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Melissa Barber

@mbarber.bsky.social
2.6K followers 430 following 347 posts

Health economics, law, global health, and access to medicines. Economist @ MSF-USA but views my own. melissajbarber.github.io.

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Melissa Barber @mbarber.bsky.social · 28/07/2026
If you're here and want to chat drug economics and access, please say hi!
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Melissa Barber @mbarber.bsky.social · 28/07/2026
MSF is here continuing to call for Two shots, $40, Everywhere. If you want to learn more about the sorry state of access to long-acting PrEP, please attend our session “Where's my lenacapavir? How to break monopolies and end the HIV epidemic” on Thursday, 12:00-13:00 in room 202.
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Melissa Barber @mbarber.bsky.social · 28/07/2026
In Rio for #AIDS2026. Gilead has put up more promo banners than it has allowed people in Brazil to access lenacapavir. It's a grim echo of past AIDS conferences: we celebrate scientific breakthroughs inside a conference center while people outside still can't access the medicines being discussed.
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Melissa Barber @mbarber.bsky.social · 22/07/2026
The peculiar situation of Gilead not selling HIV drugs to MSF has been hard to explain: "Wait, the drug company doesn't want cash money, what am I missing?" is the constant q I get from journalists. Thanks to #tbfighters who are finding ways to explain in sharp (& very funny) ways what's happening.
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Celeste Moss @celestevmoss.bsky.social · 17/07/2026
YEZTUGO (lenacapavir) is a new injectable form of long-acting PrEP that only requires 2 doses per year to prevent HIV infection, and 3 million people are expected to get access to the drug by 2028 via The Global Fund. Sounds great, right? (1/5)
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Melissa Barber @mbarber.bsky.social · 22/07/2026
And your semi-regular update: this podcast is being released 113 days after MSF went public with Gilead's refusal to sell lenacapavir to us, at any price. We have clinics ready to use this drug today but can't, because Gilead has said no and currently has complete control over global supply.
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Melissa Barber @mbarber.bsky.social · 22/07/2026
We dig into market segmentation beyond patents, a worrying trend toward draconian supply chain controls, post-trial access, and why the credible threat of being able to manufacture or purchase non-originator supply is ultimately what gives countries leverage to negotiate prices and licensing terms.
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Melissa Barber @mbarber.bsky.social · 22/07/2026
Some folks (including me) spoke w/Tracy Swan and the Make Medicines Affordable pod abt lenacapavir. Come for a deep dive into Gilead’s VL. Stay for a broader (occasionally 🌶️) convo abt how VLs don't just determine access today, but shape generic markets tomorrow. open.spotify.com/episode/5Klc...
open.spotify.com
Exploring Access Barriers to Lenacapavir Created by Gilead's Voluntary Licnese
Make Medicines Affordable · Episode
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Thiru Balasubramaniam @thirugeneva.bsky.social · 21/07/2026
The minutes of the TRIPS Council meeting in April 2026 documented heated exchanges on the triplets: biodiversity, traditional knowledge and patenting of life forms. For more background on the 719 document, please see: www.keionline.org/40837 @wto.org
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Melissa Barber @mbarber.bsky.social · 20/07/2026
I'm not saying revoking strict patentability criteria is bad for your odds of winning the World Cup, and mandating drug price transparency is good for them. But I'm not *not* saying it.
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Melissa Barber @mbarber.bsky.social · 28/06/2026
Doctors Without Borders is at NYC Pridefest (4th Ave & 13th St) talking abt our campaign demanding global access to lenacapavir: Two Shots, $40, Everywhere. If you’re at pride, stop by! So far 100 folks have written postcards to Gilead abt why they believe in global access. Let’s get to 1000!
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Melissa Barber @mbarber.bsky.social · 24/06/2026
MSF technical brief on diagnostics for Bundibugyo Ebola disease: msfaccess.org/The-diagnost...
msfaccess.org
The diagnostic blind spot in the 2026 Bundibugyo Ebola disease outbreak: access gaps and priority actions
A technical briefer sharing gaps and access priorities to ensure access to right diagnostics for Bundibugyo Ebola virus outbreak in DRC and Uganda.
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Melissa Barber @mbarber.bsky.social · 24/06/2026
Hoping someone across my network (or yours - please share!) knows an ingenious diabetes campaigner looking for a 12-month contract with MSF, with the possibility of extension. JD is defined more broadly, but campaigning on insulin will be central. July 3 deadline. www.msf.org/internationa...
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Melissa Barber @mbarber.bsky.social · 08/06/2026
👀 indeed.
