• Partnerships, Not Parachutists, for Zika Research

      Heymann, DL; Liu, J; Lillywhite, L (Massachusetts Medical Society, 2016-03-09)
    • Patent dispute: Delhi High Court gives a boost to access to affordable medicines

      Menghaney, Leena; Medecins Sans Frontieres-Campaign for Access to Essential Medicines, C 236 Defence Colony, New Delhi, India (Forum for Medical Ethics Society, 2010-04-01)
      The Delhi High Court has rejected the petition filed by Bayer Corporation seeking to stop the Drugs Controller of India (DCGI) from registering a generic version of a patented cancer drug. The case was filed in 2008 by Bayer to try and introduce "patent linkage" which involves linking the registration (marketing approval) of drugs with their patent status. If Bayer's plea for "patent linkage" had been accepted by the court, it would have undermined public health safeguards contained in India's patent legislation. This comment discusses the Bayer case in the context of efforts by multinational pharmaceutical companies to introduce barriers to generic competition, the only proven means of reducing the prices of medicines to make them affordable to those in need. Bayer has filed an appeal in the Supreme Court, indicating that it does not intend to give up.
    • Pathway to affordable quality assured sources of pegylated interferon alpha for treating hepatitis C

      Milani, Barbara; Gaspani, Sara (Pro Pharma Communications International, 2014-04-18)
    • A piece of my mind. Educational malpractice.

      Stitham, S; Médecins Sans Frontières, Mission Sri Lanka. (1991-08-21)
    • 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)
    • Pricing of drugs and donations: options for sustainable equity pricing.

      Pérez-Casas, C; Herranz, E; Ford, N; Campaign for Access to Essential Medicines, Médecins sans Frontières, Geneva, Switzerland. carmen_perez@madrid.msf.org (Wiley-Blackwell, 2001-11)
      Effective medicines exist to treat or alleviate many diseases which predominate in the developing world and cause high mortality and morbidity rates. Price should not be an obstacle preventing access to these medicines. Increasingly, drug donations have been established by drug companies, but these are often limited in time, place or use. Measures exist which are more sustainable and will have a greater positive impact on people's health. Principally, these are encouraging generic competition; adopting into national legislation and implementing TRIPS safeguards to gain access to cheaper sources of drugs; differential pricing; creating high volume or high demand through global and regional procurement; and supporting the production of quality generic drugs by developing countries through voluntary licenses if needed, and facilitating technology transfer.
    • Promotion of access to essential medicines for Non-Communicable Diseases: Practical implications of the UN Political Declaration

      Hogerzeil, Hans V; Liberman, Jonathan; Wirtz, Veronika J; Kishore, Sandeep P; Selvaraj, Sakthi; Kiddell-Monroe, Rachel; Mwangi-Powell, Faith N; von Schoen-Angerer, Tido; Department of Global Health, University of Groningen, University Medical Centre, Groningen, Netherlands. h.v.hogerzeil@umcg.nl (2013-02-12)
      Access to medicines and vaccines to prevent and treat non-communicable diseases (NCDs) is unacceptably low worldwide. In the 2011 UN political declaration on the prevention and control of NCDs, heads of government made several commitments related to access to essential medicines, technologies, and vaccines for such diseases. 30 years of experience with policies for essential medicines and 10 years of scaling up of HIV treatment have provided the knowledge needed to address barriers to long-term effective treatment and prevention of NCDs. More medicines can be acquired within existing budgets with efficient selection, procurement, and use of generic medicines. Furthermore, low-income and middle-income countries need to increase mobilisation of domestic resources to cater for the many patients with NCDs who do not have access to treatment. Existing initiatives for HIV treatment offer useful lessons that can enhance access to pharmaceutical management of NCDs and improve adherence to long-term treatment of chronic illness; policy makers should also address unacceptable inequities in access to controlled opioid analgesics. In addition to off-patent medicines, governments can promote access to new and future on-patent medicinal products through coherent and equitable health and trade policies, particularly those for intellectual property. Frequent conflicts of interest need to be identified and managed, and indicators and targets for access to NCD medicines should be used to monitor progress. Only with these approaches can a difference be made to the lives of hundreds of millions of current and future patients with NCDs.
    • Public Health and Company Wealth.

      Ford, N; Médecins Sans Frontières, London EC1N 8QX. nathan.ford@london.msf.org (Published by: BMJ Publishing Group Ltd, 2003-06-14)
    • Reaching across the linguistic divide in management and leadership education.

      Linnander, E; Nolna, SK; Mwinsongo, A; Bechtold, K; Boum, Y (Elsevier, 2019-09-01)
    • Report of the Commission on Intellectual Property Rights, Innovation and Public Health: A Call to Governments.

