Category Archives: Medecines Sans Frontieres

Ebola – the search for a vaccine

LONDON, 27 January 2015 – When Ebola hit West Africa last year, it was a disease with no sign of a vaccine or cure. To those affected that may have been an indication that the wider world didn’t care about them or the diseases that affected them, but in truth there has simply been no incentive for anyone to develop these therapies. Yet now pharmaceutical companies are racing to produce an effective vaccine, and on 23 January the British company GlaxoSmithKline shipped the first 300 doses of its candidate to Liberia to start phase II trials.

At an event in the UK Houses of Parliament to discuss the economics of developing such vaccines, Jon Pender, a vice president of GSK, said he had been surprised, in the circumstances, that companies had any possible candidates at all on their shelves which could be developed and tested. He challenged suggestions that this was just because Ebola epidemics happened in poor countries where there was little scope for profit.

“That isn’t the reason why we don’t have vaccines for Ebola. The reason we don’t have a vaccine is because it wasn’t a priority for anyone, and there are understandable reasons for that…. The number of people affected each year was very small and the overall disease burden, in comparison to other disease like malaria or HIV, is tiny. The fact is that in the forty years that we have known about Ebola, including the present outbreak, there have been about 24,000 known cases. There are that many cases of malaria every hour.”

Now, clearly, it has become a priority. So if it isn’t just about money, how do you persuade the pharmaceutical industry to work on a normally obscure disease like Ebola? Adrian Thomas is a vice-president at Janssen Pharmaceutical Companies, which is also now working to get an Ebola vaccine to market. He says, “The first question is, what is the strength of the science? The second thing is to what extent there is a reward for innovation or a willingness to risk-share. And the third is, will we actually reach people? I think we have to understand what are the clear priorities for global health…

“Some companies do it for the reputation, others do it for the science or for alternative incentives. Other companies do it for direct financial reward, and I think you have to understand what are the different incentives that are necessary across that spectrum.”

Profit may not be everything, but the companies are not setting out to lose money. In this case they have been incentivized with public money – American, Canadian or European – to pay development costs, and assurances from the global vaccine alliance GAVI that there will be a market for any successful vaccine they produce, with up to $300 million available to pay for it.

Médecins Sans Frontières has been campaigning on the high and rising price of vaccines and the lack of transparency in the pharmaceutical industry, and earlier this month it published a new edition of its campaign document, the Right Shot.

Rohit Malpani is director of policy and analysis for MSF’s Vaccine Access Campaign. He told IRIN that despite substantial sums of public money poured into the development of an Ebola vaccine, very little was being demanded of the companies in return. “These vaccines are being developed with full public funding,” he says, “compensating the manufacturers for whatever investments they have to make, and for the cost of the clinical trials. Yet at this stage it is very non-transparent what the costs of development are, and not clear what guarantees there are about the outcomes and how they will ensure affordability. Governments are just writing them blank cheques.”

MSF welcomes the fact that GAVI has earmarked money to buy any successful vaccine, since that sends a signal to the manufacturers that there is a market, but thinks that GAVI should also be more demanding. Malpani says, “We are still not sure at what price it will be sold to GAVI. MSF would prefer that it is sold at or near cost. And if any cost is not covered by public funding, it’s better for that to be compensated directly, rather than through higher prices for the vaccine. The idea would be to de-link the cost of development from the final price.”

GAVI negotiates lower prices for the vaccines it buys for developing countries, but it is likely that the US or European governments will also want to stockpile some of these vaccines for their own use, and they are likely to have pay more. Malpani says MSF accepts that, but remarks that “if these countries have already paid for the development, it does seem inappropriate that they should pay all over again through high prices.”

MSF is certainly not against the development of Ebola vaccines, and intends to take part in some of the phase II clinical trials, probably at its facilities in Guinea. Julien Potet, their policy advisor on vaccines, says that planning the trial has been “a bit of a moving target”.

“Cases are declining a lot, and to demonstrate a protective effect is more difficult in a setting where there are limited or no cases. But we hope to vaccinate two groups – health workers because they are particularly exposed to the virus, and also to ring-vaccinate people who have been in contact or have a case in their neighbourhood. This is the plan today, but of course it could change.”

Others working on the response to the epidemic have more reservations about the vaccine programme. Mukesh Kapila, professor of global health at Manchester University, has just returned from West Africa. He found the affected countries alive with all kinds of stories and rumours, and he worries that time isn’t being taken to prepare people for the idea of the vaccine trials. “I am afraid they are going to think, ‘Oh, all these companies are coming to test some half-baked vaccines on black people here in Africa’. And the impact might be to put off people at risk from coming to get help, because they think, ‘Oh God, I’m going to be vaccinated’. When we do these trials for antibody response, it’s important that we do them on white people as well as black people, partly because it is important scientifically, but also because it’s important for public perception.”

More widely, Kapila thinks the rush for a vaccine may be counter-productive. “The panic associated with this epidemic has led to a lot of short cuts, with people rushing through the early phases so that human trials can start quickly. Everything may be fine, but we still don’t know how effective the vaccines are going to be. Are they going to give 90 percent protection? 80 percent? Or only 50 percent? That wouldn’t be enough.”

Kapila told IRIN: “People are expecting a vaccine to be the solution to this epidemic and it can’t be. A vaccine is no substitute for the laborious public health measures of identifying index cases, tracing and isolating contacts. By looking to a Promised Land where a vaccine is going to come and solve all our problems, we risk undermining these more important public health efforts. A huge amount of public money is going into vaccines. Once we have started we might as well finish, but I am sceptical whether it is a useful effort, on either public health or social and economic grounds.”

