THE RIGHT SHOT REMOVING THE BARRIERS TO COVID-19 TREATMENTS AND VACCINES - Médecins Sans Frontières Australia
←
→
Page content transcription
If your browser does not render page correctly, please read the page content below
THE RIGHT
SHOT
REMOVING THE BARRIERS TO COVID-19
TREATMENTS AND VACCINES
1
TODAY, THE HEALTH
OF BILLIONS OF
PEOPLE IS AT STAKE
As COVID-19 started to Our teams saw the devastating direct and we are now ramping up the debate over the
secondary impacts of COVID-19 on these availability of COVID-19 diagnostics, treatments
spread globally in early
communities, especially in places with and vaccines for all, through our advocacy
2020, overwhelming some of weak or fragile health systems. For people arm at the Access Campaign. Meanwhile,
the world’s more advanced in already vulnerable circumstances, the this pandemic remains a major challenge
healthcare systems, countries disruption of essential healthcare has had for Médecins Sans Frontières projects.
serious, even fatal, consequences.
like South Sudan, Yemen, COVID-19 is not over until it is over for
Bangladesh and Democratic That is why, as soon as the first COVID-19 everyone, everywhere. We still need
vaccines were registered and ready for rollout your help.
Republic of Congo – where in late 2020, the world breathed a sigh of
What is constant is the independent support
Médecins Sans Frontières runs relief. The developed world, that is. In fact,
you, our donors, provide. It allows us to
some of our biggest projects – countries representing only 13 per cent of the
respond to emergencies as they unfold, and
world’s population have already reserved 50
braced for what was yet to come. run programs in some of the world’s most
per cent of new vaccines in the pipeline.
conflict-ridden and inaccessible places. It
There is no place for profiteering or excessive will also enable us to speak out in solidarity
nationalism as long as the world still faces the for all.
threat of COVID-19. This report highlights how
OUR SHARED VALUES
Wherever Médecins Sans assistance based on need alone. independence and impartiality,
Frontières works across the world, Our work is guided by a charter, which have carried us through
your independent support enables which sets out our commitment critical moments in many different
us to use our own resources, to medical ethics. It contains contexts over the past five decades.
equipment and supplies to allocate our principles of neutrality,
2
A PANDEMIC IS NO TIME - Jennifer Tierney, executive director,
FOR BUSINESS AS USUAL Médecins Sans Frontières Australia &
New Zealand.
“Not even a global pandemic and treatments for COVID-19 as COVID-19 tools to be more
a public good, because they are affordable and accessible.
can stop pharmaceutical
primarily publicly funded, but
corporations from following their As we continue to turn up the
what we are actually seeing are
volume on this debate, we will not
business-as-usual approach, bilateral agreements where the rich
stop helping people. We remain
so countries need to use every countries are securing what they
committed to responding at scale
need for their population and poor
tool available to make sure that for people most in need – running
countries are being put to the side.
COVID-19 medical products are dedicated COVID-19 treatment
“Business as usual,” is a phrase that centres, protecting frontline health
accessible and affordable for keeps coming up – and it is true. workers, delivering medical care
everyone who needs them,” This pandemic knows no borders,
where health systems are overrun,
Doctor Sidney Wong, executive and working with refugee and
it knows no nations or ethnicity,
displaced populations and in
co-director, Médecins Sans it does not recognise power, nor
remote regions where healthcare is
Frontières Access Campaign. does it distinguish between high-
non-existent.
income or low-income countries.
But the impact of the disease I am incredibly grateful for
will not be distributed equally the support we receive from
You would think in this moment if the tools to combat it are only our committed and dedicated
of global crisis where everyone available to the privileged. supporters like you, which
is coming together, that we may enables Médecins Sans Frontières
see the pharmaceutical industry In October, India and South
to remain at the forefront of
doing something different. But Africa proposed to waive some
emergency medical response.
they are choosing not to. It is a intellectual property rights on
You have stayed by our side, you
tragic situation that they are not coronavirus tools during the
care enough to get to know our
embracing this fully. COVID-19 pandemic. Médecins
programs, and you deeply care
Sans Frontières supports the
Through our Access Campaign, about the people we serve.
waiver, and urges all countries
Médecins Sans Frontières is to back the proposal, which Together, we call for human lives
amplifying the debate, as we have is already supported by more over corporate profits at this
done throughout our history. We than 100 countries, to allow critical moment for global health.
are seeing the writing on the wall.
There is a lot of talk about vaccines
OUR CHARTER
Médecins Sans Frontières provides universal medical ethics and the As volunteers, members
assistance to populations in right to humanitarian assistance understand the risks and dangers
distress, to victims of natural and claims full and unhindered of the missions they carry out and
or man‑made disasters and to freedom in the exercise of make no claim for themselves or
victims of armed conflict. We do its functions. their assignments for any form
so irrespective of race, religion, of compensation other than that
Members undertake to respect
creed or political convictions. which the association might be
their professional code of
able to afford them.
Médecins Sans Frontières ethics and maintain complete
observes neutrality and independence from all political,
impartiality in the name of economic or religious powers.
