Journal Article > CommentaryFull Text
Rev Int Croix Rouge. 13 October 2021; Volume First View; 1-16.; DOI:10.1017/S1816383121000266
Marin AP, Ali R
Rev Int Croix Rouge. 13 October 2021; Volume First View; 1-16.; DOI:10.1017/S1816383121000266
In certain contexts associated with counterterrorism, some governments and military forces have stigmatized civilians, not because of the acts they perform but rather from loose associations with groups perceived as “terrorists”, based on geographical proximity or common social, ethnic and religious backgrounds. Access to humanitarian assistance has been affected by this stigmatization, and in specific geographical areas it has been blocked, restricted, made conditional or undermined. This article draws on recent literature and examples to argue that certain counterterrorism frameworks and practices have inhibited the impartial delivery of aid to all affected populations.
Conference Material > Abstract
Briskin E, Smith JS, Caleo GNC, Lenglet AD, Pearlman J, et al.
MSF Scientific Days International 2021: Research. 18 May 2021
INTRODUCTION
In April 2020, “shielding” (separate living spaces with enhanced infection control support for groups at high risk of severe COVID-19 disease) was proposed for COVID-19 prevention in settings where lockdown is not feasible (i.e. displaced persons camps). MSF used qualitative methods to explore community perceptions of shielding and other potential COVID-19 prevention measures applicable in settings where it works. Nigeria and Sierra Leone served as initial pilot sites for this multi-site study that ultimately included 13 countries.
METHODS
We carried out qualitative assessments between April and August 2020 within 9 MSF-supported sites in Nigeria and Sierra Leone, with the aim of exploring community perceptions of potential COVID-19 prevention measures. Sites in Nigeria included internally displaced camps in two states, and in Sierra Leone, an open village setting. We conducted multiple rounds of participant-led individual in-depth qualitative interviews in the study sites between April-August 2020. We recruited participants purposively, ensuring participants recruited were representative of underlying demographic and ethnic diversity. Data were coded by hand on paper copies of transcripts and in NVivo12 and analyzed for key themes. Findings were built on through iteration with participants.
ETHICS
This study was approved by the MSF Ethics Review Board and by the Ethical Review Boards of Benue State, Nigeria, Zamfara State, Nigeria, and the District Health Management team,
Tonkolilli, Sierra Leone.
RESULTS
Participants reported that access to both COVID-19 and non- COVID-19 care was challenging due to fear of infection and practical difficulties attending care facilities. Key priorities noted
by participants included obtaining food, masks and handwashing, and continuing to get access to non-COVID-19 healthcare. In Nigeria, shielding (providing separate dwellings for high-risk
people) was described as a challenge.
Reasons for this included close living conditions affecting practicality, its impact on mental health, and the community’s inter-generational reliance. Shielding was only seen as feasible
with sustained provision of resources for shielded persons including COVID testing, food from the family, mobile phones, and socially distanced visitation. For Sierra Leone, previous
experiences (e.g. war, Ebola) influenced fears of separation and the possibility of infection from contact with strangers and health workers or health facilities. Lockdowns and school
closures have a negative effect on support networks and local economies, and in Sierra Leone increased the perceived risk of sexual and gender-based violence and exploitation. Participants reported the desire for self-management of contact tracing and transmission prevention activities within their communities. Context-specific activities to address these priorities were implemented in response.
CONCLUSION
The community-based feedback provided a better understanding of attitudes towards and feasibility of COVID-19 control measures. Commonalities were reported across sites, while
differences in findings across sites highlighted the importance of context-specific engagement. Early and continued community engagement allowed context-specific activities to address these priorities to be implemented in partnership with communities in response. Implemented activities included enhancement of handwashing points, subsidizing locally-produced cloth masks, and reinforcement of prevention and control for non-COVID diseases such as malaria.
CONFLICTS OF INTEREST
None declared.
In April 2020, “shielding” (separate living spaces with enhanced infection control support for groups at high risk of severe COVID-19 disease) was proposed for COVID-19 prevention in settings where lockdown is not feasible (i.e. displaced persons camps). MSF used qualitative methods to explore community perceptions of shielding and other potential COVID-19 prevention measures applicable in settings where it works. Nigeria and Sierra Leone served as initial pilot sites for this multi-site study that ultimately included 13 countries.
METHODS
We carried out qualitative assessments between April and August 2020 within 9 MSF-supported sites in Nigeria and Sierra Leone, with the aim of exploring community perceptions of potential COVID-19 prevention measures. Sites in Nigeria included internally displaced camps in two states, and in Sierra Leone, an open village setting. We conducted multiple rounds of participant-led individual in-depth qualitative interviews in the study sites between April-August 2020. We recruited participants purposively, ensuring participants recruited were representative of underlying demographic and ethnic diversity. Data were coded by hand on paper copies of transcripts and in NVivo12 and analyzed for key themes. Findings were built on through iteration with participants.
ETHICS
This study was approved by the MSF Ethics Review Board and by the Ethical Review Boards of Benue State, Nigeria, Zamfara State, Nigeria, and the District Health Management team,
Tonkolilli, Sierra Leone.
RESULTS
Participants reported that access to both COVID-19 and non- COVID-19 care was challenging due to fear of infection and practical difficulties attending care facilities. Key priorities noted
by participants included obtaining food, masks and handwashing, and continuing to get access to non-COVID-19 healthcare. In Nigeria, shielding (providing separate dwellings for high-risk
people) was described as a challenge.
