Fatima Hassan

Fatima is challenging unfair patent monopolies, advocating transparency in medicine pricing, and building a worldwide movement for health equity. Her goal is a complete transformation of the global health landscape, where access to essential medicines and services is treated as an inviolable human right, not a privilege reserved for the few.

Fatima Hassan is improving equity in medicine access by proactively dismantling the systemic barriers to life-saving medicine being treated as a public good rather than a commodity. She envisions a world where healthcare systems are transparent, governments and corporations are held to account for equitable health delivery, and access to essential medicine is a fundamental human right, not a luxury. Fatima's blueprint for change focuses on three key pillars: increasing transparency, ensuring equitable access to essential medicines, and establishing fair intellectual property rules.
The issue of medicine access is inherently global because of the nature of the pharmaceutical industry, but South Africa provides a useful frontline for this work. South Africa's healthcare system is a stark reflection of global disparities, with deep divides leaving many of the most vulnerable without access to essential medicine. Additionally, due to a major movement in South Africa in the 1990s and early 2000s that mobilized around the HIV crisis—in which Fatima played a key role as a lawyer in several high profile cases —South Africa has an extensive community of health and other organizations ready to be mobilized. Fatima has leveraged that network and the COVID-19 moment to begin creating change in the global pharmaceutical system, addressing issues such as unfair patent laws and secret pricing deals. South Africa is her base and testing ground for a larger strategy.
Fatima's systemic approach has three main components: 1) strategic litigation and other legal engagements to achieve regulatory and policy wins that create important precedents, particularly related to the drug patent system, 2) research and storytelling to shift the narrative around medicine access and push government and pharmaceutical companies to act, and 3) engaging civil society to leverage and advance the wins. She and her team file creative precedent-setting lawsuits targeting the laws, policies and corporate actions that deny people access to the medicines they need to survive. At the same time, Fatima has forged a powerful network of researchers, NGOs, healthcare workers, community activists, lawyers, and more to collectively advocate for change.
A crucial piece of her strategy is bringing light to secretive dealings that determine who has access to treatment. For example, in a landmark case that had global impact (and was featured globally, including in the New York Times, among others), Fatima sued the South African government to disclose the details of their COVID-19 vaccine contracts. The successful release of the contracts and negotiation documents showed how some pharmaceutical companies had bullied the South African government into untenable terms and ultimately changed how some companies were dealing with African countries around the vaccine.
In a matter of a few years, with a small budget, the Health Justice Initiative has achieved outsized wins that have sent ripples around the world. Each win puts another crack in the armor of a system that puts profits over patient rights and opens up new opportunities for those challenging barriers to medicine access worldwide to push forward.

The South African Constitution guarantees the right to have access to healthcare services and places a positive obligation upon the state to take measures that progressively realize that right. However, often people do not have access to the medicines they need due to a weak patent system, evergreening, high drug prices, and barriers to generic competition. South Africa's patent laws have been a significant barrier to access to affordable medicines, particularly for treating chronic diseases like HIV/AIDS and tuberculosis. South Africa employs a unique patent system known as the depositary model. Unlike many other countries that rigorously examine patent applications for novelty, inventive step, and industrial applicability before granting a patent, South Africa simply accepts and registers patent applications. This allows for the registration of weak or invalid patents, creating a complex network of intellectual property rights which prevents competition. The absence of rigorous examination also allows for patent monopolies, preventing generic drug manufacturers from entering the market in a timely manner and leading to high drug prices due to limited competition that can restrict access to essential medicines, particularly for vulnerable populations. More than two decades since the right was enshrined in the Constitution, many South Africans in a dual health care system, still struggle to get access to affordable, lifesaving treatments, as profits are prioritized in an industry that treats essential medicines as a commodity.
In South Africa, only around 15% of the population held medical scheme membership in 2019-2020, according to the Council for Medical Schemes. Unsurprisingly, those with private insurance are predominantly drawn from the ranks of the wealthy and employed. Meanwhile, the vast majority of South Africans have no choice but to rely on an overburdened and under-resourced public health sector. At the root of this divide lies the country's staggering economic inequality, with the richest 10% controlling the lion's share of wealth, while black Africans and women are disproportionately burdened by poverty.
The Treatment Action Campaign (TAC), a social movement established in 1998 to respond to the lack of HIV/AIDS treatment, was the forerunner of the health equity work Fatima is building on and where she was ‘schooled’ in public interest litigation and research. Through litigation and various campaigns, the TAC was able to secure free access to antiretroviral treatment (ART) and lower drug prices, and today there is universal access to ART. This set a precedent that it is possible to have universal access to life saving drugs for free. Fatima, an integral part of the success of the TAC and the then AIDS Law Project, is building on this work and expanding it to address continuing health inequity.
As was the case with HIV treatment the Global South was last in line to access treatment, during the COVID-19 pandemic when similar challenges emerged around vaccine access and treatments. Like with other epidemics, early on in the COVID-19 pandemic, wealthy countries secured most vaccine doses while low- and middle-income countries struggled to obtain adequate supplies – mainly due to intellectual property restrictions and unequal distribution models. Efforts like the TRIPS waiver were advocated to address this, similar to past ART drug access campaigns.
As with ART drugs, unaffordable prices and patent protections have meant limited access to key drugs for treating multidrug-resistant tuberculosis (MDR-TB), and many other essential medicines. Pharmaceutical monopolies have kept prices high, restricting access to life-saving treatment for millions of patients in low-income countries. In all these cases, restrictive patent laws, and the dominance of pharmaceutical monopolies limit access to critical medicines, disproportionately affecting vulnerable populations in low- and middle-income countries. The efforts to lower costs, improve access, and challenge these monopolies echo the challenges faced in the ART drug campaigns.