3
ACCESS CAMPAIGN
HEALTH
IS NOT A
COMMODITY
AND MEDICINES SHOULDN’T BE A LUXURY
Multiple barriers still prevent Médecins Sans Frontières Access dying from the disease. This was
access to lifesaving medicines in Campaign was founded over 20 despite the availability of lifesaving
years ago to remove the obstacles antiretroviral treatment. However,
many parts of the world. At time
that prevent people from getting priced at US$10,000 for one
of writing, the COVID-19 vaccines the lifesaving medicines they person for one year, because of
could be the latest in a long list. need. Patents are the major barrier patent monopolies, it was out of
that stands in the way of lower reach for many. Now, the same
cost generic drugs being made, treatment is available for less than
which vastly limits the available $100 per person per year, thanks
supply and drives up prices. We to the Access Campaign’s push
have seen it happen to our patients for robust competition among
with TB and to people living generic drug manufacturers. That
with HIV. The Access Campaign is why Médecins Sans Frontières
was launched at the height of is demanding no patents and
the HIV/AIDS epidemic, when no profiteering on COVID-19
large numbers of people were medical tools.
4
ADVOCACY IN ACTION
The Access Campaign slogan – Medicines Shouldn’t be a Luxury – is
more relevant today than ever. Kate Elder, senior vaccines policy
advisor for the Access Campaign answers five crucial questions.
What brought you to the Access
Campaign?
Every parent wants to have their
child healthy. We take these
services to people that are affected
by crisis. Immunisation is one
of the core building blocks to
improving health. Immunisation
is something that Médecins Sans
Frontières has been doing since
it was founded. For the last 50
years we have offered vaccination
to children and other population
Kate Elder, senior vaccines policy
groups, especially when we have advisor, Access Campaign. © MSF 2020
these amazing medical tools that
can prevent epidemics, and can advocating for them to consider
stem outbreaks. the needs of crisis affected
populations, and advocating
There are now more vaccines for them to not be so singularly
available against more diseases – it is minded about just how they are
miraculous – but it does not mean it going to make the most money
is easy for us to get hold of them. from which customers. We are
What involvement does Médecins Sans asking them to also think about
Frontières currently have with the big true health needs to guide some
pharmaceutical companies? of their allocation work.
On the Access Campaign side we We are also engaging directly with
are laying the groundwork so that high income country governments
when the vaccines are available, and that have already signed advanced
if Médecins Sans Frontières sees a purchase deals for a tremendous
role operationally, we will be able volume of vaccines. We are
COVID-19 patients being treated in the severe to get access to those vaccines. We asking them, “are you considering
case ward with medication and oxygen are dealing with the pharmaceutical the needs of the humanitarian
support at Al-Kindy hospital, in Baghdad. corporations to make sure – as community? Or are you intending
© MSF 2020 to absorb all of those vaccines
everybody anticipates there will be
finite supply – that we will be able to that you have purchased?” We are
access the supply. making the case that maybe they
bought more than they will need,
This means dealing with the and maybe they should think
pharmaceutical corporations more globally.
themselves, going directly to the
source. They are the ones that hold What will be the challenges for our
all the power in deciding who they patients in getting hold of these
are selling to, at what price and vaccines?
when, so we are trying to engage I think it is going to be really
directly with these companies. challenging. We have to think
We are sharing with them what about it first in terms of the
we think our needs might be,
5
ACCESS CAMPAIGN
people that Médecins Sans companies are going to charge, Pallet loader and firefighter in Maastricht
Frontières traditionally serve – do we can see if that aligns with the Airport, Netherlands. © MSF/Pierre Crozes
they fit? And if yes, where into cost price. The bottom line is 2020
the prioritisation criteria. The right now, no company – even
World Health Organization has companies that have claimed that
very clearly stipulated priority they will charge a not-for-profit
groups, beginning with frontline price – have committed to any
healthcare workers, and then older real transparency.
people with co-morbidities, and
That is why we need a strong
they have put some indicative
Access Campaign, to be able to
figures around what proportion
fight those battles if necessary, in
of each population they think fits
a very public forum so that we can
into those priority groups. We
be heard, and so our patients can
have to think about it very much
be heard.
through the epidemiological lens.
I think right now for the majority How would you describe the
of the countries where we work, importance of donor support right now?
they are not going to get vaccines Médecins Sans Frontières donors
for at least a few months. understand the value of impartial
medical care – medical care in its
And what about price? purest form to people who need
Price is subjective. What is a high it, regardless. Donors right now
price? What is a low price? I like to are helping us to truly realise at
talk about price and affordability this most historic moment what
based upon what does it actually needs to be done to fulfil the
cost to make these vaccines? This humanitarian ideals and principles
COVID pandemic brought with it of not forgetting about people, of
claims by some pharma companies fighting for them to make sure
that we literally had never seen that they have access to medical
before – that they would charge tools now, not years behind those
a not-for-profit price during the in wealthy countries. Many of
pandemic. That was a huge claim our donors, like myself and my
to make and more progressive parents who give to Médecins Sans
than we have seen before. There Frontières, are going to be the
are also some companies that have people that get these vaccines first.
said, “No, we’re not charging a They will probably accept them
not-for-profit price.” I think about warmly. They will also know that
price first through the lens of, “Is there is something unjust in it,
there transparency around what because they care about Médecins A biotechnician is extracting a sample of
the actual costs are of making Sans Frontières. So their gift a COVID-19 suspected case in the National
these vaccines?” When we have will achieve a better balance and Public Health Laboratory in Juba, South
indicative prices of what the promote truth, justice and equity. Sudan. © MSF/Tetiana Gaviuk 2020
6
Deals done by pharmaceutical companies to develop COVID-19
DEALS vaccines are shrouded in secrecy, and the details that are released
CLOAKED IN reveal worrying terms. At the same time, the six front running
vaccine candidates have had a total of over US$12 billion of tax
SECRECY payer and public money poured into them.
