• Defective Interfering Genomes and Ebola Virus Persistence

      Calain, P; Roux, L; Kolakofsky, D (Elsevier, 2016-08-13)
    • The Ebola Clinical Trials: a Precedent for Research Ethics in Disasters

      Calain, P (BMJ Publishing Group, 2016-08-29)
      The West African Ebola epidemic has set in motion a collective endeavour to conduct accelerated clinical trials, testing unproven but potentially lifesaving interventions in the course of a major public health crisis. This unprecedented effort was supported by the recommendations of an ad hoc ethics panel convened in August 2014 by the WHO. By considering why and on what conditions the exceptional circumstances of the Ebola epidemic justified the use of unproven interventions, the panel's recommendations have challenged conventional thinking about therapeutic development and clinical research ethics. At the same time, unanswered ethical questions have emerged, in particular: (i) the specification of exceptional circumstances, (ii) the specification of unproven interventions, (iii) the goals of interventional research in terms of individual versus collective interests, (iv) the place of adaptive trial designs and (v) the exact meaning of compassionate use with unapproved interventions. Examination of these questions, in parallel with empirical data from research sites, will help build pragmatic foundations for disaster research ethics. Furthermore, the Ebola clinical trials signal an evolution in the current paradigms of therapeutic research, beyond the case of epidemic emergencies.
    • Ethics and images of suffering bodies in humanitarian medicine

      Calain, P; Unité de Recherche sur les Enjeux et Pratiques Humanitaires (UREPH), Médecins Sans Frontières - Switzerland, Rue de Lausanne 78, CH-1211 Genève 21, Switzerland. Electronic address: philippe_calain@hotmail.com. (Elsevier, 2012-07-27)
      Media representations of suffering bodies from medical humanitarian organisations raise ethical questions, which deserve critical attention for at least three reasons. Firstly, there is a normative vacuum at the intersection of medical ethics, humanitarian ethics and the ethics of photojournalism. Secondly, the perpetuation of stereotypes of illness, famine or disasters, and their political derivations are a source of moral criticism, to which humanitarian medicine is not immune. Thirdly, accidental encounters between members of the health professions and members of the press in the humanitarian arena can result in misunderstandings and moral tension. From an ethics perspective the problem can be specified and better understood through two successive stages of reasoning. Firstly, by applying criteria of medical ethics to the concrete example of an advertising poster from a medical humanitarian organisation, I observe that media representations of suffering bodies would generally not meet ethical standards commonly applied in medical practice. Secondly, I try to identify what overriding humanitarian imperatives could outweigh such reservations. The possibility of action and the expression of moral outrage are two relevant humanitarian values which can further be spelt out through a semantic analysis of 'témoignage' (testimony). While the exact balance between the opposing sets of considerations (medical ethics and humanitarian perspectives) is difficult to appraise, awareness of all values at stake is an important initial standpoint for ethical deliberations of media representations of suffering bodies. Future pragmatic approaches to the issue should include: exploring ethical values endorsed by photojournalism, questioning current social norms about the display of suffering, collecting empirical data from past or potential victims of disasters in diverse cultural settings, and developing new canons with more creative or less problematic representations of suffering bodies than the currently accepted stereotypes.
    • The Evolving Role of CSR in International Development: Evidence from Canadian Extractive Companies’ Involvement in Community Health Initiatives in Low-Income Countries

      Lamb, S; Jennings, J; Calain, P (Elsevier, 2017-05-31)
      Overseas development agencies and international finance organisations view the exploitation of minerals as a strategy for alleviating poverty in low-income countries. However, for local communities that are directly affected by extractive industry projects, economic and social benefits often fail to materialise. By engaging in Corporate Social Responsibility (CSR), transnational companies operating in the extractive industries ‘space’ verbally commit to preventing environmental impacts and providing health services in low-income countries. However, the actual impacts of CSR initiatives can be difficult to assess. We help to bridge this gap by analysing the reach of health-related CSR activities financed by Canadian mining companies in the low-income countries where they operate. We found that in 2015, only 27 of 102 Canadian companies disclosed information on their websites concerning health-related CSR activities for impacted communities. Furthermore, for these 27 companies, there is very little evidence that alleged CSR activities may substantially contribute to the provision of comprehensive health services or more broadly to the sustainable development of the health sector.
    • High prevalence of multidrug-resistant tuberculosis, Swaziland, 2009-2010

      Sanchez-Padilla, E; Dlamini, T; Ascorra, A; Rüsch-Gerdes, S; Tefera, Z D; Calain, P; de la Tour, R; Jochims, F; Richter, E; Bonnet, M; et al. (Center for Disease Control, 2012-01)
      In Africa, although emergence of multidrug-resistant (MDR) tuberculosis (TB) represents a serious threat in countries severely affected by the HIV epidemic, most countries lack drug-resistant TB data. This finding was particularly true in the Kingdom of Swaziland, which has the world's highest HIV and TB prevalences. Therefore, we conducted a national survey in 2009-2010 to measure prevalence of drug-resistant TB. Of 988 patients screened, 420 new case-patients and 420 previously treated case-patients met the study criteria. Among culture-positive patients, 15.3% new case-patients and 49.5% previously treated case-patients harbored drug-resistant strains. MDR TB prevalence was 7.7% and 33.8% among new case-patients and previously treated case-patients, respectively. HIV infection and past TB treatment were independently associated with MDR TB. The findings assert the need for wide-scale intervention in resource-limited contexts such as Swaziland, where diagnostic and treatment facilities and health personnel are lacking.
    • Research Ethics and International Epidemic Response: The Case of Ebola and Marburg Hemmorrhagic Fevers

      Calain, P; Fiore, N; Poncin, M; Hurst, S; Medecins Sans Frontieres (Oxford University Press, 2009-08-01)
      Outbreaks of filovirus (Ebola and Marburg) hemorrhagic fevers in Africa are typically the theater of rescue activities involving international experts and agencies tasked with reinforcing national authorities in clinical management, biological diagnosis, sanitation, public health surveillance and coordination. These outbreaks can be seen to be as a paradigm for ethical issues posed by by epidemic emergencies, through the convergence of such themes as: isolation and quarantine, privacy and confidentiality and the interpretation of ethical norms across different ethnocultural settings. With an emphasis on the boundaries between public health investigations and research, this article reviews specific challenges, past practices and current normative documents relevant to the application of ethical standards in the course of outbreaks of filovirus hemorrhagic fevers. Aside from the commonly identified issues of informed consent, and institutional review process, we argue for more clarify over the specification of which communities are expected to share benefits, and we advocate for the use of collective definitions of duty to care and standard of care. We propose new elaborations around existing normative instruments, and we suggest some pathways toward more comprehensive approaches to the ethics of research in outbreak situations.
    • What is the relationship of medical humanitarian organisations with mining and other extractive industries?

      Calain, P; Unité de Recherche sur les Enjeux et Pratiques Humanitaires, Médecins Sans Frontières, Genève, Switzerland. philippe.calain@geneva.msf.org (Public Library of Science, 2012-08-28)
      Philippe Calain discusses the health and environmental hazards of extractive industries like mining and explores the tensions that arise when medical humanitarian organizations are called to intervene in emergencies involving the extractive sector.