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Adam R Houston @healthlawadamh.bsky.social · 08/06/2026
👀"Drugs for Neglected Diseases initiative (DNDi), the GARDP Foundation, and Medicines for Malaria Venture (MMV) join forces to accelerate drug development for patients in greatest need" 🔬🧪💊💉🤝 dndi.org/press-releas...
Screenshot from the link reading "Geneva — 8 Jun 2026
The three non-profit research and development (R&D) organizations have signed a strategic cooperation agreement to explore opportunities to pool resources and maximize their impact amid global aid cuts and calls to reform the global health architecture.

Three non-profit R&D organizations—the Drugs for Neglected Diseases initiative (DNDi), the GARDP Foundation (known as GARDP), and Medicines for Malaria Venture (MMV)—have signed a cooperation agreement to explore how they can further pool their expertise and resources to strengthen the efficiency and coordination of their activities, with the ultimate goal of accelerating the development of life-saving treatments for patients who need them most.

The areas to be explored will focus particularly on R&D. The three organizations—known as product development partnerships, or PDPs—will also strengthen joint policy advocacy and communications activities to raise awareness of their alternative, non-profit drug development model.

Through this initiative, the three organizations aim to maximize the impact of limited global health R&D resources and show global leadership as calls to reform the global health architecture multiply. Equitable medical innovation, driven by patient needs, must be at the core of the future global health architecture, and economic incentives alone will not suffice to deliver the innovations or the equitable access patients urgently need."
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Thiru Balasubramaniam @thirugeneva.bsky.social · 06/05/2026
Voluntary contributions to the General Fund of WHO in 2025. Gates Foundation - $321,652,415 European Commission - $250,754,314 Gavi, the Vaccine Alliance - $295,771,914 Germany - $140,992,167 United Kingdom - $76,328,886 Canada - $58,089,144 India - $47,325,703 China - $2,960,515 #WHA79 @who.int
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Adam R Houston @healthlawadamh.bsky.social · 29/04/2026
👀 "Canada becomes the first G7 country to approve a generic version of #semaglutide" www.canada.ca/en/health-ca...
Screenshot of the linked press release
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BK. Titanji @boghuma.bsky.social · 29/04/2026
A major serogroup C meningitis outbreak is unfolding in Chad, amid mass displacement driven by war in Sudan. It deserves far more attention than it is getting. Since Jan more than 1,500 patients have been admitted to isolation units amid meningitis C & measles. www.msf.fr/communiques-...
msf.fr
Tchad : MSF alerte sur une double épidémie de rougeole et de méningite dans l’est du pays
Alors que des milliers de personnes fuyant la guerre au Soudan se réfugient dans l’est du Tchad, les équipes de Médecins Sans Frontières (MSF) font face à une double épidémie de rougeole et de méningi...
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Judy Stone @drjudystone.bsky.social · 17/04/2026
Gilead's battle with Médecins Sans Frontières (MSF) and plans for limited access to #Lenacapavir raise disturbing questions about #ResearchEthics and who a corporation is responsible to. My latest: www.forbes.com/sites/judyst... #ClinicalResearch #AccessToMedicines #Bioethics
forbes.com
Breakthrough HIV Drug Is Out Of Reach For Many Who Need It Most
Lenacapavir, almost 100% effective at preventing HIV, is priced by Gilead at $28,200 and inaccessible to many in low-income countries plagued by the disease.
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Melissa Barber @mbarber.bsky.social · 16/04/2026
@gregggonsalves.bsky.social: "The policy by Gilead is delay and deflect—it’s disingenuous, manipulative and will cost lives..In the end Gilead sees one audience for what it is doing, its shareholders, & maximizing share prices is more important to them than the lives of people around the world.” 4/4
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Melissa Barber @mbarber.bsky.social · 16/04/2026
@gregggonsalves.bsky.social: “This drip-drop, slow-walking approach to LEN access is again evident in Gilead’s refusal to sell LEN to Doctors Without Borders, telling them to go ask the Global Fund, when the supply availability through the Fund is limited and way below need in LMICs." 3/4
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Melissa Barber @mbarber.bsky.social · 16/04/2026
Forbes: "If corporations’ sole responsibility is to shareholders, that leads us to the question Ugandan researcher Peter Mugyenyi asked at the 2000 AIDS Conference, “Where are the drugs? The drugs are where the disease is not. And where is the disease? The disease is where the drugs are not.”2/4
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Melissa Barber @mbarber.bsky.social · 16/04/2026
As a pharma company, you know your position is morally indefensible when even business publications like Forbes are scathing about your refusal to supply HIV drugs to MSF and much of the world, while charging the few you do sell to exorbitant prices. 1/4 www.forbes.com/sites/judyst...
forbes.com
Breakthrough HIV Drug Is Out Of Reach For Many Who Need It Most
Lenacapavir, almost 100% effective at preventing HIV, is priced by Gilead at $28,200 and inaccessible to many in low-income countries plagued by the disease.
