Author Affiliations: Fondation Médecins Sans Frontières, Paris, France.
Drugs offer a simple, cost-effective solution to many health
problems, provided they are available, affordable, and properly used.
However, effective treatment is lacking in poor countries for many
diseases, including African trypanosomiasis, Shigella
dysentery, leishmaniasis, tuberculosis, and bacterial meningitis.
Treatment may be precluded because no effective drug exists, it is too
expensive, or it has been withdrawn from the market. Moreover, research
and development in tropical diseases have come to a near standstill.
This article focuses on the problems of access to quality drugs for the
treatment of diseases that predominantly affect the developing world:
(1) poor-quality and counterfeit drugs; (2) lack of availability of
essential drugs due to fluctuating production or prohibitive cost; (3)
need to develop field-based drug research to determine optimum
utilization and remotivate research and development for new drugs for
the developing world; and (4) potential consequences of recent World
Trade Organization agreements on the availability of old and new drugs.
These problems are not independent and unrelated but are a result of
the fundamental nature of the pharmaceutical market and the way it is
Pécoul B, Chirac P, Trouiller P, Pinel J. Access to Essential Drugs in Poor CountriesA Lost Battle?. JAMA. 1999;281(4):361-367. doi:10-1001/pubs.JAMA-ISSN-0098-7484-281-4-jsc80337