The challenge of accessing MS treatment in Yemen

There are several hundred people living with MS in Yemen, and many of them struggle to access disease modifying therapies (DMTs). These treatments are crucial for slowing the progression of the condition and limiting irreversible disability.

There is no health insurance system in Yemen, and no external or internal support programs currently provide sustained assistance for MS medication coverage.

At different time periods in the past, there has been some limited government support for MS treatment. Interferon therapies were supported by the Fund for the Care and Rehabilitation of Persons with Disabilities between 2014-2018. During this time, access to this medication was largely a matter of luck, depending on whether a person with MS knew it was available free of charge, and whether they were in the 25% of the population eligible for coverage by this fund.

When the Fund stopped providing MS medications in 2018, there were no DMTs available in the country. In theory DMTs could be bought from outside of Yemen, but this was not an option for around 99% of the patient population due to the severe economic crisis faced by the country. People with MS were left completely without treatment, leading to irreversible disease progression.

Dr. Naji Al-Dhubyani’s wife lives with MS, and so he decided to take action. It had taken a long time to get a diagnosis, and after that they faced the reality of being unable to afford any medication due to its high cost. Even when Dr Al-Dhubyani’s wife was registered with the Fund to get access to Interferon, the supply was frequently interrupted and eventually cut off.

Drawing on his personal experiences and witnessing how many other people with MS struggled in the health system catalysed Dr. Al-Dhubyani to set up a non-profit association, the Yemeni Association for the Care of Multiple Sclerosis Patients. Personal hardship was transformed into a collective, institutional solution to advocate on behalf of everyone living with MS and their families.

“My goal was to move from personal struggle to collective action: advocating for sustainable drug supplies, raising awareness of this “hidden disease,” and supporting families facing the same isolation we once did.”

Dr Naji Al-Dhubyani in discussion with the Minister of Health regarding the provision of medications for MS patients in Yemen.

He began collecting data about people with MS in the country and assessing their needs over the course of a year. Then as President of the Association, Dr. Al-Dhubyani submitted a formal request to the Ministry of Health, advocating for the approval of at least one DMT to treat people with MS, helping prevent their condition from progressing. Understanding who lived with MS and what their needs were provided the evidence underpinning Dr. Al-Dhubyani’s advocacy.

As a result, the DMT dimethyl fumarate was provided and subsidised by the Ministry of Health between 2020-2023.

Dr. Al-Dhubyani’s advice for MS organisations in similar situations is to diversify funding sources by engaging donors from multiple countries, establish partnerships with pharmaceutical companies in other countries where medication costs are lower, and ensure efficient cross-border distribution of medicines to reach countries with the greatest need.