Journal Article > CommentaryFull Text
Health Aff (Millwood). 2015 September 1; Volume 34 (Issue 9); 1569-1577.; DOI:10.1377/hlthaff.2015.0375
Kishore SP, Kolappa K, Jarvis JN, Park PH, Belt R, et al.
Health Aff (Millwood). 2015 September 1; Volume 34 (Issue 9); 1569-1577.; DOI:10.1377/hlthaff.2015.0375
The modern access-to-medicines movement grew largely out of the civil-society reaction to the HIV/AIDS pandemic three decades ago. While the movement was successful with regard to HIV/AIDS medications, the increasingly urgent challenge to address access to medicines for noncommunicable diseases has lagged behind-and, in some cases, has been forgotten. In this article we first ask what causes the access gap with respect to lifesaving essential noncommunicable disease medicines and then what can be done to close the gap. Using the example of the push for access to antiretrovirals for HIV/AIDS patients for comparison, we highlight the problems of inadequate global financing and procurement for noncommunicable disease medications, intellectual property barriers and concerns raised by the pharmaceutical industry, and challenges to building stronger civil-society organizations and a patient and humanitarian response from the bottom up to demand treatment. We provide targeted policy recommendations, specific to the public sector, the private sector, and civil society, with the goal of improving access to noncommunicable disease medications globally.
Journal Article > CommentaryFull Text
Lancet. 2013 February 1; Volume 381 (Issue 9867); 680-689.; DOI:10.1016/S0140-6736(12)62128-X
Hogerzeil H, Liberman J, Wirtz V, Kishore SP, Selvaraj S, et al.
Lancet. 2013 February 1; Volume 381 (Issue 9867); 680-689.; DOI:10.1016/S0140-6736(12)62128-X
Access to medicines and vaccines to prevent and treat non-communicable diseases (NCDs) is unacceptably low worldwide. In the 2011 UN political declaration on the prevention and control of NCDs, heads of government made several commitments related to access to essential medicines, technologies, and vaccines for such diseases. 30 years of experience with policies for essential medicines and 10 years of scaling up of HIV treatment have provided the knowledge needed to address barriers to long-term effective treatment and prevention of NCDs. More medicines can be acquired within existing budgets with efficient selection, procurement, and use of generic medicines. Furthermore, low-income and middle-income countries need to increase mobilisation of domestic resources to cater for the many patients with NCDs who do not have access to treatment. Existing initiatives for HIV treatment offer useful lessons that can enhance access to pharmaceutical management of NCDs and improve adherence to long-term treatment of chronic illness; policy makers should also address unacceptable inequities in access to controlled opioid analgesics. In addition to off-patent medicines, governments can promote access to new and future on-patent medicinal products through coherent and equitable health and trade policies, particularly those for intellectual property. Frequent conflicts of interest need to be identified and managed, and indicators and targets for access to NCD medicines should be used to monitor progress. Only with these approaches can a difference be made to the lives of hundreds of millions of current and future patients with NCDs.
Conference Material > Slide Presentation
Kiddell-Monroe R, Farber J, Devine C, Orbinski J
MSF Scientific Days International 2021: Innovation. 2021 May 20; DOI:10.1016/S2542-5196(21)00177-7
Journal Article > CommentaryFull Text
Global Health. 2016 September 14; Volume 12 (Issue 1); 54.; DOI:10.1186/s12992-016-0190-8
Greenberg A, Kiddell-Monroe R
Global Health. 2016 September 14; Volume 12 (Issue 1); 54.; DOI:10.1186/s12992-016-0190-8
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.
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.
Conference Material > Abstract
Farber J, Kiddell-Monroe R, Saranchuk P, Martinez J, Burnicho S
MSF Scientific Days International 2021: Innovation. 2021 May 20
WHAT CHALLENGE OR OPPORTUNITY DID YOU TRY TO ADDRESS? WERE EXISTING SOLUTIONS NOT AVAILABLE OR NOT GOOD ENOUGH?
Isolated and vulnerable communities, such as indigenous and migrant communities, face increased risk of mortality during the COVID-19 pandemic. They lack access to health services, testing, and personal protective equipment (PPE). They may not have the tools to find clear and adapted information, and to distinguish facts from rumours.
WHY DOES THIS CHALLENGE OR OPPORTUNITY MATTER – WHY SHOULD MSF ADDRESS IT?
