“Patents on all of the WHO-recommended patented first- and second-line treatments for HIV are licensed to MPP. The value of MPP’s work is recognised by the global health community and corporations alike.”

The Medicines Patent Pool at 10

– By Ellen ‘t Hoen, director of Medicines Law & Policy, founder and first executive director of the Medicines Patent Pool

The Medicines Patent Pool at 10

In 2002, a group of people attending the International AIDS Conference (IAS) first began to discuss a novel idea to save the lives of people living with HIV/AIDS. At the time, patents on antiretroviral medicines prohibited the supply of low-cost generic versions of life saving medications. The originator versions were often priced too high for the over 30 million patients in low- and middle-income countries to access them. Inspired by an idea from the military airplane industry – where patented technologies were pooled by the US government to spur access to flight technology desperately needed for World War 1. “If we can do this for reasons of war, why can’t we do this to fight HIV/AIDS?” was the question James Love, from Knowledge Ecology International put to the group at the IAS.

The experts gathered at the IAS went on to develop a proposal to create the Medicines Patent Pool. The objective was to spur innovation and access to medicines needed to fight the HIV pandemic. In 2010, Unitaid founded the Medicines Patent Pool (MPP) and continues to be one of its key funders to-date.

MPP’s success story

Ten years on, the model has proved its worth. Since its creation in 2010 MPP’s ‘pooled’ intellectual property has led to the supply of nearly 15 billion doses of medicines across 141 countries and saved USD 1.66 billion in public health spending (see MPP’s impact). In 2015, in light of its success in HIV, MPP’s mandate was expanded to include hepatitis C and tuberculosis. In 2019, it was expanded again to include other treatments on the World Health Organization (WHO)’s Essential Medicines List. And in 2020 it agreed to lend its expertise to the effort to fight COVID-19. (See MPP’s mandate)

That MPP would be as successful as it has been was not obvious in the early days. The idea was first met by scepticism. Almost everyone in the global health and trade community thinking “this is never going to work.” But short of changing the intellectual property rules of the World Trade Organization, no one had a better idea. MPP’s first breakthrough came when the US National Institutes for Health (NIH) offered to license its patents related to HIV medications. The then US President Obama’s White House blog welcomed the move and encouraged all holders of patents related to HIV treatments to share their patents with MPP. From then on, there was no going back. Gilead was the first company to follow suit in 2011 and generic companies joined the initiative in the same year.

Today, the scepticism has vanished. Patents on all of the WHO-recommended patented first- and second-line treatments for HIV are licensed to MPP. The value of MPP’s work is recognised by the global health community and corporations alike. This is a success story, but will its lessons be applied beyond HIV?

The COVID-19 challenge

The access challenges that came starkly into view during the HIV pandemic are not unique to it; the same issues prevent access to lifesaving technologies for many other diseases. The COVID-19 pandemic is laying bare the fault lines. High-income countries scramble to get first in line to purchase vaccines and therapeutics. Unless an international mechanism for sharing of the COVID-19 health technologies is put in place, we risk again creating a situation where the ‘disease is in the South and the treatments and vaccines are in the North’ as it was during the HIV pandemic.

To prevent this, WHO has established the COVID-19 Technology Access Pool (C-TAP), again with the support of Unitaid. But so far it has not had many takers, and that is reason for concern. Today, in the response to COVID-19 it would be a shame to not use MPP’s experience and expertise with licensing needed to scale up production of COVID-19 health technologies. As we have seen with HIV, the success of pooling of technologies will depend on the political support for the C-TAP initiative. Again, doubts are being expressed about the efficacy of the C-TAP initiative. However, past experience from MPP is ample proof this model can work if it receives adequate government support and industry participation.

COVID-19 is now in the spotlight. But we should not lose sight of the need to work to increase access to other new essential medicines. Including those to treat diabetes, cancer and cardiovascular diseases. After COVID, I believe cancer will prove to be the next big challenge for MPP to have impact. There is increasing demand and treatments are improving. Nonetheless they are priced well beyond the ability to pay for most people and communities in the developing world.

The Medicines Patent Pool at 10

About Ellen ‘t Hoen:

Ellen ‘t Hoen is the director of Medicines Law & Policy, a group of legal and policy experts offering advice to international organisations and governments. She was the founder and first executive director of the Medicines Patent Pool. Ellen is a fellow at the law faculty of the University of Groningen. She has a Master’s degree in law from the University of Amsterdam and a PhD from the University of Groningen. Ellen has published widely and is the author of several books. In 2017 she received the Prix Prescrire for her book “Private Patents and Public Health: Changing intellectual property rules for public health”. In 2020, she is appointed Officer of the Order of Oranje-Nassau, a royal award in recognition of her work on access to medicines.