This year COVID-19 has shone a spotlight on the issue of access like never before, or at least not since the early days of the HIV epidemic, which of course was the spur for the creation of the Medicines Patent Pool. It is now so clear that leaving low- and middle-income countries (LMICs) behind is not just a cost, both human and financial, to those countries, it’s a cost to the whole world. Access is finally taking centre stage. Access is not optional: it’s crucial. Things are improving. Vaccines are finally reaching LMICs, albeit not yet in the numbers required for good coverage of a full course, let alone boosters. And in the last four months of the year, we signed five new licences – two for COVID-19 therapeutics and one for a COVID-19 diagnostic, as well as two for long-acting technologies.

The two COVID-19 licences, one for MSD’s drug molnupiravir and the other for Pfizer’s drug now named nirmatrelvir, are particularly important because they are the first drugs for use outside a hospital setting. Because they are oral medicines and therefore easy to take and because they are likely to be easy to manufacture and therefore cheap, all of which make them extremely suitable for people in LMICs, which is of course where the vaccine coverage still lags. The geography covered by each licence means that more than four billion people should have affordable access to potentially life-saving medicines.

In addition to these firsts, the licence for the COVID-19 diagnostic from CSIC, the Spanish National Research Council, is the first licence for C-TAP, the World Health Organization (WHO) COVID-19 Technology Access Pool. MPP provides the licensing expertise to this initiative and holds the licences. We have also launched our first vaccine patent and licensing database, VaxPaL devoted to COVID-19 vaccines.

Addressing access in the short term is urgent, but it cannot detract from the need to address systemic issues. One of those has been the lack of local production of vaccines in LMICs, especially in Africa. So, we were delighted to be asked by WHO to co-lead with them the part of the COVAX Vaccine Manufacturing Taskforce that will support the transfer of needed technology to LMICs to allow them not only to start manufacturing vaccines for this pandemic but also to possess the know-how to do so for the next one. This involves setting up a global technology and training hub in South Africa, establishing the technology (mRNA) there and then making it available to other LMICs. WHO realised that our experience and expertise in public health licensing will be critical for in-licensing technology to the hub and then out-licensing it to the recipients. This technology transfer hub project is well underway with the first three recipients already selected, one in South Africa, one in Argentina and one in Brazil. A selection process for further recipients is happening now.

Keeping the focus also on access in the rest of health

COVID-19 is a huge challenge in itself, but it is also a huge challenge for access to health. Even so, MPP’s licensees supplied over 4.21 billion doses of treatment in the first six months of the year, bringing the total number of doses supplied to an extraordinary 22.76 billion by June 2021 across the 148 countries included in our licences. As an example of what this access means to people living with HIV, I invite you to read this story from Chad. Since September, four upper-middle-income countries have also started to receive their first supplies: Azerbaijan, Belarus, Kazakhstan, and Malaysia, thanks to a  bespoke licence that allows affordable access. On 1 December, we marked World Aids Day and yet another reminder that we still have an epidemic, that our fight against HIV is not over.

Children are too often one of the groups most in need of access and most threatened by its lack. In May, the first generic version of the paediatric formulation of dolutegravir (DTG) as a 10 mg scored dispersible tablet was ready to be supplied through MPP’s generic partner Viatris, and already 29 countries have received their first doses. Macleods has also started to supply treatments. MPP remains committed to ensuring no child in LMICs is left behind when it comes to adapted quality treatments.

In September, WHO published its revised essential medicines list; despite welcome additions, it highlights the lag for cancer treatments in LMICs due to various access barriers. In particular, it called on MPP to intervene using our licensing model to reduce prices. Prices, however, are only one of the barriers. Our partnerships with the Union for International Cancer Control, the International Diabetes Federation and the World Heart Federation have become essential in addressing these other barriers. Access is not about affordable drugs per se; it’s about affordable drugs in the hands of the people who need them.

Looking ahead at new innovations

At MPP, we are also looking ahead to tomorrow’s treatments and prevention methods. The dapivirine ring shows excellent promise in HIV prevention in women, as Zeda Rosenberg unpacks its potential in an interview we did earlier this year (read more). In December, we signed a licence agreement with the University of Washington for an investigational long-acting injectable drug combination candidate for HIV treatment, offering hope for alternative treatment delivery methods. We also signed a licence with Tandem Nano, the University of Liverpool start-up, focused on developing its proprietary long-acting nano-technology platform that could be applied in three disease areas with a high prevalence in LMICs: malaria, tuberculosis, and hepatitis C. The long-acting space holds great promise for the future.

A model that works

In October, the Lancet Public Health published a modelling study of two important MPP licences (DTG for HIV and daclatasvir for hepatitis C). Based on MPP’s existing portfolio, the revised methodology estimates that MPP will have saved the international community an estimated USD3.5 billion by 2030.

We can only do all this because of our partners 

This has been a year of huge change for MPP, not least because of the much greater focus on access and voluntary licensing to address the problems that COVID-19 has illustrated so starkly. MPP is a small organisation in the global public health space. Yes, we punch well above our weight, but that is only because of the huge range of partnerships we enjoy – with civil society, with governments, with UN agencies, with other international organisations, with industry, both originator and generic, with academia and in particular with our funders, some of them funding us for the first time this year. I want to thank all of you who have worked tirelessly with us this year. I also want to thank the MPP Board and our Expert Advisory Committee, who have been repeatedly called upon to make decisions with the tightest deadlines, and also our Scientific Advisory Panel, whose expert advice continues to guide us.

I look forward to working with every one of you in 2022.

Charles Gore