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Melissa Barber @mbarber.bsky.social · 13/04/2026
Do I know anyone who has recently done a MSc Politics and International Relations at SOAS? Asking for a friend who is looking into the program and has some questions. thank you!
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Melissa Barber @mbarber.bsky.social · 08/04/2026
I'll be speaking on goods in transit issues at the Fordham University School of Law IP and Policy Conference this week. Glad to connect with others working on all things pharmaceutical - feel free to reach out.
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Melissa Barber @mbarber.bsky.social · 07/04/2026
"Companies sought...to reduce budgets for scientific & policy activities carried out by WHO, to pit other UN agencies against WHO, to convince developing countries that WHO’s tobacco control program was a “First World” agenda...to distort the results of important scientific studies on tobacco." 5/5
publichealthlawcenter.org
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Melissa Barber @mbarber.bsky.social · 07/04/2026
Some excerpts: "In their campaign against WHO, the documents show that tobacco companies hid behind a variety of ostensibly independent quasi-academic, public policy, and business organizations whose tobacco industry funding was not disclosed." 4/5 www.publichealthlawcenter.org/sites/defaul...
publichealthlawcenter.org
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Melissa Barber @mbarber.bsky.social · 07/04/2026
Also recommend a banger of a report - "Tobacco Company Strategies to Undermine Tobacco Control Activities at WHO." There are multiple chapters on scientific misdeeds alone, not to mention surveillance. 3/5 www.publichealthlawcenter.org/sites/defaul...
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Melissa Barber @mbarber.bsky.social · 07/04/2026
"Efforts to deny & distort the scientific evidence of smoking's harms are demonstrated by not only decades of press releases, reports...& scientific symposia & publications, but also by evidence of their concerted efforts to attack & undermine the studies in mainstream scientific publications." 2/5
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Melissa Barber @mbarber.bsky.social · 07/04/2026
Is the Philip Morris currently on an advertising blitz to 'free the science' the same one that DOJ described as having "suppressed research, destroyed documents... distorted the truth, and abused the legal system"? 🤔❓😠 See DOJ summary of U.S. v. Philip Morris www.justice.gov/osg/brief/ph... 1/5
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Melissa Barber @mbarber.bsky.social · 03/04/2026
This is concerning but the impact is hard to gauge without detailed guidance defining how 'ingredients' and 'onshore' will be implemented in practice. www.whitehouse.gov/fact-sheets/...
whitehouse.gov
Fact Sheet: President Donald J. Trump Bolsters National Security and Strengthens U.S. Supply Chains by Imposing Tariffs on Patented Pharmaceutical Products
BOLSTERING NATIONAL SECURITY: Today, President Donald J. Trump imposed tariffs on patented pharmaceuticals and their ingredients under Section 232 of the
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Asia Russell @asia-ilse.bsky.social · 31/03/2026
Gilead spends millions on PR to make 2 million doses sound like something other than the pittance it is. 2 million will have virtually no impact, see the green line below >>
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Asia Russell @asia-ilse.bsky.social · 31/03/2026
20 million people need PrEP, and of those many would prefer lenacapavir to oral options. Unless Gilead makes more doses available, access will just remain cruel hype. Already in Eswatini, where HIV prevalence is 25%, clinics are stocked out of lenacapavir because demand is so great >>
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Melissa Barber @mbarber.bsky.social · 30/03/2026
In 2027! But the drug is needed today.
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pharmalot.bsky.social @pharmalot.bsky.social · 30/03/2026
Doctors Without Borders calls Gilead ‘unconscionable’ for refusing to sell HIV prevention drug to organization.. statnews.com/pharmalot/20... #pharma #HIV #AIDS #pharma #Gilead
statnews.com
Doctors Without Borders calls Gilead 'unconscionable' for refusing to sell HIV prevention drug to organization
The move came after months of talks in which Doctors Without Borders asked Gilead Sciences for a “limited” supply of lenacapavir.
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Melissa Barber @mbarber.bsky.social · 30/03/2026
I've walked thru the economic logic here, but Gilead obviously does not say this out loud. They don't really have a good reason not to sell to MSF, which is why they landed on negotiating supply contracts is "a lot of work" (actual thing they said). 13/ www.doctorswithoutborders.org/latest/preve...
doctorswithoutborders.org
Open letter to Gilead: Prevention should not be a privilege
MSF calls on Gilead for direct access to lenacapavir, as the current rollout falls far short of the needs.