Médecins Sans Frontières
urges governments – which “As long as we do not know
have provided funding to what is in these deals, pharma
these companies – to demand will continue to hold the power
transparency on vaccine licensing to decide who gets access
deals, trial costs and data. when, and at what price.
Without decisive action from
The six candidates and the amount
governments demanding more
that each has received in public
transparency from companies,
funding so far are vaccines being
equitable access to COVID-19
developed by AstraZeneca/Oxford
vaccines is in jeopardy. The public
University (over $1.7 billion),
has the right to know what is in
Johnson&Johnson/BiologicalE
these deals – there is no place for
($1.5 billion), Pfizer/BioNTech
secrets during a pandemic, there
($2.5 billion), GlaxoSmithKline/
is too much at stake.”
Sanofi Pasteur ($2.1 billion),
Kate Elder, senior vaccines policy
Novavax/Serum Institute of India
advisor, Access Campaign.
(nearly $2 billion), and Moderna/
Lonza ($2.48 billion).
We are in a time of unprecedented mobilisation to tackle COVID-19.
THE COVAX Gavi, the Vaccine Alliance, is co-leading a new fund – the COVAX
FACILITY Facility – a global risk-sharing mechanism for pooled procurement
and equitable distribution of COVID-19 vaccines.
COVAX aims to provide two Médecins Sans Frontières
billion doses of safe and effective Australia and New Zealand
COVID-19 vaccines for all executive director Jennifer
nations by the end of 2021. Tierney notes, “it is unclear
Developed countries will be able if they come first or how the
to buy in and secure enough prioritisation is going to be.
doses for their populations We have been calling on every
proportional to the amount they country that is participating
used to buy into the fund. Other in the COVAX Facility to
countries will be guaranteed again make sure that there are
doses to vaccinate up to 20 per controls within the Facility
cent of their population until for guaranteeing equal access,
further doses become available. whether or not you are a rich or
a less rich nation.”
7
LOGISTIC
CHALLENGES
FOR THE ULTRA-COLD CHAIN COVID-19 VACCINES
Virtually all of the 13 vaccines This would make vaccination refrigerator temperatures. This
that currently are in the campaigns difficult to implement is positive news, as it would
in many of the crises and conflict potentially facilitate distribution
advanced phase require several
settings where Médecins Sans in low-resource settings
doses or booster injections, Frontières works. However, the where the existing cold-chain
and need to be stored and AstraZeneca/Oxford University equipment for storage of vaccines
transported in cold chain at vaccine candidate was recently used in routine programs covers
announced to require cold-chain this temperature range.
low temperatures with some management at standard 2-8°C
requiring sub-zero conditions.
8
Delivering measles vaccines to Boso Manzi, a
hard-to-reach area of Northern DRC badly hit
by the measles epidemic, was a real journey.
Sent from Kinshasa to Lisala by plane, the
vaccines had to be transported for over six
hours in refrigerated boxes by motorbike
on very difficult roads. Keeping the vaccines
refrigerated throughout the process is “As Médecins Sans Frontières knows
essential to preserve the effectiveness of the best, getting a vaccine to somebody
vaccines. © MSF/Caroline Thirion 2020 that lives in a remote area is very
difficult. Some of the vaccines that
WHAT IS THE COLD CHAIN AND WHY IS IT SO IMPORTANT? are first off the block, like the Pfizer
Each year Médecins Sans Frontières While the majority of developed vaccine and the Moderna vaccine,
teams vaccinate millions of people nations are focusing on the which use the new technologies
in remote communities that are the realities of getting the COVID-19 of the mRNA platform, require
most at risk from severe outbreaks vaccine quickly to their significantly different cold chain
of vaccine-preventable diseases like populations, one of the greatest than the one typically used for
measles, meningitis, diphtheria and barriers for vulnerable people who vaccinations. If we are looking at
whooping cough. need it most is its stringent storage those vaccines that require the
requirements. ultra-cold chain, it is going to be a
Most of the vaccines we use logistical nightmare.
need to be kept in a rigid cold Keeping vaccines cold remains a
This is not to say it is insurmount-
chain, refrigerated at a constant major constraint on their delivery
able, but the experience that we
temperature, from manufacture in low and middle income
had for the Ebola vaccine, that had
through to the point of countries. Half of the healthcare
similar cold chain requirements,
vaccination of our patients. facilities in the poorest countries
says that it was not easy. You
have no electricity supply, and
This can be a huge logistical have to think about exponentially
only 10 per cent have a reliable
challenge in countries where magnifying that. People who
electricity supply.
electricity is scarce, and often work in developing countries
involves hand-carrying vaccines Conventional cold chains are like Médecins Sans Frontières, or
packed in cold boxes across intended for vaccines that need to be foundations that support them like
rough terrain, on motorbikes and stored between 2°C and 8°C. Frozen Gavi, do not really think that these
even by canoe to reach the most cold chains are used for vaccines first vaccines that require ultra-cold
remote communities. However, it that need to be stored at -20°C . chain are best suited for the contexts
is the only way to maintain their Ultra-cold chains are needed for the where we work.”
efficacy in order to give patients – few vaccines that need to be stored Kate Elder, senior vaccines policy advisor,
particularly young children – the at ultra-temperatures, between Access Campaign.
best shot against a deadly disease. -60°C and -80°C.
9
COMBATTING SOME OF THE WORLD’S DEADLIEST DISEASES
“Instead of stepping up for TB, we
are at risk of slipping back due to
COVID-19.”
