• 25 years of the WHO essential medicines lists: progress and challenges.

      Laing, R; Waning, B; Gray, A; Ford, N; 't Hoen, E; Boston University School of Public Health, Boston, MA 02118, USA. richardl@bu.edu <richardl@bu.edu> (Elsevier, 2003-05-17)
      The first WHO essential drugs list, published in 1977, was described as a peaceful revolution in international public health. The list helped to establish the principle that some medicines were more useful than others and that essential medicines were often inaccessible to many populations. Since then, the essential medicines list (EML) has increased in size; defining an essential medicine has moved from an experience to an evidence-based process, including criteria such as public-health relevance, efficacy, safety, and cost-effectiveness. High priced medicines such as antiretrovirals are now included. Differences exist between the WHO model EML and national EMLs since countries face varying challenges relating to costs, drug effectiveness, morbidity patterns, and rationality of prescribing. Ensuring equitable access to and rational use of essential medicines has been promoted through WHO's revised drug strategy. This approach has required an engagement by WHO on issues such as the effect of international trade agreements on access to essential medicines and research and development to ensure availability of new essential medicines.
    • Angola's suffering behind a pretence of normality.

      Stokes, C; Ford, N; Sanchez, O; Perrin, J M; Poncin, M; Joly, M; Médecins Sans Frontières, London, UK. (Elsevier, 2000-12-16)
    • Attacks on Civilians and Hospitals Must Stop

      Trelles, M; Stewart, BT; Kushner, AL (Elsevier, 2016-05-01)
      On Oct 3, 2015, a US airstrike hit Médecins Sans Frontières' (MSF's) Kunduz Trauma Centre in Afghanistan; 42 lives, including 14 MSF hospital staff, were lost.1 The 92-bed hospital was the only facility with essential trauma care capabilities for hundreds of thousands of people living in northern Afghanistan; those who continue to live amid conflict will critically miss it. The attack was a violation of international humanitarian law and the Geneva Conventions, a war crime, and an incursion on the sanctity of humanitarian action globally.
    • Attacks on Civilians and Hospitals Must Stop

      Trelles, M; Stewart, BT; Kushner, AL (Elsevier, 2016-03-21)
    • Avoiding Catastrophes: Seeking Synergies Among the Public Health, Environmental Protection, and Human Security Sectors

      Stoett, P; Daszak, P; Romanelli, C; Machalaba, C; Behringer, R; Chalk, F; Cornish, S; Dalby, S; de Souza Dias, BF; Iqbal, Z; et al. (Elsevier, 2016-10-04)
    • Clinical bacteriology in low-resource settings: today's solutions

      Ombelet, S; Ronat, JB; Walsh, T; Yansouni, CP; Cox, J; Vlieghe, E; Martiny, D; Semret, M; Vandenberg, O; Jacobs, J (Elsevier, 2018-03-05)
      Low-resource settings are disproportionately burdened by infectious diseases and antimicrobial resistance. Good quality clinical bacteriology through a well functioning reference laboratory network is necessary for effective resistance control, but low-resource settings face infrastructural, technical, and behavioural challenges in the implementation of clinical bacteriology. In this Personal View, we explore what constitutes successful implementation of clinical bacteriology in low-resource settings and describe a framework for implementation that is suitable for general referral hospitals in low-income and middle-income countries with a moderate infrastructure. Most microbiological techniques and equipment are not developed for the specific needs of such settings. Pending the arrival of a new generation diagnostics for these settings, we suggest focus on improving, adapting, and implementing conventional, culture-based techniques. Priorities in low-resource settings include harmonised, quality assured, and tropicalised equipment, consumables, and techniques, and rationalised bacterial identification and testing for antimicrobial resistance. Diagnostics should be integrated into clinical care and patient management; clinically relevant specimens must be appropriately selected and prioritised. Open-access training materials and information management tools should be developed. Also important is the need for onsite validation and field adoption of diagnostics in low-resource settings, with considerable shortening of the time between development and implementation of diagnostics. We argue that the implementation of clinical bacteriology in low-resource settings improves patient management, provides valuable surveillance for local antibiotic treatment guidelines and national policies, and supports containment of antimicrobial resistance and the prevention and control of hospital-acquired infections.
    • Demand Forecasting and Order Planning for Humanitarian Logistics: An Empirical Assessment