Fatima’s experiences during the HIV epidemic, where she witnessed the devastating impact of government inaction and denialism, have profoundly shaped her understanding of the critical need for accountability and equitable health access. She draws stark parallels between the HIV crisis and the COVID-19 pandemic, noting the similar challenges of an overburdened health system and a vulnerable population in need of timely and affordable access. The pandemic exacerbated existing inequalities, intersecting through race, class, and gender, and Fatima’s work aims to ensure that the public health system serves everyone effectively.
Fatima's strategy through HJI is aimed at addressing the root causes and social and political determinants of health inequity. She conducts targeted strategic legal work (either by pursuing litigation or other strategies herself through HJI, or by strategically engaging other parties to do so), supports research and storytelling to shift narratives around medicine access, and engages civil society to leverage and advance the wins that HJI achieves.

Fatima engages in highly creative legal efforts to achieve legislative and regulatory reforms aimed at shifting IP regulations to prioritize public health needs over corporate profits.

A prominent victory for HJI was a successful court ruling in 2022 that required the South African government to publicly disclose the (unredacted) contracts that it signed with pharmaceutical companies for COVID-19 vaccines. As global inequities in vaccine access started to emerge, Fatima suspected that there were problems in the contracts that South Africa and other countries in the Global South were signing with these companies. She recognized that no pharmaceutical company would be willing to open up their contracts classifying them as ‘secret’ - that litigation against them directly would involve legal warfare against her small organization. So, she decided to instead seek to get the South African government to open the contracts. South Africa has an open procurement law such that government contracts are supposed to be visible to the public and reasonably strong access to information laws. In the case of the vaccine contracts, the South African government had to agree to non-disclosure agreements (NDAs) with the companies, which required the contracts to remain ‘secret.’ Fatima methodically pursued a series of steps rooted in South Africa’s freedom to information rules to try to seek access to the contracts (or any information around the contracts), which ultimately allowed her to sue the government on solid legal ground, but timing her case so as not to jeopardize vaccine access at the time. She asked the court to require the government to open the contracts, and if not the contracts, then at least the contract negotiation documents. The court gave her both, in unredacted form, ruling that a private company’s right to confidentiality could not trump the public’s right to know, and in a pandemic.

The disclosure and the analysis days later that Fatima painstakingly and speedily put together with a local and global group of public interest groups and academics revealed worrying inequities in pricing, liability clauses, and lack of transparency, which were hidden until then from public scrutiny. For one, it revealed that South Africa in several instances was being charged more than Europe for vaccines. Additionally, at a time when many countries were banning exports of vaccines produced in their countries to ensure their citizens had first access to those vaccines, one company’s contract with South Africa required that the country be not permitted to do so. That company then made a side deal with a local producer of vaccines to send them to Europe instead of making them available to South Africans and others in Africa.

The release of the contract negotiations also shed light on how pharmaceutical companies had bullied the South African government into accepting these indefensible terms, so while Fatima at first lost allies in the government by suing them, she recovered them once they realized how her carefully crafted lawsuit ultimately helped them in exposing the tactics of a global set of actors in the industry. By securing this court ruling, HJI set a legal precedent for greater transparency and accountability in public health procurement during pandemic and disaster times. This win also highlighted the importance of legal strategies in ensuring that governments can be held accountable for their health-related procurement decisions.

