“It is legitimate for society to want to protect vaccinations, it is a public health tool which keeps populations healthy”

Dr. Marie-Paule Kieny is currently Director of Research at Inserm (Institut national de la santé et de la recherche médicale) in Paris, where she assists the President on International Institutional Collaborations. She worked with the World Health Organisation (WHO) for almost two decades, where she conducted research programmes into vaccines for diseases such as Ebola, rabies and meningitis, and research into innovating healthcare systems.
 
She currently forms part of the advisory boards if several organisations, including the Drugs for Neglected Diseases Initiative (MPPF), the Human Vaccine Project (HVP) and the Medicine Patent Pool Foundation (MPPF). With MPPF she is working to provide vaccines and medicine at the lowest price possible to the most vulnerable populations.
 
How does Medicine Patents Pool work?
 
The system seeks to promote open access to medicine at very low prices. The idea is to negotiate licences of innovative products manufactured originally by large pharmaceuticals to help public healthcare. We look for manufacturers in countries such as China, India and some in Africa who are willing to produce these drugs and distribute them at a much lower price, because they would be generic drugs. The idea is not to lower the costs through an agreement, but to have sub-licences given to many generic drug manufacturers who would then compete against each other and offer the lowest prices possible, which would then increase the number of people able to access these drugs.
 
Are the pharmaceuticals in favour of this initiative?
 
Often they are companies with social responsibility policies, but also work in markets that are of interest to the MPP, because they are middle to low income countries. The large pharmaceuticals have little to nothing to win in these markets. Therefore, they are willing to help because instead of registering and gaining access in these countries for their products, they hand over the responsibility to MPPF and the foundation is the one to permit the manufacturing of generic brands. It works because the part of the market they yield to us is very little, compared to what in normal for a profitable market in the private sector.
 
What have the results been?
 
It is working very well with HIV drugs, but we are also working with other diseases,, such as tuberculosis and Hepatitis C. We received licences for thirteen antiretrovirals for the HIV virus and for three Hepatitis C which we handed over to generic drug manufacturers. Until now we have helped in the development of 130 projects, because each of the manufacturers must develop the formulations and compare it with the original in terms of stability and physical characteristics. The manufacturers already have delivered more than 6.2 billion doses which have been used for the treatments of over 70 million patients. Now the challenge is to see if this model works for others diseases.
 
What would be the next diseases targeted using this same model?
 
We are looking at cancer, for example. The price of medicines is very high. Some of the drugs are not so affordable even in rich countries. But the manufacturers have not yet decided what their social responsibility is in this case. We have met to find an approach and see if they are willing to work with the MPPF in diseases such as cancer, cardiovascular diseases and diabetes. We are studying which would be the most favourable situation for both parts. We hope there will be a way for large pharmaceuticals to provide licences to the public healthcare systems of middle and low income countries which would benefit a great number of people.
 
You defend a universal healthcare system for all countries. Is this not a utopia?
 
No, I believe it is a question of the majority of countries not offering commitments, although when the WHO communicates its resolutions and assemblies, they are all committed to providing universal healthcare to their people. A universal health system must be seen in the long term. Especially in poor countries, there is no way you can provide healthcare for everyone at the same time. Thus, most countries must first cover the most vulnerable part, focusing first on mothers and children and providing primary healthcare. Then the services can grow, both in terms of amount of services offered to this group, and in the number of people covered by the system.
 
But a system of universal healthcare coverage is also a challenge for rich countries. Most countries in Europe have universal coverage, but the growing price of drugs is making it difficult to maintain. There must be a reform of the services to find a way to attend everyone while at the same time lowering costs.
 
How can European healthcare systems be reformed?
 
One of the approaches focuses on putting more emphasis n primary healthcare, because as a society we do not give enough importance to health promotion and disease prevention. We wait until a person becomes ill to then try to cure them. But if you look at the diseases afflicting us, many of them are related to lifestyles. That is why we must set down policies, in the case of diabetes for example, which is rising globally, and focus on its prevention, in promoting healthy eating habits, etc. Of course we will have the medicine and use it, but we should avoid this as much as possible.
 
One of your main objectives is to design vaccines for developing countries. Where along the process are you now?
 
There are not too many vaccines available for a wide array of infectious diseases, but in the majority of low income countries we do have them thanks to the public support offered by the international organisation Gavi. What we do see however is that there are many anti-vaccine groups. Therefore, it is very important to continue developing new vaccines, but also look to build up the trust in vaccines among the population. If not, in the end it can be counterproductive to introduce new products while the old ones are being rejected. I am now participating in a new European vaccination project which recently began. It is studying the research projects in which I participated with the aim of deciding which should be used to design new policies which can help these populations understand the importance of prevention and want to receive vaccines.
 
Here in Spain a judge ruled in favour of a city council which did not accept the enrolment into a public nursery of a child who was not vaccinated.
 
The vaccines included in the children vaccination schedule are all effective, safe, and not only protect the children but also the whole population. Vaccines are a public health tool necessary to keep societies healthy, and therefore I believe it is legitimate for society to protect and oblige all infants in general to be vaccinated, in order to protect those who cannot be for medical reasons. In France, eleven vaccines are mandatory since the 1980s. There were and still are anti-vaccine groups, but I have not heard much from them since the law was passed. Before some vaccines were mandatory and some only recommended, and the population did not understand why there was a difference. Essentially it is better to make it mandatory because that makes the vaccination policy clearer.
 
So you find the judge ruled correctly?
 
Each country must decide on what it wants and that is part of the democratic process. I don't have a positive or negative answer. But if the vaccine coverage truly were beneath the threshold of what is considered necessary, as we saw in Switzerland with measles, or if the life of dozens of children were at risk, because many parents were against vaccines, then we would need to do something. Of course you cannot force parents to vaccinate their children, but there can be a law stating that non vaccinated children cannot go to public schools. There is a huge discussion on the flu shot, for example. Must it be mandatory for healthcare professionals? In some countries it is and in others it is not. At the Geneva hospital, for example, if these professionals do not get the shot they must wear a mask during their shirt and for the entire flu season.
 
What infectious diseases must we urgently tackle?
 
There are three pandemics which are still very important around the world: HIV, tuberculosis and malaria. There has been progress however, mainly with the HIV virus in which 60% of those affected are receiving treatment. There has also been advances in tuberculosis, but less in malaria, where there was a decrease in the disease but it is now returning.
 
If we talk about epidemic diseases, the WHO set up an evidence-based list, which they update yearly, in which they study the risk of epidemic, mortality and transmission routes of the main diseases. Among these are Ebola, Lassa fever, and the severe acute respiratory syndrome (SARS). The list serves to design research plans and develop, in the case of an epidemic, the diagnosis, drugs and vaccines which will be necessary.
 
I think we must be very careful, because the global climate change and close contacts between wildlife and humans make the risk of new diseases which are passed from animals to humans increasingly likely.