Should the Medicines Patent Pool work on hepatitis C medicines?

The Medicines Patent Pool (MPP) is a United Nations-backed organisation that negotiates voluntary licenses for HIV medicines with the aim of expanding access to these medicines. It was founded in 2010 and is funded by UNITAID.
In recent months studies were conducted to explore whether the MPP should expand its work to medicines for tuberculosis and hepatitis C. We urge UNITAID to make the findings of these studies public.
 We note that a number of civil society organisations have written letters arguing against the MPP expanding its work to include medicines for hepatitis C. We are also aware of an online petition that makes similar arguments.
The Treatment Action Campaign (TAC) has decided against signing this petition or supporting any of the letters. The TAC does not have a position in favour or against the involvement of the MPP in hepatitis C medicines.
Whether or not the MPP expands its work to hepatitis C is an important decision that could influence the lives of many people. We therefor urge the UNITAID board to make its decision based on a thorough and open-minded interrogation of the available evidence. We are concerned that accommodating ideological positions on either side of the argument may lead to a suboptimal outcome for patients.
We suggest that there are two key questions to be answered:

  1. Would the MPP’s involvement in hepatitis C lead to better voluntary licenses or worse voluntary licenses than what would be the case without it?

In our view the chances of the MPP negotiating licenses that are worse than those negotiated by industry alone is negligible. How much better MPP licenses in this area would be than industry-only licenses is uncertain. But, even if there is only a limited possibility that the MPP licenses would be significantly superior to industry-only licenses then it may nevertheless be a worthwhile investment.
We also do not believe that problems with the recent Gilead license for the hepatitis C medicine sofosbuvir provides any basis on which to argue against MPP involvement in hepatitis C since that license was not negotiated by the MPP.

  1. What evidence do we have that the MPP’s involvement in hepatitis C will harm access to new hepatitis medicines?

Given that the MPP will most likely deliver licenses that are anything from marginally or significantly better than industry-only licenses, the question then becomes whether there is any potential harms that would offset this benefit. While we note that some civil society groups foresee harms relating to MPP involvement, we cannot find much compelling evidence to support these fears of harm although we acknowledge a theoretical risk of harm.
So, for example, we find little supporting evidence for the idea that there is a choice to be made between either the use of voluntary licenses or the use of TRIPS flexibilities and the accompanying idea that the MPPs involvement in this area would reduce the usefulness of TRIPS flexibilities. We believe that good voluntary licenses can work well with the progressive use of TRIPS flexibilities. In our view voluntary licenses are only one of the many tools we can use to achieve greater access to medicines. While the focus of the ‘Fix the Patent Laws’ campaign, of which we are a founding member, is on TRIPS flexibilities, we also know very well that voluntary licenses won through pressure exerted through competition law was essential to the drop in the price of antiretrovirals in South Africa. While there are valid concerns that badly negotiated voluntary licenses can lock down production and exclude markets and patients in harmful ways, this risk has to be weighed up in context.
We are also aware of arguments relating to the fact that much of the global market for hepatitis C medicines are in middle-income countries. There is an argument that these countries are unlikely to be included in any licenses negotiated by the MPP. Even if evidence to this effect can be provided, then evidence would also have to be provided to show that the net effect in these excluded countries would be negative – e.g. that countries excluded from these licenses would not indirectly benefit due to increased production of the relevant medicine or through a combination of TRIPS flexibilities and the license. If compelling evidence could be provided to show that the MPP’s involvement in this area will restrict access to hepatitis medicines, then we would oppose its involvement.
 We have however not seen all the potential risks and benefits relating to our second question weighed up in a balanced manner that allows us to make a judgement either way. We hope that the UNITAID studies will provide this evidence.
 Finally, we are concerned that some civil society groups are describing the MPP and its licenses as an industry driven initiative. The MPP has its roots in civil society and has from its inception had significant support from groups like TAC and Doctors without Borders. While there are differences on the value of the MPP, describing it as an industry-driven initiative is inaccurate.
We stress again that the TAC does not have a position in favour or against the involvement of the MPP in hepatitis C medicines.
We do however urge that the UNITAID board must take the decision as to the MPP’s involvement in hepatitis C medicines only after thorough consideration and scrutiny of the available evidence.
For more information contact Marcus Low, TAC head of policy,  at