• 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.
    • Self-immolation a common suicidal behaviour in eastern Sri Lanka.

      Laloë, V; Ganesan, M; Médecins Sans Frontières, 50 Lady Manning Drive, Batticaloa, Sri Lanka. veronique.laloe@bigfoot.com (Elsevier, 2002-08)
      A high number of self-burning injuries are noted in Batticaloa. The epidemiology, outcome and psychosocial aspects of 87 patients admitted with such burns over a 2-year-period was studied. The patients were compared with accidental burns and patients using other methods of suicide. Seventy nine percent of the victims were females and 72% were in the 15-34 years age-group. Most had marital problems. The majority were Tamils, but Muslims were fairly well represented. The median extent of burn was 48% of total body surface area (TBSA), with the top of the body mainly affected. The use of fire proved to have a high mortality in a group of patients who did not really want to die; 61 (70%) died. Mortality was higher than for accidental burns after matching for age and burn extent. The survivors had long hospital stays and suffered severe disfigurement. The cases where the patient denied self-harm, but in which the injuries were suggestive of this motive, were strikingly similar in age, sex and burn extent to the suicide group. In contrast, poison suicide records showed a male predominance and a gross under-representation of Muslims. Fire is a very significant method of suicide in our area. Social make-up and poor problem-solving ability may be contributing factors.
    • Should active recruitment of health workers from sub-Saharan Africa be viewed as a crime?

      Mills, E; Schabas, W A; Volmink, J; Walker, R; Ford, N; Katabira, E; Anema, A; Joffres, M; Cahn, P; Montaner, J; et al. (Elservier, 2008-06-02)
    • Strengthening the evidence base for health programming in humanitarian crises.

      Ager, A; Burnham, G; Checchi, F; Gayer, M; Grais, R F; Henkens, M; Massaquoi, M B F; Nandy, R; Navarro-Colorado, C; Spiegel, P (High Wire Press, 2014-09-12)
      Given the growing scale and complexity of responses to humanitarian crises, it is important to develop a stronger evidence base for health interventions in such contexts. Humanitarian crises present unique challenges to rigorous and effective research, but there are substantial opportunities for scientific advance. Studies need to focus where the translation of evidence from noncrisis scenarios is not viable and on ethical ways of determining what happens in the absence of an intervention. Robust methodologies suited to crisis settings have to be developed and used to assess interventions with potential for delivery at scale. Strengthening research capacity in the low- to middle-income countries that are vulnerable to crises is also crucial.
    • Stuck in the middle: a systematic review of authorship in collaborative health research in Africa, 2014–2016

      Jeufack, H; Neufeld, N; Alem, A; Sauer, S; Odhiambo, J; Boum, Y; Shuchman, M; Volmink, J (BMJ, 2019-10-18)
      BACKGROUND: Collaborations are often a cornerstone of global health research. Power dynamics can shape if and how local researchers are included in manuscripts. This article investigates how international collaborations affect the representation of local authors, overall and in first and last author positions, in African health research. METHODS: We extracted papers on 'health' in sub-Saharan Africa indexed in PubMed and published between 2014 and 2016. The author's affiliation was used to classify the individual as from the country of the paper's focus, from another African country, from Europe, from the USA/Canada or from another locale. Authors classified as from the USA/Canada were further subclassified if the author was from a top US university. In primary analyses, individuals with multiple affiliations were presumed to be from a high-income country if they contained any affiliation from a high-income country. In sensitivity analyses, these individuals were presumed to be from an African country if they contained any affiliation an African country. Differences in paper characteristics and representation of local coauthors are compared by collaborative type using χ² tests. RESULTS: Of the 7100 articles identified, 68.3% included collaborators from the USA, Canada, Europe and/or another African country. 54.0% of all 43 429 authors and 52.9% of 7100 first authors were from the country of the paper's focus. Representation dropped if any collaborators were from USA, Canada or Europe with the lowest representation for collaborators from top US universities-for these papers, 41.3% of all authors and 23.0% of first authors were from country of paper's focus. Local representation was highest with collaborators from another African country. 13.5% of all papers had no local coauthors. DISCUSSION: Individuals, institutions and funders from high-income countries should challenge persistent power differentials in global health research. South-South collaborations can help African researchers expand technical expertise while maintaining presence on the resulting research.
    • Stuck in the middle: a systematic review of authorship in collaborative health research in Africa, 2014–2016