Sharonann Lynch, senior TB policy advisor
for the Access Campaign.
TB CRISIS
A Médecins Sans Frontières mobile
clinic brings life-saving medical
care to an area of Greater Pibor,
South Sudan after flooding made
the roads impassable.
© MSF/Tetiana Gaviuk 2020
THREE MILLION PATIENTS LEFT BEHIND
Tuberculosis (TB) is one of the world’s biggest global health crises, with more than 10 million people
falling ill with TB in 2019, and 1.4 million people dying. Even before the pandemic, new drugs and testing
for the world’s deadliest infectious disease were not getting to people quickly enough. COVID-19 has now
had a severe impact on services such as testing for TB.
Spotlighting the damaging “Working on the frontlines of
impact the pandemic has had on the raging TB epidemic, it is “We cannot stress enough how
TB services, the World Health distressing to see the sluggish urgent it is now for governments
Organisation (WHO) revealed uptake of TB LAM in national and donors to intensify their efforts
a sharp drop in the number of treatment programmes, despite its so that critical medical innovations
people now being diagnosed. proven role in saving the lives of and tools reach people with TB. We
A key finding was that 85 per people living with HIV.” finally have better drugs and tests
cent of countries surveyed still to tackle and prevent this extremely
By urgently rolling out up-to- infectious yet curable disease,
do not use the lifesaving point-
date testing policies, countries so it is both mind-boggling and
of-care urinary TB LAM test
can potentially reach nearly 3 unacceptable that they are still not
for routine diagnosis of TB in
million people still being missed. being used to save as many lives
people living with HIV. Doctor
Sharonann Lynch, senior TB as possible.”
Patrick Mangochi, Médecins
policy advisor for the Access
Sans Frontières deputy medical
Campaign, explained:
coordinator in Malawi said:
10We are continuing to highlight
the need for immediate
implementation of people-centred
TB policies, and increase TB testing
and treatment. This includes:
• Minimising the unnecessary
risk of COVID-19 by reducing
visits to health facilities,
without disrupting TB
treatment.
• Prioritising the use of all-oral
treatment regimens for people
with drug-resistant TB (DR-
TB) that no longer include
older, toxic drugs that have to
be injected and cause serious
side effects.
“I do not want anyone else to have to
go through this ordeal. With newer
medicines, it is now possible to give
people all-oral treatment that works
to cure them. People with TB cannot
be excluded from accessing these
innovations anymore, especially
when they are afraid to visit
treatment centres due to COVID-19.”
Médecins Sans Frontières patient
Meera Yadav, a survivor of extreme
drug-resistant TB.
All images © MSF/Tetiana Gaviuk 2020
“Countries must step up the use of TB
LAM as a core component of testing
services, otherwise delays … will
continue to fail people with HIV who
get TB.”
Doctor Patrick Mangochi, Médecins Sans
Frontières deputy medical coordinator,
Malawi.
11COMBATTING SOME OF THE WORLD’S DEADLIEST DISEASES
HOPE IN
THE TIME
OF EBOLA
Ebola is a highly infectious Médecins Sans Frontières The new treatments have also
virus that can kill up to 90 per responded to the most recent been rolled out in treatment
outbreak in Equateur Province, centres. These tools allow for
cent of the people who catch it,
Democratic Republic of Congo, a radical change in approach.
causing terror among infected which was declared over late While limiting the circulation
communities. last year. The new Ebola vaccine of the Ebola virus remains a
was deployed early in the very important objective for
outbreak, and may have played the response, efforts are now
an important role in reducing increasingly focused on patient
the spread of the virus, explains care and recovery.
Doctor Guyguy Manangama,
Previously, we could do little
Médecins Sans Frontières medical
more than isolate the sick and
and operational lead for Ebola
provide them with symptomatic
activities there:
treatments. Having curative
“Our vaccination strategy prioritises treatments at our disposal means
vaccinating people who have had that the patient and the quality of
direct or indirect contact with care can take centre stage.
the sick, but in rural and sparsely
Although this deadly virus is very
populated areas it is often more
serious, it is at last beginning to
expedient and effective to vaccinate
look like a treatable – and, through
the entire community, which results
vaccination, preventable – disease,
in a higher level of protection.
rather than a biological threat.”
12“COVID HAS TURNED
THE CLOCK BACK
15 YEARS”
Maintaining care for common killers must never be underestimated.
our patients, where we have been able to quite smart: we have added activities
maintain continuity of care. for COVID-19, but we have also, where
we could, really strongly prioritised
“When it comes to Médecins Sans
keeping all of the ongoing activities
Frontières activity during COVID-19, there
going. Because the cost of not doing
are obviously direct human as well as
that potentially dwarfs the impact of
health impacts. We have added over 60
COVID-19. This is especially so in the
projects that specifically care for patients
places we are working now: for example,
with COVID-19, from hospital care and
the impact of not providing preventative
end of life care to social care. We work
care for malaria during the next malaria
with people trapped at home, the elderly,
season would have a staggering impact
people who are on chronic medicines,
on mortality, much greater than COVID-19
people needing mental healthcare,
has had. This is an important point that
refugees, and more.