MSF is committed to developing people-centred approaches to emergency medical interventions. If communities are well-equipped and informed on COVID-19, and feel a sense of dignity, ownership, and agency in managing their response, MSF interventions will be more effective and sustainable.
DESCRIBE YOUR INNOVATION AND WHAT MAKES IT INNOVATIVE
CommunityFirst is an approach that recognises the role that communities play in organising, preparing, and responding to COVID-19. CommunityFirst Solutions for COVID-19 involves the Roadmap, a step-by-step guide to emergency response, resources, and an action plan template; the Accompaniment, trainings, workshops, and mentorship; and the Solidarity Network, through which virtual communities of practice are established with community leaders (“Activators”) using the Roadmap to share resources and challenges.
WHO WILL BENEFIT (WHOSE LIFE / WORK WILL IT IMPROVE?) AND WERE THEY INVOLVED IN THE DESIGN?
Community organisations and leaders (indigenous, migrants, women and youth) are adopting this tool as a methodology to support the health of their communities. This initiative was co-created with the Inuit of Clyde River, Nunavut, Canada and continues to evolve based on the input and participation of community Activators worldwide.
WHAT OBJECTIVES DID YOU SET FOR THE PROJECT – WHAT DID YOU WANT TO ACHIEVE AND HOW DID YOU DEFINE AND MEASURE SUCCESS (IMPROVED SERVICE, LOWER COST, BETTER EFFICIENCY, BETTER USER EXPERIENCE, ETC.)?
Our objectives were to support communities to: increase resilience to COVID-19 and future health emergencies; identify their needs and set the terms of their relationships with humanitarian actors and local authorities; improve mental health and reduce anxiety by providing a step-by-step guide to managing COVID-19; and access and disseminate accurate information. We measured success by assessing uptake of the Roadmap; feedback from Activators; adaptability of the methodology to distinct contexts; community partnerships formed; and number of community leaders trained.
WHAT DATA DID YOU COLLECT TO MEASURE THE INNOVATION AGAINST THESE INDICATORS AND HOW DID YOU COLLECT IT? INCLUDE IF YOU DECIDED TO CHANGE THE INDICATORS AND WHY.
We collected Roadmap website analytics and completed COVID-19 community plans. We conducted interviews with Activators.
HOW DID YOU ANALYSE THIS DATA TO UNDERSTAND TO WHAT EXTENT THE INNOVATION ACHIEVED ITS OBJECTIVES? DID THIS INCLUDE A COMPARISON TO THE STATUS QUO OR AN EXISTING SOLUTION?
We asked Activators to compare this initiative to the support that communities received from governments and humanitarian actors.
WERE THERE ANY LIMITATIONS TO THE DATA YOU COLLECTED, HOW YOU COLLECTED IT OR HOW YOU ANALYSED IT, OR WERE THERE ANY UNFORESEEN FACTORS THAT MAY HAVE INTERFERED WITH YOUR RESULTS?
Due to the pandemic and the timeframe, the qualitative data is mainly anecdotal. While we have gathered quantitative data, we will carry out more scientific data collection in 2021.
WHAT RESULTS DID YOU GET?
The Roadmap website was accessed by users in 96 countries. Community readiness plans were completed by ten communities in Canada, Mexico, Guatemala, Honduras, Peru, Colombia, and Kenya. Training on the Roadmap was provided for 284 community leaders, and we partnered with 12 community organisations. Through Activator interviews, we found that many communities received little relevant support from governments. For example, small Indigenous communities reported receiving generic plans meant for large cities or 40-page documents that were not written in the local language. Activators expressed that having the support to create a plan adapted to their own environment made them feel calm and gave them the confidence to develop their locally relevant response.
COMPARING THE RESULTS FROM YOUR DATA ANALYSIS TO YOUR OBJECTIVES, EXPLAIN WHY YOU CONSIDER YOUR INNOVATION A SUCCESS OR FAILURE?
The widespread uptake of the website, training, and accompaniment indicates a demand from communities around the world for accessible support and tools to respond to COVID-19. Activators reported reduced anxiety about COVID-19 since having access to accurate health information to share with their communities. Many Activators were women and reported that the Roadmap strengthened their leadership skills.
TO WHAT EXTENT DID THE INNOVATION BENEFIT PEOPLE’S LIVES / WORK?
Community members gained skills in emergency preparedness and created mechanisms for community wellbeing that will increase their resilience to future health emergencies.