      Hedt-Gauthier, BL; Jeufack, HM; Neufeld, NH; Alem, A; Sauer, S; Odhiambo, J; Boum, Y; Shuchman, M; Volmink, J (BMJ Publishing Group, 2019-10-01)
      Background Collaborations are often a cornerstone of global health research. Power dynamics can shape if and how local researchers are included in manuscripts. This article investigates how international collaborations affect the representation of local authors, overall and in first and last author positions, in African health research. Methods We extracted papers on ‘health’ in sub-Saharan Africa indexed in PubMed and published between 2014 and 2016. The author’s affiliation was used to classify the individual as from the country of the paper’s focus, from another African country, from Europe, from the USA/Canada or from another locale. Authors classified as from the USA/Canada were further subclassified if the author was from a top US university. In primary analyses, individuals with multiple affiliations were presumed to be from a high-income country if they contained any affiliation from a high-income country. In sensitivity analyses, these individuals were presumed to be from an African country if they contained any affiliation an African country. Differences in paper characteristics and representation of local coauthors are compared by collaborative type using χ² tests. Results Of the 7100 articles identified, 68.3% included collaborators from the USA, Canada, Europe and/or another African country. 54.0% of all 43 429 authors and 52.9% of 7100 first authors were from the country of the paper’s focus. Representation dropped if any collaborators were from USA, Canada or Europe with the lowest representation for collaborators from top US universities—for these papers, 41.3% of all authors and 23.0% of first authors were from country of paper’s focus. Local representation was highest with collaborators from another African country. 13.5% of all papers had no local coauthors. Discussion Individuals, institutions and funders from high-income countries should challenge persistent power differentials in global health research. South-South collaborations can help African researchers expand technical expertise while maintaining presence on the resulting research.
    • Sudan: In Through the Back Door.

      Veeken, H; Médecins Sans Frontières, PO Box 10014, 1001 EA Amsterdam, Netherlands. hans_veeken@amsterdam.msf.org (Published by: BMJ Publishing Group Ltd, 1998-05-09)
    • Supplementary protection certificates and their impact on access to medicines in Europe: case studies of sofosbuvir, trastuzumab and imatinib

      Hu, Y; Eynikel, D; Boulet, P; Krikorian, G (BioMed Central, 2020-01-14)
      In recent years, there has been increasing pressure on public health systems in high-income countries due to high medicines prices, one of the underlying causes of which are the market monopolies granted to pharmaceutical undertakings. These monopolies have been facilitated by expanded forms of intellectual property protections, including the extension of the exclusivity period after the expiration of the patent term concerning medicinal products. In the European Union such an approach lies in the Supplementary Protection Certificate, a mechanism formally introduced under Regulation 1768/92/EEC (now: Regulation 469/2009/EC, amended). After more than 20 years of implementation since it was first introduced, the common justifications for SPCs are being challenged by recent findings as to their functioning and impact. Similarly, legitimate questions have been voiced as to the negative impact of SPCs on timely access to affordable medicines. On the basis of an analysis of three medicines for hepatitis C and cancer treatments, the present article critically engages with the policy justifications underlying SPCs. It then analyses access challenges to a hepatitis C medicine and an HIV treatment in Europe, highlighting the social cost of the introduction of SPCs. Both the normative and empirical analyses have demonstrated that the common justifications supporting the SPC regime are deeply questionable. The addition of SPC exclusivity has also heavily delayed competition and maintained high medicines prices in European countries. Ultimately, the granting of such extended exclusive private rights on medicines may result in unnecessary suffering and be a factor in the erosion of access to medicines for all.