Prior to the legal case, HJI had also been tracking vaccine deliveries and the delayed and missing supplies for South Africa. Through this work, Fatima and her team discovered that doses manufactured in South Africa were earmarked by a global pharmaceutical giant for Europe all while South Africans were STILL waiting for its doses.

HJI began to work with global researchers, whistleblowers and investigative journalists to determine why this was the case and to expose it- the reason was staggering: European lives were being prioritised over African lives by a pharmaceutical giant that insisted in its contracts that doses made in Africa would be delivered to Europe, first- while South Africa was experiencing variant after variant of COVID. The New York Times broke the story, and the embarrassment and scandal led to direct consequences: The European shipments were paused, and deliveries were from then on were prioritised for Africa instead, with the African Union vaccine team no longer being sidelined in this process.

In another case, Fatima, working with other leading international NGOs, conducted and shared key research to show South Africa’s anti-trust regulator, the Competition Commission, why it was imperative to investigate a global pharmaceutical company’s market dominance regarding a key tuberculosis drug, and particularly its evergreening patent and pricing practices.

The regulator announced a formal investigation including assessing whether the company’s patenting strategy was designed to prevent generic competition, and within days of the announcement, the company announced a 55% price reduction for South Africa and within weeks, announced that it was dropping it secondary patent not only for and in South Africa but across 130 low-income countries.

Fatima and HJI with the support of many groups and researchers, have been able to achieve significant wins in a short amount of time because she strategically builds on the strategies and precedents created during the fight for ARVs in the HIV/AIDS crisis in the late 90s and early 2000s, and because she deliberately taps into the coalition of organizations, lawyers, researchers, healthcare professionals, patient communities and others who coalesced around that movement. Recognizing the vital role of civil society organizations especially, Fatima collaborates carefully with them to build broad capacity to advocate for health justice. This includes conducting foundational research and time-sensitive analysis to inform policy changes, convening educational webinars, initiating advocacy campaigns, and building disease and theme specific coalitions to amplify collective voice. She bridges the gap between research and public understanding by translating complex findings into clear, accessible information, strategically utilizing public information and media to disseminate information and shape new narratives on health equity. This aspect of her work is critical to being able to call on support for HJI’s legal and other strategies. Her goal is to engage, include, and explain so that civil society understands and supports the cases and campaigns that HJI takes up.

Civil society engagement also helps bolster HJI’s influence as a small organization and helps ensure that individual legal wins have maximum impact. In the groundbreaking case related to the pandemic contracts, Fatima worked closely with ten other organizations and individuals to analyze all the contracts and records in less than a week and then released both the contracts and multistakeholder analysis. This strategy both enabled the speedy review of the contracts, public sharing of all information and mitigated review bias.

Fatima also works in partnership with organizations across the Global South. By sharing knowledge, building capacity, and advocating for collective action, through HJI, Fatima leverages her experience in South Africa to develop insights and strategies applicable in other countries too. Fatima has been at the forefront of challenging the narrative that intellectual property protections are essential for innovation, especially in times of global health emergencies. HJI highlighted that public funding and participation played a critical role in the development of COVID-19 vaccines, to show why pharmaceutical monopolies should not hold exclusive rights over life-saving technologies.

Building on her previous work as an AIDS activist, she continues to form strong alliances with older and newer global alliances and organizations to campaign for a more just and equitable global health system. These partnerships have shaped and amplified the call for structural reform, including changes to the TRIPS Agreement and the establishment of global mechanisms that can ensure equitable access to medicines in future health crises. By ensuring that the voices of affected communities are amplified, Fatima ensures that the voices of marginalized and vulnerable communities, especially in South Africa, are heard in global health forums. This approach has strengthened the legal and moral argument for equitable access to essential medicines.

HJI’s work has been mentioned in and has influenced discussions at major global forums, and institutions where equitable access to vaccines and treatments and research knowledge has become a central issue. HJI’s contributions have also helped to shape global health policy, pushing wealthier nations to rethink their stance on intellectual property rights during pandemics and urging international institutions and regulatory bodies to prioritize health equity.
This demonstrates Fatima’s ability to leverage legal, advocacy, and public engagement strategies to challenge global health inequities, push for reform of intellectual property laws, and promote transparency and accountability in public health decision-making.

