Medicine and public health

On 3rd and 4th February 2022, the CRASH organised a workshop aimed principally at the directors and operational managers of MSF Operational Centre Paris (OCP) to reflect on current debates, and to determine which elements of the discussion would be the most relevant to resolve to support the advancement of MSF OCP’s operational projects. Is access to medicines the same issue today as it was when MSF first became interested in the mid-1990s? Rather than just concentrating on the obstacles to accessing medicines, should the debate be broadened to encompass what are now called ‘health products’ or even further, towards access to care and thus largely structural problems of human resources, financing, or the absence of national health insurance policies?

“Death is an extremely grave non-emergency; its only treatment is mourning”. That is how doctor Miguel Martinez Almoyna introduces his concept of emergency. The retired 92-year-old anaesthesiologist played an active role in creating France’s SMUR, and later SAMU, emergency medical systems. Still quite active overseas (in Brazil and Mexico), where he has exported the French pre-hospital model, he explains his approach to régulation médicale, whose purpose is to guide patients to the medical services their condition requires while offering a range of responses corresponding to different degrees of severity and urgency.

This article was published on December 22nd, 2021, in the Journal of Humanitarian Affairs (Issue 3, Volume 3).
Despite a concerted international effort in recent decades that has yielded significant progress in the fight against HIV/AIDS, the disease continues to kill large numbers of people, especially in certain regions like rural Ndhiwa district in Homa Bay County, Kenya. Although there is still no definitive cure or vaccine, UNAIDS has set an ambitious goal of ending the epidemic by 2030, specifically via its 90-90-90 (treatment cascade) strategy – namely that 90 per cent of those with HIV will know their status; 90 per cent of those who know their status will be on antiretroviral therapy and 90 per cent of those on antiretroviral therapy will have an undetectable viral load. These bold assumptions were put to the test in a five-year pilot project launched in June 2014 by Médecins Sans Frontières (MSF) and Kenya’s Ministry of Health in Ndhiwa district, where an initial NHIPS 1 study by Epicentre (MSF’s epidemiology centre) in 2012 revealed some of the world’s highest HIV incidence and prevalence, and a poor “treatment cascade”. Six years later a new Epicentre study, NHIPS 2, showed that the 90-90-90 target had been more than met. What explains this ‘success’? And given the still-high incidence, is it truly a success? What follows is an interview on the political, scientific, and operational challenges of the Ndhiwa project with MSF Deputy Director of Operations Pierre Mendiharat and physician Léon Salumu, Head of MSF France Kenya programs, conducted by Elba Rahmouni.

This article was published on December 22nd, 2021 in the Journal of Humanitarian Affairs (Issue 3, Volume 3).
In this article, Natalie Roberts analyses the actions and positioning of MSF during the Ebola outbreak in Nord Kivu (Democratic Republic of Congo, 2018-2020).

In this article, Rony Brauman identifies the dynamics and events that made bending the HIV/AIDS epidemic curve possible. He explains the climate in which the tug-of-war with parts of the pharmaceutical industry played out from MSF’s perspective, and recalls that fears about international security and political stability also helped push governments to mobilise against the epidemic.

All the warning lights are flashing red this year: drought, the high prices of grains and fertilisers exacerbated by the war in Ukraine, reduced imports and speculation, numerous armed conflicts, a record number of refugees to be fed, disengagement of institutional donors,… With the exception of locusts, all the determinants of severe food scarcity are there, from Afghanistan to the Sahel, including Yemen, the Horn of Africa, and the Indian subcontinent. To the point of threatening all of the progress that was made in treating undernutrition after the 2005 crisis in Niger, which was the starting point for global advances in managing malnutrition in places where it is commonplace. It is time for a general mobilisation to limit the scale of the coming catastrophe. Interview with Jean-Hervé Bradol by Elba Rahmouni.

Reconstructing Lives: Victims of war in the Middle East and Médecins Sans Frontières was published in January 2022 by Manchester University Press. The book is the result of extensive fieldwork, in collaboration with the Crash. It is fully available on our website.

This article was first released in the 18th volume of the Humanitarian Alternatives magazine. Designed to reduce the incidence of HIV/AIDS in a Kenyan district, a Médecins Sans Frontières project successfully exceeded the “90-90-90” target set by UNAIDS. A look back on the results that the authors of this article - Pierre Mendiharat, Deputy director of operations at MSF France and Léon Salumu Luzinga, Program manager at MSF France, interviewed by Elba Rahmouni - believe are encouraging but by no means a guarantee that the epidemic will be over by 2030.

We can all agree that the emergence of Covid-19 vaccine is “an absolutely astonishing development”, but vaccines are unlikely to completely halt the spread of the virus, let alone eradicate it. Yet even without achieving herd immunity, the ability to vaccinate vulnerable people seems to be reducing hospitalizations and deaths from Covid-19. 

Blog written by Jean-Hervé Bradol, director of studies at the Crash.

Today, in order to obtain supplies of vaccines against Covid-19, there is neither a major difficulty related to price, nor a major obstacle related to intellectual property rules, nor a deficit in bio-medical research. However, these three topics are generally at the heart of MSF's communication in the area of access to medical care for those in most need. Our discourse must therefore evolve.
With the emergence of worrying variants of the virus present in the early stages of the pandemic and, as a consequence, the need to vaccinate on a global scale as quickly as possible, the world is facing a double challenge: biological engineering and ultra-industrial production – “ultra” echoing the need to produce on a global scale in a short period of time.

In this paper, the two authors examine certain aspects of the French response to the epidemic in the light of the experience of Médecins Sans Frontières (MSF) in that field, primarily with respect to the relationship between the actors of the response and the beneficiaries.

After a few months of respite the coronavirus epidemic has resumed its spread. With the second wave becoming a reality in many European countries, the Crash team decided to share some recent reading on the biomedical, political and social aspects of the pandemic in an attempt to shed some light on this tragic Season 2. As in previous editions, some articles are in English and some in French, and they are taken from both mainstream and specialist sources.