      't Hoen, E; Access to Essential Medicines Campaign, Médecins sans Frontières, Paris, France. ellen.t.hoen@paris.msf.org (Published by WHO, 2006-05)
    • ReRouting Biomedical Innovation: Observations from a Mapping of the Alternative Research and Development (R&D) Landscape

      Greenberg, A; Kiddell-Monroe, R (BioMed Central (Springer Science), 2016-09-14)
      In recent years, the world has witnessed the tragic outcomes of multiple global health crises. From Ebola to high prices to antibiotic resistance, these events highlight the fundamental constraints of the current biomedical research and development (R&D) system in responding to patient needs globally.To mitigate this lack of responsiveness, over 100 self-identified "alternative" R&D initiatives, have emerged in the past 15 years. To begin to make sense of this panoply of initiatives working to overcome the constraints of the current system, UAEM began an extensive, though not comprehensive, mapping of the alternative biomedical R&D landscape. We developed a two phase approach: (1) an investigation, via the RE:Route Mapping, of both existing and proposed initiatives that claim to offer an alternative approach to R&D, and (2) evaluation of those initiatives to determine which are in fact achieving increased access to and innovation in medicines. Through phase 1, the RE:Route Mapping, we examined 81 initiatives that claim to redress the inequity perpetuated by the current system via one of five commonly recognized mechanisms necessary for truly alternative R&D.Preliminary analysis of phase 1 provides the following conclusions: 1. No initiative presents a completely alternative model of biomedical R&D. 2. The majority of initiatives focus on developing incentives for drug discovery. 3. The majority of initiatives focus on rare diseases or diseases of the poor and marginalized. 4. There is an increasing emphasis on the use of push, pull, pool, collaboration and open mechanisms alongside the concept of delinkage in alternative R&D. 5. There is a trend towards public funding and launching of initiatives by the Global South. Given the RE:Route Mapping's inevitable limitations and the assumptions made in its methodology, it is not intended to be the final word on a constantly evolving and complex field; however, its findings are significant. The Mapping's value lies in its timely and unique insight into the importance of ongoing efforts to develop a new global framework for biomedical R&D. As we progress to phase 2, an evaluation tool for initiatives focused on identifying which approaches have truly achieved increased innovation and access for patients, we aim to demonstrate that there are a handful of initiatives which represent some, but not all, of the building blocks for a new approach to R&D.Through this mapping and our forthcoming evaluation, UAEM aims to initiate an evidence-based conversation around a truly alternative biomedical R&D model that serves people rather than profits.
    • Research & development in the dark: what does it take to make one medicine? And what could it take?

      Reid, J; Balasegaram, M; MSF (2016-08)
      Earlier this year a series of advertisements appeared in London's Westminster tube stations asking viewers to consider a seemingly simple question, 'what does it take to make one medicine?' But as it turns out, this question is not so simple to answer. In this commentary we highlight some key considerations and questions on what it takes to make one medicine, and what it could take to develop medicines that meet people's health needs and are accessible and affordable for all who need them.
    • The responsibility of research universities to promote access to essential medicines.

      't Hoen, E; Campaign for Access to Essential Medicines, Médicins Sans Frontières. (Yale University Press, 2003)
    • The rite of passage of becoming a humanitarian health worker: experiences of retention in Sweden

      Albuquerque, S; Eriksson, A; Alvesson, HM (Taylor & Francis Open, 2018-01-15)
      Low retention of humanitarian workers poses constraints on humanitarian organisations' capacity to respond effectively to disasters. Research has focused on reasons for humanitarian workers leaving the sector, but little is known about the factors that can elucidate long-term commitment.
    • 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)
    • The role of community-based organizations in household ability to pay for health care in Kilifi District, Kenya

      Molyneux, Catherine; Hutchison, Beryl; Chuma, Jane; Gilson, Lucy; Kenya Medical Research Institute (KEMRI)/Wellcome Trust Collaborative Research Programme, Centre for Geographic Medicine Research, Kilifi, Kenya; Medecins Sans Frontieres, Amsterdam, The Netherlands; Centre for Health Policy, University of Witwatersrand, Johannesburg, South Africa; London School of Hygiene and Tropical Medicine, London, UK; (2007-11-01)
      There is growing concern that health policies and programmes may be contributing to disparities in health and wealth between and within households in low-income settings. However, there is disagreement concerning which combination of health and non-health sector interventions might best protect the poor. Potentially promising interventions include those that build on the social resources that have been found to be particularly critical for the poor in preventing and coping with illness costs. In this paper we present data on the role of one form of social resource--community-based organizations (CBOs)--in household ability to pay for health care on the Kenyan coast. Data were gathered from a rural and an urban setting using individual interviews (n = 24), focus group discussions (n = 18 in each setting) and cross-sectional surveys (n = 294 rural and n = 576 urban households). We describe the complex hierarchy of CBOs operating at the strategic, intermediate and local level in both settings, and comment on the potential of working through these organizations to reach and protect the poor. We highlight the challenges around several interventions that are of particular international interest at present: community-based health insurance schemes; micro-finance initiatives; and the removal of primary care user fees. We argue the importance of identifying and building upon organizations with a strong trust base in efforts to assist households to meet treatment costs, and emphasize the necessity of reducing the costs of services themselves for the poorest households.
    • Saving the World, or Saving One Life at a Time?

      Delaunay, S (Springer, 2016-01-11)
    • 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.