Reasons for this included close living conditions affecting practicality, its impact on mental health, and the community’s inter-generational reliance. Shielding was only seen as feasible
with sustained provision of resources for shielded persons including COVID testing, food from the family, mobile phones, and socially distanced visitation. For Sierra Leone, previous
experiences (e.g. war, Ebola) influenced fears of separation and the possibility of infection from contact with strangers and health workers or health facilities. Lockdowns and school
closures have a negative effect on support networks and local economies, and in Sierra Leone increased the perceived risk of sexual and gender-based violence and exploitation. Participants reported the desire for self-management of contact tracing and transmission prevention activities within their communities. Context-specific activities to address these priorities were implemented in response.
CONCLUSION
The community-based feedback provided a better understanding of attitudes towards and feasibility of COVID-19 control measures. Commonalities were reported across sites, while
differences in findings across sites highlighted the importance of context-specific engagement. Early and continued community engagement allowed context-specific activities to address these priorities to be implemented in partnership with communities in response. Implemented activities included enhancement of handwashing points, subsidizing locally-produced cloth masks, and reinforcement of prevention and control for non-COVID diseases such as malaria.
CONFLICTS OF INTEREST
None declared.
Conference Material > Slide Presentation
Briskin E, Smith JS, Caleo GNC, Lenglet AD, Pearlman J, et al.
MSF Scientific Days International 2021: Research. 18 May 2021
Journal Article > ResearchFull Text
N Engl J Med. 12 December 2019; Volume 381 (Issue 24); 2293-2303.; DOI:10.1056/NEJMoa1910993
Mulangu S, Dodd LE, Davey RT, Tshiani Mbaya O, Proschan M, et al.
N Engl J Med. 12 December 2019; Volume 381 (Issue 24); 2293-2303.; DOI:10.1056/NEJMoa1910993
BACKGROUND
Although several experimental therapeutics for Ebola virus disease (EVD) have been developed, the safety and efficacy of the most promising therapies need to be assessed in the context of a randomized, controlled trial.
METHODS
We conducted a trial of four investigational therapies for EVD in the Democratic Republic of Congo, where an outbreak began in August 2018. Patients of any age who had a positive result for Ebola virus RNA on reverse-transcriptase–polymerase-chain-reaction assay were enrolled. All patients received standard care and were randomly assigned in a 1:1:1:1 ratio to intravenous administration of the triple monoclonal antibody ZMapp (the control group), the antiviral agent remdesivir, the single monoclonal antibody MAb114, or the triple monoclonal antibody REGN-EB3. The REGN-EB3 group was added in a later version of the protocol, so data from these patients were compared with those of patients in the ZMapp group who were enrolled at or after the time the REGN-EB3 group was added (the ZMapp subgroup). The primary end point was death at 28 days.
RESULTS
A total of 681 patients were enrolled from November 20, 2018, to August 9, 2019, at which time the data and safety monitoring board recommended that patients be assigned only to the MAb114 and REGN-EB3 groups for the remainder of the trial; the recommendation was based on the results of an interim analysis that showed superiority of these groups to ZMapp and remdesivir with respect to mortality. At 28 days, death had occurred in 61 of 174 patients (35.1%) in the MAb114 group, as compared with 84 of 169 (49.7%) in the ZMapp group (P = 0.007), and in 52 of 155 (33.5%) in the REGN-EB3 group, as compared with 79 of 154 (51.3%) in the ZMapp subgroup (P = 0.002). A shorter duration of symptoms before admission and lower baseline values for viral load and for serum creatinine and aminotransferase levels each correlated with improved survival. Four serious adverse events were judged to be potentially related to the trial drugs.
CONCLUSIONS
Both MAb114 and REGN-EB3 were superior to ZMapp in reducing mortality from EVD. Scientifically and ethically sound clinical research can be conducted during disease outbreaks
and can help inform the outbreak response.
ClinicalTrials.gov number NCT03719586.)
Although several experimental therapeutics for Ebola virus disease (EVD) have been developed, the safety and efficacy of the most promising therapies need to be assessed in the context of a randomized, controlled trial.
METHODS
We conducted a trial of four investigational therapies for EVD in the Democratic Republic of Congo, where an outbreak began in August 2018. Patients of any age who had a positive result for Ebola virus RNA on reverse-transcriptase–polymerase-chain-reaction assay were enrolled. All patients received standard care and were randomly assigned in a 1:1:1:1 ratio to intravenous administration of the triple monoclonal antibody ZMapp (the control group), the antiviral agent remdesivir, the single monoclonal antibody MAb114, or the triple monoclonal antibody REGN-EB3. The REGN-EB3 group was added in a later version of the protocol, so data from these patients were compared with those of patients in the ZMapp group who were enrolled at or after the time the REGN-EB3 group was added (the ZMapp subgroup). The primary end point was death at 28 days.
RESULTS
A total of 681 patients were enrolled from November 20, 2018, to August 9, 2019, at which time the data and safety monitoring board recommended that patients be assigned only to the MAb114 and REGN-EB3 groups for the remainder of the trial; the recommendation was based on the results of an interim analysis that showed superiority of these groups to ZMapp and remdesivir with respect to mortality. At 28 days, death had occurred in 61 of 174 patients (35.1%) in the MAb114 group, as compared with 84 of 169 (49.7%) in the ZMapp group (P = 0.007), and in 52 of 155 (33.5%) in the REGN-EB3 group, as compared with 79 of 154 (51.3%) in the ZMapp subgroup (P = 0.002). A shorter duration of symptoms before admission and lower baseline values for viral load and for serum creatinine and aminotransferase levels each correlated with improved survival. Four serious adverse events were judged to be potentially related to the trial drugs.
CONCLUSIONS
Both MAb114 and REGN-EB3 were superior to ZMapp in reducing mortality from EVD. Scientifically and ethically sound clinical research can be conducted during disease outbreaks
and can help inform the outbreak response.
ClinicalTrials.gov number NCT03719586.)