Greg Elder, medical coordinator for should not be lost in the shadows.
the Access Campaign. © MSF 2020 Then there is the big hidden impact of
Then there is Médecins Sans Frontières
COVID-19 on our other activities, all the
Millions of vulnerable people have only advocacy - the positioning, the shining the
collateral damage – because all the work
been made more vulnerable during this light on the root causes that underlie all
that we were doing a year ago in the
pandemic. Médecins Sans Frontières these health inequalities. These are now
field has not gone away. In fact, it has
continues to urgently respond and scale more visible – we are all in the same boat,
just become harder. We have had short
up our programs wherever the needs are rich and poor. There are opportunities that
supplies, staff have been reallocated
greatest. However, in many of the crisis come with this from our perspective. In
elsewhere, there have been lockdowns.
and conflict settings where we work, terms of the Access Campaign, vaccines and
That has a huge social and economic
such as in Syria, Yemen, and Bangladesh, health policy, this is the fight of our lives.
impact particularly in the places where
the negative impact of the pandemic we work, where people live hand to This is what has been fascinating about
casts a long shadow. Our challenge mouth. Routine vaccination has been COVID-19. It has brought together
ahead is to preserve or rebuild lifesaving interrupted, as has malaria prevention, advocates from a whole range of different
activities and other essential care for treatment for nutrition, safe maternity fields – civil rights movements, human
the vulnerable people who are at risk of care, TB diagnostics and treatment. rights groups, social justice movements,
being left behind. labour organisations, health professionals,
There have been estimates by a few
Doctor Greg Elder, medical coordinator for all holding their hands around the idea of
clever modellers that say the clock has
the Access Campaign, explains the impact solidarity and equity, and that no one is
been turned back 15 years in terms of TB
COVID-19 has had on Médecins Sans safe until everyone is safe. This is a new
control, vaccine preventable diseases and
Frontières activities, but also the impact deal on health. I think this is a moment to
infant mortality. So we are scrambling.
our teams have been able to make for not miss, and a chance to shine that light
However, I also think we have been
on some of the root causes.”
13SOUTH SUDAN
RESPONDING
TO DOUBLE
EMERGENCIES
MEASLES AND FLOODING
As a measles outbreak began When we began responding to campaign, more children will
the measles outbreak, patients continue to die.”
in Pibor, South Sudan late last
were mostly coming from central
year, threatening thousands of Measles is highly contagious and
Pibor town, but as the disease
there is no specific treatment for it,
children’s lives, the area was also rapidly spread, many people
but a well-conducted vaccination
hit by severe flooding. Our teams walked and paddled through
campaign is extremely effective
stagnant and moving water,
immediately escalated their to prevent new cases. In areas like
sometimes for up to seven days,
response to tackle urgent and Pibor, with large-scale movements
to reach care at our urgently
of people and low immunisation
increasing needs. erected healthcare clinic in Pibor.
coverage, vaccination can reduce
Médecins Sans Frontières doctor
infant mortality by 50 per cent.
Adelard Shyaka in Pibor said:
However, a campaign of this scale
“The severity of the outbreak is
also poses enormous challenges,
being magnified by other illnesses
explained Josh Rosenstein,
like severe malaria, pneumonia
Médecins Sans Frontières field
and severe malnutrition. Two
coordinator in Pibor:
children have already died and we
are deeply concerned that without “Measles campaigns in this
a prompt reactive vaccination region are notoriously difficult
14Above: Flooding in the Greater Pibor to implement for people living in higher, Médecins Sans Frontières
Administrative Area, South Sudan. remote and widespread locations. epidemiologist Laura Wright said:
© MSF/Tetiana Gaviuk 2020 However, today with the floods,
“There are many children in Pibor
Top right: People pass the Médecins many communities are clustered
Sans Frontières surface water treatment
who, having fled ongoing conflict
on small islands of dry land. We
center in Greater Pibor, South Sudan. or the floods with their families,
accept that this is a challenge, but
© MSF/Tetiana Gaviuk 2020 are now living in close contact to
by no means impossible.
Right: A young patient recovers after each other.”
surgery at Médecins Sans Frontières This is the moment to vaccinate as
Our teams are running mobile
hospital in Bentiu Protection of Civilians many children as possible through
clinics in five villages and an
Site. © MSF/Tetiana Gaviuk 2020 small mobile teams visiting these
emergency clinic in Pibor town,
small islands.”
and are treating thousands of
Teams have been urgently children with malaria and measles.
responding. Children with measles
We have also been supporting
are generally expected to infect
water and sanitation activities,
around 12 to 18 other people, but
distributing about 60,000 litres of
our teams expect the infection rate
water daily.
in Pibor today to be alarmingly
15VULNERABLE COMMUNITIES: THE ELDERLY
RESPONDING
TO VULNERABLE
COMMUNITIES
Throughout this pandemic, many Our teams closely monitor Participants were tested at
the evolving situation in these emergency shelters, food
people are unable to access
contexts, ready to intervene where distribution points and workers’
healthcare simply because of needs are greatest. In the first hostels. COVID-19 seroprevalence
who they are, because they are four months of the pandemic, our – the percentage of people who
afraid to seek help, or because teams provided medical care in have been in contact with the virus
over 70 accommodation facilities and developed antibodies – was
they are excluded and forced to for homeless people in the Île-de- found to be extremely high in all
live on the margins of society. France region (Paris area), to help 14 sites.
prevent the spread of the virus.
This compared to one in ten
With winter coming, and in people found to have coronavirus
the face of a second wave of antibodies across the whole
infections, a survey co-conducted Île-de-France region. Epicentre-
by Médecins Sans Frontières in the Médecins Sans Frontières
region found COVID-19 infection epidemiologist Thomas Roederer,
rates to be as high as 94 per cent who led the survey, said:
“We have a specific role towards among some people living in
populations that are excluded from “The results confirm that the
extreme hardship.
the system. We work with migrants spread of the virus is particularly
and with refugees who are displaced
or conflict affected, and various
other groups of people who have
just dropped out of the system,
like prisoners. We will be making
arguments to try to provide COVID-19
vaccination in these more limited
settings.”
