Journal Article > CommentaryFull Text
Afr J Emerg Med. 2020 June 1; Volume 10; DOI:10.1016/j.afjem.2020.05.012
Pegg AM, Palma M, Roberson C, Okonta C, Massamba MH, et al.
Afr J Emerg Med. 2020 June 1; Volume 10; DOI:10.1016/j.afjem.2020.05.012
Conference Material > Video (talk)
Nsaibirni R, Assao B, Roberts N
MSF Scientific Days International 2022. 2022 June 10; DOI:10.57740/j309-9q89
Journal Article > ResearchFull Text
Confl Health. 2020 November 25; Volume 14; 80.; DOI:10.1186/s13031-020-00325-6
Garry S, Abdelmagid N, Baxter LM, Roberts N, de Waroux OL, et al.
Confl Health. 2020 November 25; Volume 14; 80.; DOI:10.1186/s13031-020-00325-6
The COVID-19 pandemic has the potential to cause high morbidity and mortality in crisis-affected populations. Delivering COVID-19 treatment services in crisis settings will likely entail complex trade-offs between offering services of clinical benefit and minimising risks of nosocomial infection, while allocating resources appropriately and safeguarding other essential services. This paper outlines considerations for humanitarian actors planning COVID-19 treatment services where vaccination is not yet widely available. We suggest key decision-making considerations: allocation of resources to COVID-19 treatment services and the design of clinical services should be based on community preferences, likely opportunity costs, and a clearly articulated package of care across different health system levels. Moreover, appropriate service planning requires information on the expected COVID-19 burden and the resilience of the health system. We explore COVID-19 treatment service options at the patient level (diagnosis, management, location and level of treatment) and measures to reduce nosocomial transmission (cohorting patients, protecting healthcare workers). Lastly, we propose key indicators for monitoring COVID-19 health services.
Journal Article > CommentaryFull Text
Journal of Humanitarian Affairs. 2021 December 22; Volume 3 (Issue 3); 14-23.; DOI:10.7227/JHA.070
Roberts N
Journal of Humanitarian Affairs. 2021 December 22; Volume 3 (Issue 3); 14-23.; DOI:10.7227/JHA.070
This article explores the actions of Médecins Sans Frontières during the 2018–20 Ebola outbreak in Nord Kivu, in the Democratic Republic of Congo. Based on the experiences of practitioners involved in the response, including the author, and on the public positioning of MSF during the first year of the epidemic, it argues that although the actions of response actors were usually well intentioned, they could rarely be described as lifesaving, may have exacerbated disease transmission as much as limited it and had the perverse effect of fuelling corruption and violence. The article documents and analyses contradictions in MSF’s moral and technical positioning, and the complicated relationship between the organisation and the international and Congolese institutions leading the response. It argues that the medical and social failure of the response was the result of an initial belief in a strategy designed at a time when the only realistically attainable outcome was to relieve suffering, and of the later inability of the organisation to convince the authorities in charge of the response to adjust their approach. It suggests that for future success new protocols must be elaborated and agreed based on a better social and political comprehension and a better understanding of the tools now available.
Conference Material > Abstract
Roberts N
Epicentre Scientific Day Paris 2021. 2021 June 10
In late 2013 an outbreak of Ebola Virus Disease (EVD) began in Guinea and spread to neighboring Liberia and Sierra Leone. Over 2,5 years the outbreak resulted in more than 28,000 cases, and more than 11,000 deaths. The Ebola Ça Suffit! rVSV-ZEBOV vaccine trial began in Guinea in 2015, at the tail end of the West African epidemic. A ring vaccination study design was used in the aim of obtaining rapid, high-quality effectiveness data and addressing ethical concerns about the use of placebos during an outbreak. The trial concluded that rVSV-ZEBOV offers substantial protection against EVD. The vaccine is now named Ervebo and approved by the FDA, EMA and prequalified by the WHO, but the original study design has continued to determine how the vaccine is deployed. Since the results of Ebola Ça Suffit! were published, more than 300,000 doses of rVSV-ZEBOV have been administered via a reactive ring vaccination strategy, mainly in Eastern DRC in response to an epidemic declared in August 2018.
