Hi,

We are beginning to contend with 2025 as a fairly disastrous year for global health (and beyond). Even as public health leaders and communities, are picking up the pieces of the old order, there are signs of how much worse things can go from a systemic perspective.

Take the fight to break down opacity in global health - for example.

This was supposed to be the “come-back” year for the transparency agenda. Instead, what we saw over the summer in Europe, was Politico’s revealing report on how one of the flag-bearers of the access to medicines movement had undermined transparency principles.

In today’s edition, my colleague Vineeth explains how we should read the significance of MSF’s decision to sign non-disclosure agreements with some companies, and what this means for the broader fight for meaningful transparency in pharmaceutical markets, and indeed global health.

We hope you find this analysis useful and thought-provoking in deconstructing a key moment in the prevailing power dynamics in the field.

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More soon!

Best,

Priti

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I. ANALYSIS

The Blow to Transparency: How Big Pharma Turned Principles of Médecins Sans Frontières (MSF) Against Itself

MSF's secret non-disclosure agreements reveal the limits of voluntary pharmaceutical accountability

By Vineeth Penmetsa

Priti Patnaik contributed to this analysis

Penmetsa is an India-based legal researcher with a strong interest in health law and global health policy. He is also part of the Geneva Health Files fellowship program.

The pharmaceutical industry’s biggest win perhaps isn’t higher drug prices – it’s turning critics into partners.

Revelations about Médecins Sans Frontières (MSF) signing secret pricing agreements, may not immediately suggest what this contradiction really represents: it shows how drug companies systematically pressure even their strongest opponents into cooperation.

Two months after MSF published the detailed costs of its landmark tuberculosis clinical trial in PLOS Global Public Health - becoming the first organization ever to disclose such data - documents obtained by Politico revealed the same organization had been quietly signing non-disclosure agreements with pharmaceutical companies, including German giant Bayer.

The contradiction is striking.

In April 2025, MSF championed transparency by publishing its US $ 33.6 million TB-PRACTECAL trial costs, declaring that disclosure was "essential for governments, policymakers, researchers, activists, and affected communities to determine affordable prices and ensure equitable access." In June 2025, Politico exposed that MSF had agreed to the very secrecy it publicly condemned.

This reversal reflects a broader crisis in pharmaceutical transparency.

At the World Health Assembly in Geneva in May this year, pharmaceutical secrecy featured prominently across multiple side events portraying the re-emergence of the transparency agenda in global health.

Recent research from advocacy groups show both progress, and alarming reversals in implementing transparency commitments worldwide.