Médecins Sans Frontières (MSF) is an organisation treading a fine line between providing humanitarian assistance while remaining neutral and being vocal against injustice and suffering when it feels governments and business have failed the patients it is caring for. Richard Forster spoke to Jérôme Oberreit, MSF’s Secretary General, about the funding needed to avoid further pandemics and the organisation’s latest campaign to stop Pfizer preventing access to affordable drugs in India
In terms of Médecins Sans Frontières (MSF’s) funding, a remarkable 89 percent of the organisation’s €1.28 billion income in 2014 came from individual public donations. Has there been a conscious decision to avoid lobbying donor governments in order to maintain political independence? What policies do you apply to the funding which you will accept from governments or business?
Médecins Sans Frontières (MSF) does lobby donor governments but we don’t focus on the money. It is our financial independence that allows us the freedom to put pressure on governments to respond to crises. In those cases where we do take government funding, for example for HIV, we try and encourage them to fund specific projects or we advocate for guidelines to be amended or national protocols on certain health issues to be implemented.
Receiving funds does not guide our response on the ground, nor does it influence our decision-making. What MSF does is controlled by MSF. We do accept private funds allocated to a specific crises, but only for as long as it can be absorbed by what we are doing on the ground. After the 2004 tsunami, when we realised that restricted funds were higher than needed for our operational response, we issued a public statement requesting that people stop giving us money. We then contacted people who had donated to us for this specific response asking them if they wanted us to return their donation or if it could be used to fund other projects.
MSF has policies for both institutional (governments) and corporate donors, and the main principle is that accepting funds will not compromise MSF’s mission. Our principles guiding these policies are that receiving funds cannot compromise the security of our patients or staff, that MSF does not accept funds from donors with strongly diverging positions from MSF (in particular on issues linked to our medical practice) or when there would be contradictions with MSF objectives. These principles are used to define which institutional donors and corporate sectors we don’t accept funds from, and which are acceptable in certain contexts/countries or type of operational response.
With a reliance on nearly 6 million individual donors, MSF devoted 14 percent of its budget (€147 million) to bringing in income. Which of your fundraising efforts are the most successful? How has digital technology and social media affected those efforts?
In 2014, around 50 percent of the income received from individuals (almost €1 billion) came from either regular donors or planned giving (legacies). We feel that the measure of our success is in part through the number of regular donors–in 2014, 45 percent of the 5.6 million individuals who donated to MSF were regular donors. This also allows MSF to raise unrestricted funds, and in 2014, 79 percent of the income raised was unrestricted. Unrestricted funds are very important as they allow us to react to any emergency from the moment it happens, as well as enabling us to work in places with acute needs that are forgotten crises. For regular donors the main acquisition channel is face-to-face and door-to- door fundraising. There are also online registered regular donors and this is the acquisition channel that is growing the most.
For one-off donors, the leading channel continues to be mail fundraising with online in second place. Online is growing significantly but it is still far behind mail.
You ascribe the unprecedented 27 percent increase in individual donations in 2014 to public reaction to MSF’s high-profile role in the Ebola crisis. One of the reactions to that crisis has been the World Bank’s proposal for a Pandemic Emergency Facility as a financing mechanism, which could be triggered to contain the human and financial costs of an outbreak like Ebola. What are your feelings on the facility and how can the international community prepare itself better in terms of mobilizing and releasing funds for such emergencies?
Following the Ebola outbreak in West Africa, there have been numerous discussions on improving the rapid availability of flexible funds to respond to these types of health emergencies of international concern and the World Bank’s “Pandemic Emergency Facility–PEF” is one of the tools proposed to tackle this issue. From MSF’s perspective, and based on our experience during the Ebola outbreak in West Africa, it is important to keep in mind that the trigger and design of the response, including various financing options, should retain both the public health and individual patient perspective at its core. Any financing mechanism that provides incentives for governments to declare and quickly react to contain health threats is welcome, as are any financial contributions supporting health system strengthening and preparedness before an outbreak occurs.
The international community is making additional efforts in preparing and mobilising funds for health-related emergencies. For instance, the Global Health Security Agenda (GHSA) focuses on improving local capacities on specific areas like national surveillance systems and how to best implement the International Health Regulations (2005), mainly in the hope of containing transmission in countries that demonstrate vulnerability in these technical capabilities. However, what we continue to see is that even if funds were to be quickly available, even if more importantly there was clear political will and financial incentives to declare and respond to an outbreak, even with improvements of surveillance systems, local and international responders still lack the appropriate tools to diagnose, treat or vaccinate populations. In the last 40 years, MSF has experienced this in our responses to Ebola outbreaks, and we continue to observe that challenge in responding to other communicable diseases. Thus, there is an urgent need for the international community to review the way Research & Development models work and are financed when it comes to neglected diseases. Only by keeping the global health perspective and the needs of people at the core of these discussions can we collectively improve the management of global health threats.
Donors like the UK’s DFID have used Development Impact Bonds to raise funding for healthcare research and attract private investors who are seeking a social as well as financial return on investment. How significant do you think the focus on impact investing and social finance is in terms of bringing more private investment into development finance? What are the biggest challenges to tapping into private pools of capital for projects?
While not in a position to comment on the required financial architecture needed for states to fulfil their national obligations and international commitments, MSF is nevertheless interested in looking at new avenues for fundraising. The problem we see with this kind of approach is that personal interest will gain too much influence. Whilst philanthropy has its place, we are wary of being subject to the ideas of wealthy individuals who want to guide where money goes. Reponses should be patient-driven and not dictated by private investors.