Looking ahead, Fatima focus is on institutionalizing the principle of health justice. She aims to continue to challenge unfair intellectual property rules that keep essential medicines out of reach for millions, collaborating with allies locally and globally to campaign for a more equitable system.
Recognizing the escalating threat that the climate crisis poses to public health outcomes, Fatima is also forging new collaborations with climate justice movements to develop fit for purpose strategies.
To scale HJI's impact, Fatima envisions a decentralized network of health justice "communities" in countries worldwide, each adapting the organization's model to their local context. By linking these hubs into a global web of solidarity, she aims to harness a movement capable of fundamentally transforming the power relations that shape access to healthcare. Ultimately, Fatima's goal is to make health justice the new norm - a world where every human being can access the health resources they need to thrive, regardless of where they live or who they are. Through strategic litigation, empowering advocacy, and narrative change, she is laying the foundations for this audacious vision.

Born into the brutality of apartheid in South Africa, Fatima's early life was shaped by the daily indignities and injustices of a system premised on racial segregation. From the time she was about 8 years old she vividly remembers the terror of racist police raids on her community, where she and other children would hide Black African domestic workers vulnerable to arrest and brutality. In those moments of fear and injustice, Fatima began to understand the cruelty of the apartheid system – and to feel the weight of responsibility to fight back. Guided by the teachings of her Islamic faith, which calls on believers to confront oppression wherever they see it, Fatima's resolve to become a changemaker was forged.
In a family and society where the potential of women was often discounted, and patriarchy rife, Fatima fought for her right to a tertiary education. Convincing her parents to let her pursue a law degree was no small feat – it meant committing to five years of study in a field where women, let alone Indian women from working-class backgrounds, were rare, yet she persevered, not only graduating but achieving a place in the top percentage of her graduating class – a fact she only discovered years later when she needed a transcript from her university.
After graduating from law school, she joined the community law clinic and fell in love with practicing law in a way that helps people, and pro bono. Here she represented low income women denied bail and charged with a criminal offence of shoplifting for taking a loaf of bread – and the intersection between poverty and access to justice became apparent to her. Significantly, from her graduation and the first years of practicing law, South Africa first democratic Constitution became law, supporting the equality aspirations of the country’s new democracy, and enshrining not just civil and political rights, but socio-economic rights too.
As the HIV/AIDS crisis was emerging in Africa, she joined the AIDS Law Project (ALP) at the University of Witwatersrand. Justice Edwin Cameron founded the ALP.
Her first few cases involved drafting wills - one of her clients was a wealthy man whose family managed to get him a supply of ARVs giving his quality of life back (‘Lazarus drugs’). She realized that people did not need to prematurely and needlessly die from HIV.
Fatima’s work with the AIDS Law Project (ALP) and the TAC, co-founded by Ashoka Fellow Zackie Achmat, was crucial in advancing the right to access to healthcare for people living with HIV/AIDS in South Africa. At the ALP, acting for the TAC she participated in advocating for legal protections against unfair discrimination and challenging government policies that delayed the provision of ARVs. Her legal, research and campaigning efforts there helped contribute to shaping legal frameworks that ensured people living with HIV were treated with dignity, and that they had access to health care, and could fight stigma.
With TAC, Fatima learnt how to be a public interest lawyer acting for communities, and supported grassroot mobilization efforts to demand affordable access to ARVs, including acting in the landmark 2001 case of Hazel Tau and Others v GSK and BI – which resulted in widespread generic ARVs being made available for South Africa and other countries in Sub-Saharan Africa, for the first time.
Decades later, after having pursued work in other sectors, as a Ministerial advisor and in philanthropy, and while on a career sabbatical, Fatima returned to civil society: When COVID was declared a pandemic of international concern, Fatima immediately recognized that South Africa and the Global South was likely, once again, to be (indefensibly and unethically) left behind if a vaccine or treatment came to market, as this pattern played itself out in HIV/AIDS and Ebola. So she started the HJI - at first with no funding and no staff and on a shoestring budget, but with the support of a highly regarded and diverse Advisory Group and a small governing Board, relying on local and global networks that she had previously been a part of. During that time Fatima became a leading voice globally for health equity, sought out by multiple institutions, bodies and media outlets. In the process she also built new networks and alliances - a health justice community - that in COVID and since would demand fairness, equity, knowledge sharing, transparency, accountability and timely access. That community with HJI continues tackling the systemic challenges of the current IP and patent system that deny equity in medicine access, globally. The HJI is now 5.5 years old, and Fatima’s work before and during her time at HJI have earned her several accolades, including the 2022 Calgary Peace Prize. She is also a 2023 Echoing Green Fellow.