The lack of research into diseases that affect most of the world’s poor population is known as the 10-90 gap and it occurs because pharmaceutical companies rarely make a profit when developing drugs for these diseases. Although some countries have created legislation to encourage development of "essential medicines," which are called orphan drugs in the United States, MSF started this campaign in November 1999 to bring more awareness to the issue , and used its prize money from its 1999 Nobel Peace Prize to fund the project .
HIV/AIDS is one major target for this campaign, since the vast majority of those infected live in poor, developing countries, specifically sub-Saharan Africa (see AIDS in Africa), which has 25.4 million people living with HIV, out of a worldwide total of 39.4 million (2004) . The campaign pushes generic production of antiretroviral drugs for treatment of AIDS patients, and it also helps victims pressure their governments to force drug companies to lower their prices. In 2001, MSF mediated an agreement with the Brazilian Ministry of Health, as well as Fiocruz and FarManguinhos (research and drug production companies, respectively) to produce generic antiretroviral drugs at an affordable price for use in poor countries .
Malaria is another major disease faced by sub-Saharan Africa, which sees 90% of the world-wide deaths due to malaria. Although malaria patients do have access to fairly cheap drugs, such as chloroquine and sulphadoxine-pyrimethamine, strains of malaria have developed resistance to these drugs in many severely affected areas . MSF is pressuring governments to fund the development of artemisinin-based combination therapy (ACT), which has been shown to be extremely effective .
Leishmaniasis is extremely rare in the developed world but often occurs epidemically in poor countries, such as Sudan and Bangladesh. It receives very little international attention, but occurs in four different forms (VL (kala azar), CL, MCL, DCL), three of which are very difficult to treat (VL, MCL, DCL), especially when they occur in combination with HIV infection . Cheaply available drugs include pentavalent antimony (sodium stibogluconate), but although effective in some areas, resistance to this drug is increasing, and MSF is pressuring drug companies to increase research and development into new therapies.
Sleeping sickness (human African trypanosomiasis) is currently occurring epidemically in Angola, the Democratic Republic of the Congo and Sudan, but is common in the rest of Africa as well . For advanced cases of the disease, the only available treatment is often melarsoprol, which is extremely dangerous, and increasingly ineffective. In 2000, MSF began a major effort to pressure drug companies to increase research and development for eflornithine and nifurtimox as treatments for the disease .
Meningococcal meningitis epidemics can be largely controlled by large-scale vaccinations when a few cases are detected, meaning that expensive, massive stockpiles of vaccines must be kept on hand during epidemic seasons . MSF and the World Health Organisation are negotiating with drug companies to lower costs of vaccines, and to increase research into long-term immunization and drugs for treatment .
Tuberculosis, although largely unknown in the developed world, kills millions of people in sub-Saharan Africa and southeast Asia . Vaccine and drug therapy exist for tuberculosis treatment, but these drugs are decades old, and MSF is trying to increase research into new vaccines, as well as lower the price for treatment of multiple drug resistant tuberculosis (MDR-TB). The current drug therapy, involving diligent dosage of isoniazid, rifampicin, ethambutol, and pyrazinamide, is difficult for patients to follow, leading to more cases of MDR-TB when patients don’t finish their treatment .
Other conditions, such as Buruli ulcer, must be treated with surgery for excision of the infected part . Trachoma must be treated with a combination of surgery (if trichiasis has occurred) and complicated tetracycline treatment . Many of these diseases, such as tuberculosis, occur with HIV infection as opportunistic infections, complicating treatment further.