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Melissa Barber @mbarber.bsky.social · 30/03/2026
I've walked thru the economic logic here, but Gilead obviously does not say this out loud. They don't really have a good reason not to sell to MSF, which is why they landed on negotiating supply contracts is "a lot of work" (actual thing they said). 13/ www.doctorswithoutborders.org/latest/preve...
doctorswithoutborders.org
Open letter to Gilead: Prevention should not be a privilege
MSF calls on Gilead for direct access to lenacapavir, as the current rollout falls far short of the needs.
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Melissa Barber @mbarber.bsky.social · 30/03/2026
Theoretically yes, there are a few pathways. But they require nat'l authorities (not MSF) actioning CLs, which takes time (as well as time to develop the drug). In territories where Gilead has granted a VL, generics are preparing to launch, but this isn't expected until at least next year.
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Melissa Barber @mbarber.bsky.social · 30/03/2026
Even if Gilead would likely make at least a 100% profit selling to a LIC for $80, it becomes politically incredibly difficult to justify your $28,000 price tag in the US. Here's a clip of the BIO lobby saying just this in a USITC hearing. 12/
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Melissa Barber @mbarber.bsky.social · 30/03/2026
You also have to think about price pressure: HIV is Gilead's core business, and despite the HIV burden not being heaviest in the US, 81% of Gilead's revenue comes from the US alone (bc prices are so high, even if volumes are low.) 11/
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Melissa Barber @mbarber.bsky.social · 30/03/2026
But you have to think abt a potential sale in terms of their portfolio: a 10,000% markup sounds good, unless your other drugs that are vying for time and space on production lines yield you a 70,000% markup. This is why drug companies outsource manufacturing, engage in licensing deals, etc. 10/
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Melissa Barber @mbarber.bsky.social · 30/03/2026
To understand this, you have to think about opportunity costs. Gilead told us in meetings that they expect prices to fall below the $40/year price generics have offered - this isn't an expensive drug to manufacture. 9/
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Melissa Barber @mbarber.bsky.social · 30/03/2026
At this point, I'm taking of my MSF hat and putting on my academic economist hat to step back and try to make sense of this for folks. (Again, to be clear - this is speculation about markets and I do not speak for MSF). Why would a pharma company like Gilead forego a profitable sale? 🤔8/
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Melissa Barber @mbarber.bsky.social · 30/03/2026
The focus of critiques about pharmaceutical monopolies is generally on PRICE. But this case is a compelling example for problems of SUPPLY: it's not a great world when one company controls global supply of a drug and can just refuse to sell it to people who need it. 7/
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Melissa Barber @mbarber.bsky.social · 30/03/2026
This situation is extra bad because it's not that Gilead isn't interested in markets in the rest of the world - they have filed for patents and signed licenses blocking dozens of countries from accessing future generic supply. 6/
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Melissa Barber @mbarber.bsky.social · 30/03/2026
I expect at this point you are muttering to yourself, "there must be some rational explanation." We thought so too. Which is why we tried & tried again before going public, in the hope that shame still exists and Gilead can be persuaded to do what pharma companies are supposed to do: sell drugs. 5/
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Melissa Barber @mbarber.bsky.social · 30/03/2026
Here's where things get weird: Gilead is refusing to sell lenacapavir to MSF. In a series of meetings, Gilead communicated that they're just not really interested in selling lenacapavir in most of the world beyond the cap. Depending on estimates, this cap = between 0.5% and 10% of global demand. 4/
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Melissa Barber @mbarber.bsky.social · 30/03/2026
Here's where MSF comes in. We have a long history of offering HIV treatment and prevention services. We have a long history of buying drugs from Gilead. We were not expecting this to be complicated: they have a drug, we want to buy it, thanks to our donors we have money to pay, etc etc. 3/
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Melissa Barber @mbarber.bsky.social · 30/03/2026
Lenacapavir is a twice-yearly, long-acting HIV prevention tool, and represents one of the most promising advances towards ending AIDS. In the rich world, Gilead charges $28k/year for the drug. In the rest of the world, Gilead has capped supply at just 2 million ppl over 3 years. 2/
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Melissa Barber @mbarber.bsky.social · 30/03/2026
Today, MSF is going public with something we've been fighting behind closed doors for months: Gilead will not sell us their new HIV drug, lenacapavir. The sticking point isn't even price, they just refuse to sell. Open letter linked + explainer 🧵1/ www.doctorswithoutborders.org/latest/gilea...
doctorswithoutborders.org
Gilead refuses to sell groundbreaking HIV prevention drug to MSF
Blocking humanitarian organizations from accessing a medical breakthrough puts vulnerable people across the world in danger.
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