From its foundation in 1971 through the 1990s, MSF has debated whether it should have a role on a political level even calling for military force in Rwanda in 1994 but it now has a clear policy of independent and impartial assistance free from political agendas. Despite this, MSF continues to criticise governments like France over the handling of refugees. Does your policy mean there is a line drawn between certain countries in terms of who you are prepared to bring to account?
MSF has always engaged with political realities, for example when negotiating access. Part of our role through what we call témoignage, or witnessing, is not only to highlight the hard realities faced by those we seek to assist but also to point to the failure of those states and institutions with direct responsibility to provide essential humanitarian assistance to those in need. We do this, however, on a case-by-case basis. We need to find a balance between our ability to assist and access people, and our need to speak out. We are vocal when we feel our voice, combined with our action, makes a difference and we always keep those we seek to assist at the forefront of our minds. We raised our voice about Ebola, about the bombing of our hospital in Afghanistan and most recently about the violence in Syria. We use this voice as leverage, aiming to maintain or provide access to patients and in the worse cases to denounce when we witness lack of access or total disrespect for human life.
Humanitarian action must be driven by the needs of people and cannot be dictated by the security interests of states. The reality is that the security agenda was in large part to blame for the ill-adapted Ebola response. Rather than being driven by patient concerns, there was little interest in intervening until Ebola became a direct threat. The same drivers are today pushing states to develop border protection policies (for example, the recent Turkey–EU agreement) that do not take into account the need to help protect individuals fleeing some of the most brutal wars of our time.
MSF originally was set up to provide emergency humanitarian aid but has just announced that it is fighting Pfizer the multinational drug company over patent registrations in India. While the merits of the challenge can be understood, is this an appropriate role for MSF given questions of neutrality and interference in a commercial market? Is there a danger of spreading yourself too thin in taking on complex legal cases when time and resources could be devoted to more humanitarian assistance?
By the very nature of the humanitarian medical work we do and the context and places in which we work, MSF–as an independent organisation–has an obligation to speak and act on these issues. I think then-MSF President Dr James Orbinksi said it best back in 1999, when MSF accepted the Nobel Peace Prize:
“Some of the reasons that people die from diseases like AIDS, TB, sleeping sickness and other tropical diseases are that lifesaving essential medicines are either too expensive, are not available because they are not seen as financially viable, or because there is virtually no new research and development for priority tropical diseases. This market failure is our next challenge. The challenge, however, is not ours alone. It is also for governments, international government institutions, the pharmaceutical industry and other NGOs to confront this injustice. What we as a civil society movement demand is change, not charity.”
MSF’s Access Campaign–a technical and advocacy unit within MSF that campaigns on these issues– was established with the prize money from the Nobel Peace Prize for exactly this purpose. The work of the Access Campaign is complementary to our work in the field and seeks to ensure that the people we treat have access to essential medicines, and staff are not continuously put in a position of watching people die due to the indifference of the commercial system.
MSF took this action against Pfizer in part because Pfizer is seeking a patent for the vaccine that we feel is not merited and which is nothing more than an abuse of the patent system. More fundamentally, MSF is taking this action because MSF is facing the unacceptable situation where, in emergency humanitarian settings, we’re seeing children die from a vaccine-preventable disease– because the vaccine that could save their lives is not affordable.
MSF won the Nobel Peace Prize for being a pioneer in terms of providing emergency humanitarian assistance, setting up healthcare systems in ravaged countries, and providing drugs including at no cost to patients. What have been the biggest achievements in your 22 years with MSF?
In the late 1990s and early 2000s, MSF witnessed first-hand the toll HIV and Aids were having on patients and communities in lower- and middleincome countries and, working closely with activist organisations, implemented operations to treat patients with sometimes illegally imported drugs and advocated for price reductions for antiretroviral (ARV) medication. This was a pivotal contribution to steering the political momentum towards a global increase in ARV provision. Over the years MSF has also worked to find ways to decentralise care for HIV and other diseases such as tuberculosis, to give patients more autonomy, to make access to care easier for them and to help them adhere to their treatment.
Despite haemorrhagic fevers being an uncommon occurrence, MSF retained the know-how about how to manage them by staying alert to populations affected by what remained small and contained outbreaks. It was this ability that enabled us to respond in the way we did when faced with the recent Ebola epidemic. That’s not to say that the response was easy–we had to contend with not being able to access everyone who needed medical care and we lacked the tools to diagnose and more importantly to treat our patients.
We have also maintained at the core of our response the ambition to provide care for those people caught in conflict. We treat people based on need alone, irrespective of political affiliation–something which has not been easy within the reality of the so-called ‘war on terror’.
With the organisation now active in patent disputes, do you envisage other roles where MSF could have an impact or do more? What are the biggest obstacles to expanding your mission and impact?
Access to patients is one of our biggest obstacles, as well as a lack of recognition of individual needs. Refugee rights are being ignored, conventions are not being adhered to. There is also the issue of security and the targeting of medical structures, in Afghanistan, in Syria and in Yemen.
As for our role, we have a self-given mandate to provide core humanitarian and medical aid. We provide for those not being provided for, and at the moment we foresee a lot of work for ourselves! Depending on the needs of our patients, however, we may in the future see that establishing something like our Access Campaign is required to address new emerging challenges.
Jérôme Oberreit has been Secretary General of Médecins Sans Frontières (MSF) since September 2012. Jérôme joined MSF in 1994, and has worked in Kenya, Sierra Leone, Somalia and Palestine. In 2001, he began working in programme management at MSF’s operational directorate in Brussels, becoming director of operations in 2006. Jérôme has developed particular expertise in working in conflict settings, and in managing HIV programmes. He has degrees from London University and California State University. Jérôme has been MSF Secretary General since 2012.