The patient who learned to negotiate with the world.
Highlights:
- Charles Gore turned his experience as a hepatitis C patient into a mission to remove political, economic, and moral barriers to access to medicines.
- Through The Medicines Patent Pool, he negotiates licenses that allow affordable production of patented drugs in low- and middle-income countries.
- Unequal pricing, health system inefficiencies, and high out-of-pocket spending create major obstacles to access.
- Collaboration and negotiation can align the interests of governments, companies, and patients.
- Access alone is not enough. Trust in science and strong engagement from health professionals are essential for impact.
Charles Gore, Executive Director of The Medicines Patent Pool, was diagnosed with hepatitis C and cirrhosis more than 30 years ago. As a patient and later as a representative of other patients, he experienced firsthand how prices, decisions, and the limitations of health systems, in addition to politics, economics, and other factors, determine whether life-saving treatments reach the people who need them. In 2002, he overcame the disease, although with some aftereffects, and since then his work has focused on prioritizing patients.
At the end of the day, what I am doing is bringing medicines to the people who need them.
Charles Gore
With The Medicines Patent Pool, he works to overcome barriers created by drug patents, a task that has earned him recognition as one of the 100 most influential people in the world of health. “At the end of the day, what I am doing is bringing medicines to the people who need them,” Gore explains.
The main barriers to access to medicines are political, economic, and moral, and they are reflected both in government decisions about whether or not to prioritize their purchase, and in prices that prevent many countries from being able to afford them. As Gore explains, a medicine can be scientifically effective, approved, and even classified as essential by the World Health Organization (WHO), and still remain out of reach for a large majority.
While equity does not necessarily mean that the price is as low as possible, it implies “that people have prices that reflect what they can afford to pay.” Insisting on equal prices ignores the economic differences between countries and undoubtedly ends up becoming a barrier to access.
Inefficiencies in the system often push patients to buy medicines out of pocket, transferring costs to individuals and creating additional barriers to care. More broadly, access to medicines reflects collective values: whether they are treated as a shared global responsibility, or made available only after the needs of the wealthiest markets have been met.
We are definitely better prepared than we were.
Charles Gore
That tension became unmistakable during the Covid-19 pandemic. Vaccines were developed at unprecedented speed, yet distribution quickly emerged as the critical bottleneck. Closing that gap is central to Gore’s mission, ensuring the world is better prepared to deliver life-saving treatments equitably when the next global emergency arrives. “We are definitely better prepared than we were.”
“This is how it normally works,” he says as he begins to describe the model of The Medicines Patent Pool, which operates as an intermediary between pharmaceutical innovation and access to medicines in low- and middle-income countries. Its task is to negotiate in order to align the interests, which are often divergent, of governments, companies, manufacturers, and patients. “We have to understand everyone’s point of view and then try to place ourselves in the center to build something that works for everyone.”
The model centers on licensing, which grants other manufacturers permission to produce a patented medicine in different countries. It begins by identifying unmet global needs, guided largely by the WHO list of essential medicines. Patent-holding pharmaceutical companies are then approached to negotiate licenses that allow additional producers to manufacture the drugs, using royalty structures tailored to each country’s income level. Once a license is secured, multiple manufacturers can enter the market, expanding supply and improving access.
What I see is that, while we have focused a lot on patents, I think we will now work equally on patents and technology, and that both will become equally important parts of The Medicines Patent Pool’s toolbox.
Charles Gore
In recent years, this mechanism has been strengthened by incorporating technology transfer, which provides the knowledge necessary to produce it. “What I see is that, while we have focused a lot on patents, I think we will now work equally on patents and technology, and that both will become equally important parts of The Medicines Patent Pool’s toolbox.”
One of the clearest cases of how this model works is dolutegravir, a treatment for HIV. “By discussing it with countries, we reached a price that allowed a royalty high enough to be commercially attractive for the patent holder, but that at the same time allowed countries to truly transition people living with HIV to dolutegravir.” That balance opened the door for different manufacturers to produce the medicine for distribution in African countries, where around 26.5 million people are living with HIV, according to WHO data.
Having a workforce of health professionals fully convinced that science is the way forward.
Charles Gore
However, as Gore warns, access alone does not guarantee an impact on health. It is essential that there be trust in science. If in the future there is a measure that prevents the transmission of a disease, as occurred with the Covid-19 vaccine, but a significant portion of the population rejects it, prevention simply collapses. “Having a workforce of health professionals fully convinced that science is the way forward.” The struggle must be strongest among those who are close to patients, because their attitudes determine the success or failure of public health interventions.
Having been a patient forever changed the way Gore understands his purpose in life. His mission to bring medicines to those who need them reminds us that the question should not be how sophisticated science is or how fast it advances. The real point, in fact, is who it actually reaches.
