people on treatment.
However, the secure supply of affordable, quality generics has been put at risk following India's membership in the World Trade Organisation and its negotiations with the European Union on a Free Trade Agreement.
India has been dubbed the "pharmacy of the developing world", but it may be restricted in this role depending on the outcome of the current negotiations. For public health programmes in the developing world and groups such as MSF that rely on generic diagnostic tests and medicines to provide quality treatment to poor people living with Aids, this could be disastrous.
Especially worrying is the growing number of people who have been on certain combinations of medicines to control Aids, but who now need to change their drug regimens to stay ahead of the ever-mutating virus.
"We are at that point where people who were on first-line treatment are now transitioning. They need second- and third-line treatment and these treatments are frightfully expensive," says Karunakara. He fears that in the current climate of shrinking global spending on health care and pressure to curtail generic competition, the consequences could be "catastrophic" as funding dries up and costs spiral.
"We know from past experience, the market has pretty much failed people living in poor countries," he says, referring not just to those countries affected by HIV, TB and malaria, but also those where neglected diseases such as sleeping sickness and kala-azar are endemic.
However, the fault does not lie with donors alone. Responsibility also rests with governments in the developing world, says Karunakara. "In sub-Saharan Africa, countries need to take leadership in setting agendas for research and development. They need to push for alternate solutions for diseases that affect their people and find solutions for them."