Doctor Greg Elder, medical coordinator,
Access Campaign
Matthieu, a logistician is registering
two patients’ information before their
consultation in Paris. © MSF/Mohammad
Ghannam 2020
16active in overcrowded and
cramped conditions.
Our main objective with this CARE HOMES: FIRST EVER
survey was to evaluate the
intensity of virus transmission
among people in very precarious
RESPONSE IN CZECH REPUBLIC
situations and to help define
As a part of COVID-19 response in
specific preventive activities to
Czech Republic, a Médecins Sans
better protect them. Frontières mobile team visit a care
With the increase in the number home in Božice, Southern Moravian
of positive COVID-19 cases in region, Czech Republic.
France, it also highlights the need © MSF/Nikola Tenevová 2020
to conduct more epidemiological
studies to better define priority
strategies for those people most
at risk.”
The majority of survey
participants said they had used
preventive measures (such as
frequent handwashing and
wearing masks) and followed
physical distancing advice.
However, spending lockdown in
overcrowded conditions, with
shared bedrooms, kitchens and
bathrooms, greatly increased the
risk of transmission.
This is highlighted by the fact that
people temporarily housed in
gymnasiums had a prevalence of
the virus that was three times higher
than for those housed in other types
of accommodation. Corinne Torre,
Médecins Sans Frontières head of Late last year, the Czech Republic became to visit nursing homes around the
mission for France warned: one of the countries globally with the country to give feedback and advice.
“The emergency measures highest number of COVID-19 cases Tereza Pokorná, a nurse on one of the
implemented to provide per million people. The disease spread teams, said:
homeless people with temporary particularly quickly among elderly
“We plan with the staff how to introduce
shelter must not be allowed people. Nursing home staff, who do not
‘clean’ and ‘dirty’ zones, whether they
to contribute to forming new always have medical training, often find
have isolation rooms, where staff will
clusters. Accommodation with themselves having to implement infection
put on their protective gear and where
individual living spaces, which prevention and control measures with little
they will dispose of it afterwards. We
enable the necessary precautions, to no guidance or previous experience.
need to see all of this physically because
is far preferable to communal We responded with two mobile teams, that is how the best ideas arise.”
facilities such as gymnasiums, comprising a nurse and a logistician,
which should be used only as a
very last resort.”
17IMPACT MENTAL HEALTH
A STRONG
EMOTIONAL
FIGHT
RESPONDING TO MENTAL HEALTH NEEDS
FOR PATIENTS AND STAFF
Mental healthcare has been a In the Médecins Sans Frontières Frontières and our psychologists
vital part of our treatment for COVID-19 hospital in Tijuana, and explaining what psychological
northwest Mexico, our team found support was on offer. The letter
patients, and for their recovery mental healthcare to be key to included a series of questions
from COVID-19. people’s recovery from the disease. which allowed staff to evaluate
Lucia Samayao, Médecins Sans a patient’s emotional state and
Frontières psychosocial strategy determine what care they needed
manager, said:
After this, a psychologist would
“These are people who have had hold a phone call with the patient,
“Not being able to breathe and the
a very strong emotional fight in encouraging them to let off steam,
fear of dying obviously increase
order to get better, and whose start to process what they were
patients’ anxiety levels.”
symptoms and physical state going through, and to know that
Lucia Samayao, Médecins Sans have forced them to think about they were on the road to recovery.
Frontières psychosocial strategy life and death issues. They have Staff also gave patients tools
manager, Tijuana, Mexico. had constant worries about what like breathing techniques and
will happen if they can no longer relaxation exercises to reduce their
see their family, if they can no anxiety, and other ways to express
longer hug them, increasing what they were feeling.
Above: In collaboration with the Local their anxiety and making it even
Our psychologists and social
Health Authority, Médecins Sans harder to breathe.”
workers also worked with patients’
Frontières organizes awareness-raising
sessions on how to prevent and manage When patients were admitted families, to help them cope with
COVID-19 in housing communities in to the hospital, they received a having a loved one affected
Rome. © MSF/Vincenzo Livieri 2020 letter introducing Médecins Sans by COVID-19. They ensured
18TACKLING ANXIETY IN INDIA
Médecins Sans Frontières opened a
100-bed COVID-19 treatment centre in
Patna, the capital of Bihar, in the middle
of last year. Bihar is one of India’s most
populated states, with around 100
million people. As well as providing
medical care for COVID-19 patients,
psychosocial support is also a critical part
of our treatment.
Mohit Siwach, a Médecins Sans
Frontières counsellor there, explained
how the pandemic has impacted both
the community and the way he does
his work:
© MSF/Garvit Nangia 2020
“Everyone in Patna knows someone
who has had COVID-19. There is an
overwhelming sense of hopelessness I recently spoke to a patient who lost her
and fear. We try to change patients’ father and I had to comfort her through
anxieties into hope. hand signals and body movements.