      van der Laan, E; van Dalen, J; Rohrmoser, M; Simpson, R (Elsevier, 2016-07-15)
      Humanitarian aid organizations are most known for their short-term emergency relief. While getting aid items to those in need can be challenging, long-term projects provide an opportunity for demand planning supported by forecasting methods. Based on standardized consumption data of the Operational Center Amsterdam of Médecins Sans Frontières (MSF-OCA) regarding nineteen longer-term aid projects and over 2000 medical items consumed in 2013, we describe and analyze the forecasting and order planning process. We find that several internal and external factors influence forecast and order planning performance, be it indirectly through demand volatility and safety markup. Moreover, we identify opportunities for further improvement for MSF-OCA, and for humanitarian logistics organizations in general.
    • DFID's health strategy.

      Ooms, G; Ford, N; MSF Brussels (Elsevier, 2007-08-25)
    • Dilemmas in Access to Medicines: a Humanitarian Perspective

      Smith, J; Aloudat, T (Elsevier, 2017-03-11)
    • Disparity in Market Prices for Hepatitis C Virus Direct-Acting Drugs

      Andrieux-Meyer, Isabelle; Cohn, Jennifer; de Araújo, Evaldo S Affonso; Hamid, Saeed S (Elsevier, 2015-11)
    • Drug development for neglected diseases: a deficient market and a public-health policy failure.

      Trouiller, P; Olliaro, P; Torreele, E; Orbinski, J; Laing, R; Ford, N; Centre Hospitalier Universitaire, BP 217, 38043 Grenoble cedex 9, France. PTrouiller@chu-grenoble.fr (Elsevier, 2002-06-22)
      There is a lack of effective, safe, and affordable pharmaceuticals to control infectious diseases that cause high mortality and morbidity among poor people in the developing world. We analysed outcomes of pharmaceutical research and development over the past 25 years, and reviewed current public and private initiatives aimed at correcting the imbalance in research and development that leaves diseases that occur predominantly in the developing world largely unaddressed. We compiled data by searches of Medline and databases of the US Food and Drug Administration and the European Agency for the Evaluation of Medicinal Products, and reviewed current public and private initiatives through an analysis of recently published studies. We found that, of 1393 new chemical entities marketed between 1975 and 1999, only 16 were for tropical diseases and tuberculosis. There is a 13-fold greater chance of a drug being brought to market for central-nervous-system disorders or cancer than for a neglected disease. The pharmaceutical industry argues that research and development is too costly and risky to invest in low-return neglected diseases, and public and private initiatives have tried to overcome this market limitation through incentive packages and public-private partnerships. The lack of drug research and development for "non-profitable" infectious diseases will require new strategies. No sustainable solution will result for diseases that predominantly affect poor people in the South without the establishment of an international pharmaceutical policy for all neglected diseases. Private-sector research obligations should be explored, and a public-sector not-for-profit research and development capacity promoted.
    • Ebola: a failure of international collective action

      Philips, Mit; Markham, Áine (Elsevier, 2014-09-10)
    • Expenditure ceilings, multilateral financial institutions, and the health of poor populations.

      Ooms, G; Schrecker, T; Médecins Sans Frontières, Brussels, Belgium. (Elsevier, 2008-01-31)
    • The G8 and access to medicines: no more broken promises.

      Moran, M; Ford, N; Médecins Sans Frontières, EC1N 8QX, London, UK. (Elsevier, 2003-05-10)
    • Generic medicines are not substandard medicines.

      Ford, N; 't Hoen, E (Elsevier, 2002-04-13)
    • Global Framework on Essential Health R&D.