IS THERE ANYTHING THAT YOU WOULD DO DIFFERENTLY IF YOU WERE TO DO THE WORK AGAIN?
After several months, we recognised that women and youths were the main implementers of the Roadmap. If we were to repeat the process, we would target our outreach to these groups.
WHAT ARE THE NEXT STEPS FOR THE INNOVATION ITSELF (SCALE UP, IMPLEMENTATION, FURTHER DEVELOPMENT, DISCONTINUED)?
We intend to scale up the Accompaniment programme to support additional communities and expand our geographic scope. We aim to provide more training opportunities and workshops, create more original resources, transition to a more sophisticated website, and continue to conduct rigorous data analysis, monitoring and evaluation, and research. We also aim to develop CommunityFirst Solutions for mental health and climate resilience.
IS THE INNOVATION TRANSFERABLE OR ADAPTABLE TO OTHER SETTINGS OR DOMAINS?
A Honduran community adapted the Roadmap in response to natural disasters in pandemic times. It has also been adapted for children, migrants, and other groups.
WHAT BROADER IMPLICATIONS ARE THERE FROM THE INNOVATION FOR MSF AND / OR OTHERS (CHANGE IN PRACTICE, CHANGE IN POLICY, CHANGE IN GUIDELINES, PARADIGM SHIFT)?
Given the move to decolonise humanitarian assistance and empower communities, this practical methodology will support MSF as it changes practices around engaging with vulnerable groups facing intersecting crises. The involvement of the MSF Latin America Association as a partner already demonstrates this.
WHAT OTHER LEARNINGS FROM YOUR WORK ARE IMPORTANT TO SHARE?
Humanitarian action needs to transform to put communities at the heart of the response. The CommunityFirst approach requires connection and engagement with communities, leveraging community assets, and reflecting together on results. Another learning is that communities need direct financial support to implement CommunityFirst activities on the ground.
ETHICS
This innovation project did not involve human participants or their data; the MSF Ethics Framework for Innovation was used to help identify and mitigate potential harms.
Isolated and vulnerable communities, such as indigenous and migrant communities, face increased risk of mortality during the COVID-19 pandemic. They lack access to health services, testing, and personal protective equipment (PPE). They may not have the tools to find clear and adapted information, and to distinguish facts from rumours.
WHY DOES THIS CHALLENGE OR OPPORTUNITY MATTER – WHY SHOULD MSF ADDRESS IT?
MSF is committed to developing people-centred approaches to emergency medical interventions. If communities are well-equipped and informed on COVID-19, and feel a sense of dignity, ownership, and agency in managing their response, MSF interventions will be more effective and sustainable.
DESCRIBE YOUR INNOVATION AND WHAT MAKES IT INNOVATIVE
CommunityFirst is an approach that recognises the role that communities play in organising, preparing, and responding to COVID-19. CommunityFirst Solutions for COVID-19 involves the Roadmap, a step-by-step guide to emergency response, resources, and an action plan template; the Accompaniment, trainings, workshops, and mentorship; and the Solidarity Network, through which virtual communities of practice are established with community leaders (“Activators”) using the Roadmap to share resources and challenges.
WHO WILL BENEFIT (WHOSE LIFE / WORK WILL IT IMPROVE?) AND WERE THEY INVOLVED IN THE DESIGN?
Community organisations and leaders (indigenous, migrants, women and youth) are adopting this tool as a methodology to support the health of their communities. This initiative was co-created with the Inuit of Clyde River, Nunavut, Canada and continues to evolve based on the input and participation of community Activators worldwide.
WHAT OBJECTIVES DID YOU SET FOR THE PROJECT – WHAT DID YOU WANT TO ACHIEVE AND HOW DID YOU DEFINE AND MEASURE SUCCESS (IMPROVED SERVICE, LOWER COST, BETTER EFFICIENCY, BETTER USER EXPERIENCE, ETC.)?
Our objectives were to support communities to: increase resilience to COVID-19 and future health emergencies; identify their needs and set the terms of their relationships with humanitarian actors and local authorities; improve mental health and reduce anxiety by providing a step-by-step guide to managing COVID-19; and access and disseminate accurate information. We measured success by assessing uptake of the Roadmap; feedback from Activators; adaptability of the methodology to distinct contexts; community partnerships formed; and number of community leaders trained.