[Courtesy of IRIN]

Guinea Bissau: Cholera On the Rise

Bissau — As cholera case rates decline in Guinea and Sierra Leone, they are on the rise in Guinea-Bissau, with 1,500 cases reported and nine deaths as of 11 November, according to the Ministry of Health.

Adelino Gomes, a doctor in charge of cholera treatment at the Simão Mendes national hospital in the capital Bissau, says he has treated 500 cases in recent weeks and believes the epidemic may not yet have reached its peak.

Guinea-Bissau’s low-lying capital with its minimal to non-existent water and sanitation facilities makes it an ideal breeding ground for cholera.

François Bellet, a water, sanitation and hygiene (WASH) specialist with the UN Children’s Fund (UNICEF) in West Africa, says the strain was probably passed on from fishermen in Sierra Leone and Guinea, though this has not yet been confirmed.

The outbreak has spread across seven of Guinea-Bissau’s nine administrative areas, according to the Ministry of Health.

Simão Mendes is short on medicines to help victims, said Gomes, adding that Médecins Sans Frontières (MSF) is helping to treat patients. UNICEF and the World Health Organization are also supporting treatment, as well as helping detect cases and giving public hygiene messages to prevent the spread.

The government spends 6 percent of its budget on water and sanitation, according to the Finance Ministry. WASH facilities are “catastrophic” said one aid worker, but prevention at the household level has improved incrementally since 2009, said Bellet.

A 2008 cholera epidemic in Guinea-Bissau affected 14,222 people and killed 225, according to MSF research wing Epicentre.

Courtesy  All Africa News

MYANMAR: “Urgent” need for HIV treatment

YANGON, 02 March 2012 (PlusNews) – Lack of access to anti-retroviral therapy (ARV) to treat HIV has left thousands of patients in Myanmar with deteriorating immunity and increased vulnerability to tuberculosis (TB), say health workers.

“The situation is dire,” said Peter Paul de Groote, head of Médecins Sans Frontières (MSF) in Myanmar. “The gap between the treatment that is needed and what is received is unacceptably high.”

ARV providers in Myanmar – of whom MSF is the largest – are concentrated in Yangon and Mandalay divisions, and Shan and Kachin states, which account for more than 60 percent of the country’s 133 ART distribution sites, according to UNAIDS Myanmar.

“The unfortunate case is that many people have to travel far to access treatment. This country has the potential to treat more people, save more lives and prevent transmission by expanding service provision,” Sung Gang, the UNAIDS Myanmar country coordinator, told IRIN from Yangon.

But according to MSF, funding is the biggest problem.

When donors did not deliver on pledges, the Global Fund to Fight HIV, Tuberculosis and Malaria cancelled its Round 11 fundingin late November.

While a Transitional Funding Mechanism has been established to provide emergency relief to current recipients, which will run out of money before 2014, it only covers essential services such as HIV treatment, care and prevention, leaving ARV providers unable to expand to other needed areas, notes MSF.

Scale-up interrupted

Funds from Round 11 were expected to treat 46,500 more patients in Myanmar, according to a recent MSF study.

Of the estimated 240,000 HIV-positive people, only 24 percent receive ARV therapy. Roughly 85,000 people need treatment but cannot access it, causing up to 20,000 preventable AIDS-related deaths annually, according to MSF.

“The Ministry of Health, MSF, and the hospitals all have the willingness and capacity to scale up. There are a lot of new donor pledges [going into Myanmar] but not for HIV,” MSF’s De Groote said.

Doctors are forced to prioritize treatment for patients in the most advanced stages of HIV/AIDS, despite proof that earlier treatment decreases transmission rates and improves health outcomes, according to the Inter-Agency Standing Committee’s(IASC) 2010 Guidelines for addressing HIV in humanitarian settings.

“Turning back patients is a difficult and impossible choice. We have to tell them, come back when you get sicker,” said Khin Nyein Chan, MSF’s deputy medical coordinator in Myanmar and a doctor at the NGO’s clinic in Yangon, one of four nationwide.

While the World Health Organization (WHO) recommends starting ARV medications when an HIV patient’s CD4 count, a specialized immune system cell measure, has dropped below 350 cells/mm3, doctors in Myanmar administer ARVs only to those with CD4 levels below 150 cells/mm3.

“They have to wait until severe life-threatening and opportunistic infections are in their bodies before we can treat them,” said Khin Nyein Chan.

TB threat

TB is one such opportunistic infection. An HIV-positive status can increase the chance of contracting TB by up to 37-fold, according to WHO.

In Myanmar, 300,000 people are infected with TB – 60,000 of whom are also HIV-positive – according to MSF.

The increased incidence of airborne TB among HIV patients not taking ARVs raises the likelihood that it will spread among the general population, said Maria Guavara, MSF’s medical coordinator.

“HIV/AIDS and TB are a lethal combination. Treatment of HIV drops the instance rate of TB.”

At Phoenix Association, a Yangon-based social support centre for HIV-positive people, patients seek solace from debt and disease.

One patient from Phyuu Township of Bago Division in the country’s south, Sai Hlaw Aung, 33, told IRIN in 2011 that battling HIV and TB had made him too weak to continue working as a bamboo cutter.

“Now I am not as strong as before. I have no idea how I could earn household income when I go back home,” said Sai Hlaw Aung.

The association allows out-of-town patients to sleep in the office while undergoing treatment in Yangon. Space is tight.

“Currently we need shelter to accommodate the people,” said Thiha Kyaing, head of the association told IRIN. Little has changed since.

“We don’t just want to bridge the treatment gap and walk away. We need sustainable programmes, and the sooner the better,” De Groote said. “If we don’t treat people now we will lose them,” he added.
[Courtesy of IRIN News]