In regions where resources are scarce, a gap between patients and treatment

The approximately 400 New Haven-area residents who stepped into a 48-foot tractor-trailer parked outside the School of Public Health for three days last October entered a world where treatable infectious diseases go unchecked because lifesaving medications are unavailable.

The trailer was home to AccessEXPO, a traveling exhibit that is part of the Access to Essential Medicines Campaign launched in 1999 by the international humanitarian aid group Doctors Without Borders. After almost a year in Western Europe, AccessEXPO attracted nearly 15,000 visitors in the United States between March and November 2002.

Through photographs, text, video, sound, and interaction with medical field volunteers and staff, the exhibit personalizes the crisis in access to essential medicines. Visitors spin a “Wheel of Misfortune” to be “stricken” with one of five diseases—sleeping sickness, kala azar (visceral leishmaniasis), HIV/AIDS, tuberculosis or malaria. A card titled “Your Situation” describes symptoms and concerns, family health history, obstacles to obtaining treatment, and other personal circumstances, such as living and working conditions. Visitors continue through the exhibit, learning about the history and nature of these diseases, their death rates, available treatments, the state of research and development for medicines and a host of other information. A ticking clock underscores the death rates for these diseases: every eight minutes someone dies from sleeping sickness; every 10 minutes someone dies from kala azar; and every minute five people die from AIDS, four die from TB and two children die from malaria. Visitors finish the tour with a “consultation” with a Doctors Without Borders volunteer about “their” disease and prognosis. Before leaving, visitors may sign a petition urging the U.S. government and the Pharmaceutical Research and Manufacturers of America (PHRMA) to make research and development of medicines for neglected diseases a priority.

The World Health Organization estimates that more than 14 million people die each year from infectious diseases, 90 percent of them in developing countries. For people in poor countries, the medicines they require either are too expensive or have gone out of production, often because they’re not considered profitable for sale to poor countries.

Mario Garcia, M.D., M.P.H. ’02, who worked with Doctors Without Borders from 1990 to 1995, assisted with the exhibit at EPH in October. Garcia, who served as a medical coordinator and country manager for health programs in Brazil, Bosnia, Nicaragua and Belize, said the exhibit conveys the gap between research and patients’ needs. He characterized the issue as one of “access vs. excess.” “Pharmaceutical research in Europe and the United States creates prosperity,” he said. “But with this prosperity comes responsibility. You cannot develop products only for the people who can pay.”

The pharmaceutical industry does provide assistance to those in developing countries, according to Jeff Prewhitt, a PHRMA spokesperson, including $1.5 billion in medicines to sub-Saharan Africa in 2001. “We take our charitable responsibilities around the world seriously, and we are heavily involved in a number of philanthropic programs,” Prewhitt said.

AccessEXPO’s tour of nearly 30 U.S. cities included stops at the American Public Health Association annual meeting in Philadelphia, Pa., and the American Medical Students Association convention in Washington, D.C., in March. It will conclude its tour in Washington in May, when the petitions will be delivered.

Commenting on the impact the exhibit may have on public health students at Yale and elsewhere, Garcia said it “shows that there are other needs, other ways to make a difference as a public health practitioner.”