WHAT DATA DID YOU COLLECT TO MEASURE THE INNOVATION AGAINST THESE INDICATORS AND HOW DID YOU COLLECT IT? INCLUDE IF YOU DECIDED TO CHANGE THE INDICATORS AND WHY.
We collected Roadmap website analytics and completed COVID-19 community plans. We conducted interviews with Activators.
HOW DID YOU ANALYSE THIS DATA TO UNDERSTAND TO WHAT EXTENT THE INNOVATION ACHIEVED ITS OBJECTIVES? DID THIS INCLUDE A COMPARISON TO THE STATUS QUO OR AN EXISTING SOLUTION?
We asked Activators to compare this initiative to the support that communities received from governments and humanitarian actors.
WERE THERE ANY LIMITATIONS TO THE DATA YOU COLLECTED, HOW YOU COLLECTED IT OR HOW YOU ANALYSED IT, OR WERE THERE ANY UNFORESEEN FACTORS THAT MAY HAVE INTERFERED WITH YOUR RESULTS?
Due to the pandemic and the timeframe, the qualitative data is mainly anecdotal. While we have gathered quantitative data, we will carry out more scientific data collection in 2021.
WHAT RESULTS DID YOU GET?
The Roadmap website was accessed by users in 96 countries. Community readiness plans were completed by ten communities in Canada, Mexico, Guatemala, Honduras, Peru, Colombia, and Kenya. Training on the Roadmap was provided for 284 community leaders, and we partnered with 12 community organisations. Through Activator interviews, we found that many communities received little relevant support from governments. For example, small Indigenous communities reported receiving generic plans meant for large cities or 40-page documents that were not written in the local language. Activators expressed that having the support to create a plan adapted to their own environment made them feel calm and gave them the confidence to develop their locally relevant response.
COMPARING THE RESULTS FROM YOUR DATA ANALYSIS TO YOUR OBJECTIVES, EXPLAIN WHY YOU CONSIDER YOUR INNOVATION A SUCCESS OR FAILURE?
The widespread uptake of the website, training, and accompaniment indicates a demand from communities around the world for accessible support and tools to respond to COVID-19. Activators reported reduced anxiety about COVID-19 since having access to accurate health information to share with their communities. Many Activators were women and reported that the Roadmap strengthened their leadership skills.
TO WHAT EXTENT DID THE INNOVATION BENEFIT PEOPLE’S LIVES / WORK?
Community members gained skills in emergency preparedness and created mechanisms for community wellbeing that will increase their resilience to future health emergencies.
IS THERE ANYTHING THAT YOU WOULD DO DIFFERENTLY IF YOU WERE TO DO THE WORK AGAIN?
After several months, we recognised that women and youths were the main implementers of the Roadmap. If we were to repeat the process, we would target our outreach to these groups.
WHAT ARE THE NEXT STEPS FOR THE INNOVATION ITSELF (SCALE UP, IMPLEMENTATION, FURTHER DEVELOPMENT, DISCONTINUED)?
We intend to scale up the Accompaniment programme to support additional communities and expand our geographic scope. We aim to provide more training opportunities and workshops, create more original resources, transition to a more sophisticated website, and continue to conduct rigorous data analysis, monitoring and evaluation, and research. We also aim to develop CommunityFirst Solutions for mental health and climate resilience.
IS THE INNOVATION TRANSFERABLE OR ADAPTABLE TO OTHER SETTINGS OR DOMAINS?
A Honduran community adapted the Roadmap in response to natural disasters in pandemic times. It has also been adapted for children, migrants, and other groups.
WHAT BROADER IMPLICATIONS ARE THERE FROM THE INNOVATION FOR MSF AND / OR OTHERS (CHANGE IN PRACTICE, CHANGE IN POLICY, CHANGE IN GUIDELINES, PARADIGM SHIFT)?
Given the move to decolonise humanitarian assistance and empower communities, this practical methodology will support MSF as it changes practices around engaging with vulnerable groups facing intersecting crises. The involvement of the MSF Latin America Association as a partner already demonstrates this.
WHAT OTHER LEARNINGS FROM YOUR WORK ARE IMPORTANT TO SHARE?
Humanitarian action needs to transform to put communities at the heart of the response. The CommunityFirst approach requires connection and engagement with communities, leveraging community assets, and reflecting together on results. Another learning is that communities need direct financial support to implement CommunityFirst activities on the ground.
ETHICS
This innovation project did not involve human participants or their data; the MSF Ethics Framework for Innovation was used to help identify and mitigate potential harms.