This is not how I would ideally approach
As soon as I enter the ward wearing the patients. However, it is immensely
personal protective equipment (PPE), I gratifying to find a way to change
have to readjust to the ‘new normal’ way people’s fear into a sense of hope,
of providing guidance and counselling despite the challenges.”
through face shields and masks.
families had regular phone
contact, and prepared them for
the patient’s recovery process
when they returned home, or SUPPORT TO OVERCOME
for the possibility of the patient
deteriorating or dying. TRAUMA
Psychologists also offered As a second wave of COVID-19 spread they had no training for. Sometimes
individual and group psychosocial across France late last year, Médecins they witnessed the agony of residents
support to staff. The pressure of the Sans Frontières stepped up support suffering from a lack of oxygen, while
COVID-19 emergency response for nursing home staff as the country doing the best they could to alleviate
was exhausting for health staff: urgently appealed for medical personnel. residents’ pain without appropriate
many suffered panic attacks and Our appeal centred on recruiting doctors, equipment. Marie Thomas, psychologist
feelings of helplessness in the face nurses and psychologists to help care for the Médecins Sans Frontières
of the high number of patients for people in nursing and residential program in nursing homes, said:
who died, and from fear of getting care homes, to reduce the burden on the
infected or losing colleagues and “Psychological trauma, anxiety, visual
most vulnerable facilities and strengthen
loved ones to the disease, explained and auditory flashbacks, as well as
the provision of medical care.
doctor Alberto Reyes Escamilla, physical pain, such as weight loss and
director of the hospital: Some care assistants told our teams sleep disorders, are examples of the
that during the first wave of the after-effects we frequently hear of from
“This collaboration has been very pandemic, they were left alone at nursing home workers we meet in the
important for us.” night with just a telephone for support course of our work.”
to manage complex medical cases
19RESPONDING TO REFUGEES AND DISPLACED PEOPLE
INCREASED
SUFFERING FOR
THOSE FORCED
TO FLEE
Already made vulnerable by conflict, neglect and persecution,
“I have never bought a mask – I can
barely buy bread. When I have the refugees and internally displaced people have been among
choice, I always go for bread.” the hardest hit during the pandemic. We report from three
Umm Firas, Abu Dali displacement displacement hotspots where we continue to ensure as many
camp, Syria. as possible have access to medical treatment.
SYRIA: treatment, maternity care and
As we enter the 10th year of mental health support, and
conflict, more than two million have set up isolation wards for
people are now living in camps in COVID-19 patients.
northwest Idlib governorate. The
80 MILLION PEOPLE ARE risk of COVID-19 transmission
GREECE:
In the Greek islands, tens of
CURRENTLY DISPLACED. is high and self-isolation is
thousands of refugees are living
almost impossible. Médecins
OVER HALF ARE Sans Frontières is providing
in tents or containers. With
INTERNALLY DISPLACED overcrowding, little clean water
healthcare in a number of the
and scarce sanitation, our teams
camps, including Abu Dali camp.
are concerned the pandemic
Here around 16,000 people are
could spread quickly in these
crammed into tents, some as small
camps. Médecins Sans Frontières
as six square metres.
is urging the Greek authorities
BANGLADESH: to immediately scale up their
THERE ARE NEARLY In the world’s largest refugee response to COVID-19 and
27 MILLION REFUGEES camp, in Cox’s Bazar, Bangladesh, transfer people at high risk to
we provide vital medical safe accommodation on Greece’s
AROUND THE WORLD mainland or in other countries.
LOWER-INCOME NATIONS
HOST 85 PER CENT OF THE
WORLD’S REFUGEES
20VOICES OF THE DISPLACED STAFF
SYRIA
REFLECTIONS
As infection rates increased in Syria’s “I know leaving home is risky, but I do
displacement camps late last year, local not have any choice. As scary as the virus “Idlib province has become like a
authorities imposed a lockdown to help is, I cannot leave my family without huge prison: people cannot move
slow down transmission. Kamal Adwan, food,” he said. south or north, and they are stuck
25, lives with his parents and 12 other here in the middle. They think that
family members in two adjacent tents in Umm Firas, 39, is also the sole provider the virus will reach them and their
Abu Dali camp. They fled their hometown for her family of 11 since her husband families at some point. They only
in rural Hama province two years ago, was partially paralysed in an airstrike. hope it will not get to them all at
after it came under heavy shelling. She earns her living by mending tents, once. The healthcare system simply
mattresses and bedsheets in the camp. could not manage to treat a lot of
Kamal is now the sole breadwinner for
To prevent the spread of COVID-19 in COVID-19 patients at once.”
his family of 15. For him, the economic
the camp, students must wear a mask to Hassan, Médecins Sans Frontières logistics
repercussions of the pandemic are more
school. However, money is so tight that manager, Idlib.
life-threatening than the pandemic itself.
Before COVID-19 and the subsequent Umm Firas and many local parents cannot
restrictions, Kamal used to find work on afford masks. As a result, their children are
construction sites. forced to stop their schooling.
“Refugees and people in displaced
situations are the most vulnerable
of the vulnerable when it comes to
GREECE BANGLADESH outbreaks. They are mostly living
in poverty, in very unsanitary
Oumaima, 52, a school teacher from Deir Living in dire conditions in the camp,
conditions, with no access to hand
ez-Zor, made the perilous escape from Noor Haba struggles to raise her five
sanitiser, or hand-washing. When
conflict-torn Syria with her family a year children, two of whom suffer from
they are asked to lock down it is very
ago. She lives in Vathy camp on Samos, thalassemia, a rare blood disease.
difficult for them.