      Chirac, P; Torreele, E; Médecins Sans Frontières, 75544 Paris cedex 11, France. pierchir@club-internet.fr (Elsevier, 2006-05-13)
    • Liberté, Égalité, Fraternité…Santé

      Baron, E (Elsevier, 2016-05-01)
      “We are not England, we are not France”, said Hillary Clinton about health-care insurance during a recent US presidential debate. European models of health care have their own history in which redistribution forms the cornerstone of social solidarity. Aiming to guarantee social cohesion, France's Etat Providence is rooted in models of a welfare state that developed in Germany and the UK. Ensuring universal health coverage and financed through payroll taxes, and increasingly through a general social contribution on all types of income, French health insurance is characterised by a strong redistributive scheme that benefits the poorest and the most sick.
    • Pre-emptive war epidemiology: lessons from the Democratic Republic of Congo.

      Depoortere, E; Checchi, F; Epicentre, 75011 Paris, France. evelyn.depoortere@brussels.msf.org (Elsevier, 2006-01-07)
    • The role of civil society in protecting public health over commercial interests: lessons from Thailand.

      Ford, N; Wilson, D; Bunjumnong, O; von Schoen-Angerer, T; Médecins Sans Frontières, Ladphrao, Klongchan Bangkapi, Bangkok, Thailand. Nathan.Ford@London.msf.org (Elsevier, 2004-02-14)
    • Scaling up of highly active antiretroviral therapy in a rural district of Malawi: an effectiveness assessment.

      Ferradini, L; Jeannin, A; Pinoges, L; Izopet, J; Odhiambo, D; Mankhambo, L; Karungi, G; Szumilin, E; Balandine, S; Fedida, G; et al. (Elsevier, 2006-04-22)
      BACKGROUND: The recording of outcomes from large-scale, simplified HAART (highly active antiretroviral therapy) programmes in sub-Saharan Africa is critical. We aimed to assess the effectiveness of such a programme held by Médecins Sans Frontières (MSF) in the Chiradzulu district, Malawi. METHODS: We scaled up and simplified HAART in this programme since August, 2002. We analysed survival indicators, CD4 count evolution, virological response, and adherence to treatment. We included adults who all started HAART 6 months or more before the analysis. HIV-1 RNA plasma viral load and self-reported adherence were assessed on a subsample of patients, and antiretroviral resistance mutations were analysed in plasma with viral loads greater than 1000 copies per mL. Analysis was by intention to treat. FINDINGS: Of the 1308 patients who were eligible, 827 (64%) were female, the median age was 34.9 years (IQR 29.9-41.0), and 1023 (78%) received d4T/3TC/NVP (stavudine, lamivudine, and nevirapine) as a fixed-dose combination. At baseline, 1266 individuals (97%) were HAART-naive, 357 (27%) were at WHO stage IV, 311 (33%) had a body-mass index of less than 18.5 kg/m2, and 208 (21%) had a CD4 count lower than 50 cells per muL. At follow-up (median 8.3 months, IQR 5.5-13.1), 967 (74%) were still on HAART, 243 (19%) had died, 91 (7%) were lost to follow-up, and seven (0.5%) discontinued treatment. Low body-mass index, WHO stage IV, male sex, and baseline CD4 count lower than 50 cells per muL were independent determinants of death in the first 6 months. At 12 months, the probability of individuals still in care was 0.76 (95% CI 0.73-0.78) and the median CD4 gain was 165 (IQR 67-259) cells per muL. In the cross-sectional survey (n=398), 334 (84%) had a viral load of less than 400 copies per mL. Of several indicators measuring adherence, self-reported poor adherence (<80%) in the past 4 days was the best predictor of detectable viral load (odds ratio 5.4, 95% CI 1.9-15.6). INTERPRETATION: These data show that large numbers of people can rapidly benefit from antiretroviral therapy in rural resource-poor settings and strongly supports the implementation of such large-scale simplified programmes in Africa.