Greece, with her husband and their Without regular blood transfusions,
three children. Oumaima has asthma they could quickly become sick and die. To not be able to go to work means
and her husband has hypertension and Noor Haba brings them to our hospital they are making the choice between
cardiovascular problems. Both are at every two months for their lifesaving food for the family, and isolating
high risk of COVID-19 because of their treatment, relying on blood donors from from a virus. For them, the rates
medical conditions. the community. But because of the fear of transmission can be very high,
and stigma surrounding COVID-19, her and they also do not have access to
“We are afraid of COVID-19, as in these testing the same way either. The
seven-year-old daughter Shahara has
living conditions it is impossible to idea of contact tracing and being
waited three days for a blood donor.
protect ourselves or isolate. My children able to prevent the disease from
Shahara’s legs and arms are stick thin;
have also developed mental health spreading like wildfire throughout a
her belly is extended from the swollen
issues due to living in the camp.” refugee camp, is tough.
spleen caused by her condition and
exacerbated by malnutrition. She lies One of the most important things
on the bed, semi-conscious while Noor is that population gets access to
Haba desperately awaits a lifesaving COVID-19 vaccines and drugs right
blood donation for her daughter: away, if at all possible.”
“We are searching everywhere. Jennifer Tierney, executive director,
Médecins Sans Frontières Australia.
Normally we can easily find someone to
give blood. But this time I cannot find
any blood donors due to the COVID-19
situation. No one wants to come to the
hospital because they feel afraid.”
21HEALTH WORKERS
CELEBRATING
FRONTLINE
Nurses and midwives are
the backbone of Médecins
Sans Frontières, essential
WORKERS
to providing treatment,
education and community
care in all our programs. We
salute their contributions
during our COVID-19 response.
REYNOSA, MEXICO
The Médecins Sans Frontières
nursing team at the COVID-19
treatment centre. During a
surge of COVID-19 cases, they
provided mental healthcare,
support and health education
as well as medical treatment for
© Arlette Blanco/MSF 2020
increasing patient numbers.
TAIZ HOUBAN, YEMEN
“I hope there will come a
day when this war is over.”
Wadha, a midwife at Médecins
Sans Frontières Mother and
Child Hospital, is part of the
team helping women deliver
safely, despite their own daily
© Manhal Alkallak/MSF 2020
challenges close to the frontline
of conflict.
MOSUL, IRAQ © Maxime Fossat/MSF 2020
A Médecins Sans Frontières
nurse checks on a baby in KADAMJAY, KYRGYZSTAN
the paediatric and neonatal Midwife Gulinsa provides
ward in Nablus hospital, west antenatal training for pregnant
Mosul. Our team supports women in our maternal school
intensive therapeutic feeding in Kadamjay. Amid the threat
programs, as well as caring for of COVID-19, in this remote
children with conditions such region having midwives closer
as bronchiolitis and asthma, to their community means
and treatment for newborns these young women can safely
with birth asphyxia. prepare for childbirth.
© Maya Abu Ata/MSF 2020
22© Patrick Meinhardt/MSF 2020
INSPIRED
BY OUR
DONORS
“Médecins Sans Frontières is in such
a good place because our donors are
so loyal. They understand that the
organisation can be trusted to decide
where the resources need to go, from
a medical humanitarian perspective.
© Nasir Ghafoor/MSF 2020 I get to build the advocacy and policy
route and plan based upon what I
FAR NORTH CAMEROON TIMERGARA, PAKISTAN hear from the medical operational
Nurse Silviane at our hospital In Pakistan, thousands of experts. There is no greater privilege
in Far North Cameroon women and infants die than to be able to work purely based
treats difficult cases such as each year from medical upon the needs.”
complicated fractures, severe conditions that are easily Kate Elder, senior vaccines policy
soft tissue and abdominal preventable. Midwife activity advisor, Access Campaign
infections and burn wounds. manager assistant Aarzo is
on the frontline of the fight
to save as many fragile lives
KENEMA, SIERRA LEONE as possible.
Nurse team supervisor Jerwin “For me, donor’s support is around
with a young patient in the the notion of solidarity and equality,
intensive care unit of our and the fact that we provide a
paediatric hospital. During the unique service to people who are
disruption of Sierra Leone’s left behind or left out. We continue
COVID-19 restrictions to do that work, and we continue
last year, our teams treated to provide, on a day-to-day basis, a
increased numbers of children million or so consultations under a
arriving late at the hospital, in tree or in a tent that make a huge
critical condition. difference to the communities
© Vincenzo Livieri/MSF 2020 where we work. Everything else
is secondary for me. First and
foremost, the donations that people
VACCINATING ALL HEALTHCARE provide, and that are prioritised
for our operations in the field, go
WORKERS IS ESSENTIAL into providing absolute urgent and
necessary healthcare that saves lives
every single day.”
One of the cornerstones of Médecins of frontline healthcare workers to be
Sans Frontières, response throughout this prioritised, especially in low-income Doctor Greg Elder, medical coordinator,
pandemic has been protecting both the countries. This includes ensuring that Access Campaign
physical and mental health of frontline these workers have access to any
health workers. With the advent of the treatments for COVID-19, including pre-
new COVID-19 vaccines, Médecins Sans exposure and post-exposure prophylaxis.
Frontières will push for the protection
23Médecins Sans Frontières Australia Ltd
ABN 74 068 758 654
PO Box 847 Broadway NSW 2007 Australia
Phone (61) (2) 8570 2647
Email executive.director@sydney.msf.org
msf.org.au
Nurse Josiane takes care of patient
Edith, in the sorting room of the Centre
Hospitalier Universitaire Communautaire,
where Médecins Sans Frontières runs the
advanced HIV unit.
© MSF/Adrienne Surprenant 2020
24You can also read