Although ring vaccination may help to control the transmission of EVD, it seems far from the ideal strategy, as indicated by the fact that the outbreak in Eastern DRC continued for nearly two years despite vaccination starting quickly after the declaration of the epidemic. There are both logistical and social challenges to effective real-life implementation of the ring strategy.
Testing new strategies of vaccination will be necessary to better protect at-risk populations and to better prevent and control outbreaks. This should include the routine vaccination outside epidemic periods of all healthcare, frontline workers and other high-risk population groups in areas that have recurrent epidemics or endemic EVD. During outbreaks, targeted geographic or population-based reactive vaccination campaigns are likely to be more successful than the current ring strategy. We should also return to the initial hypothesis that a range of vaccines with different specificities is probably necessary. Today there are two different vaccines against EVD with different profiles.
KEY MESSAGE: This presentation provides an overview of current Ebola vaccination strategies, their challenges and the way forward.
This abstract is not to be quoted for publication.
Although ring vaccination may help to control the transmission of EVD, it seems far from the ideal strategy, as indicated by the fact that the outbreak in Eastern DRC continued for nearly two years despite vaccination starting quickly after the declaration of the epidemic. There are both logistical and social challenges to effective real-life implementation of the ring strategy.
Testing new strategies of vaccination will be necessary to better protect at-risk populations and to better prevent and control outbreaks. This should include the routine vaccination outside epidemic periods of all healthcare, frontline workers and other high-risk population groups in areas that have recurrent epidemics or endemic EVD. During outbreaks, targeted geographic or population-based reactive vaccination campaigns are likely to be more successful than the current ring strategy. We should also return to the initial hypothesis that a range of vaccines with different specificities is probably necessary. Today there are two different vaccines against EVD with different profiles.
KEY MESSAGE: This presentation provides an overview of current Ebola vaccination strategies, their challenges and the way forward.
This abstract is not to be quoted for publication.
Protocol > Research Study
BMJ Open. 2022 March 8; Volume 12 (Issue 3); e055596.; DOI:10.1136/bmjopen-2021-055596
Watson-Jones D, Kavunga-Membo H, Grais RF, Ahuka S, Roberts N, et al.
BMJ Open. 2022 March 8; Volume 12 (Issue 3); e055596.; DOI:10.1136/bmjopen-2021-055596
INTRODUCTION
Ebola virus disease (EVD) continues to be a significant public health problem in sub-Saharan Africa, especially in the Democratic Republic of the Congo (DRC). Large-scale vaccination during outbreaks may reduce virus transmission. We established a large population-based clinical trial of a heterologous, two-dose prophylactic vaccine during an outbreak in eastern DRC to determine vaccine effectiveness.
METHODS AND ANALYSIS
This open-label, non-randomised, population-based trial enrolled eligible adults and children aged 1 year and above. Participants were offered the two-dose candidate EVD vaccine regimen VAC52150 (Ad26.ZEBOV, Modified Vaccinia Ankara (MVA)-BN-Filo), with the doses being given 56 days apart. After vaccination, serious adverse events (SAEs) were passively recorded until 1 month post dose 2. 1000 safety subset participants were telephoned at 1 month post dose 2 to collect SAEs. 500 pregnancy subset participants were contacted to collect SAEs at D7 and D21 post dose 1 and at D7, 1 month, 3 months and 6 months post dose 2, unless delivery was before these time points. The first 100 infants born to these women were given a clinical examination 3 months post delivery. Due to COVID-19 and temporary suspension of dose 2 vaccinations, at least 50 paediatric and 50 adult participants were enrolled into an immunogenicity subset to examine immune responses following a delayed second dose. Samples collected predose 2 and at 21 days post dose 2 will be tested using the Ebola viruses glycoprotein Filovirus Animal Non-Clinical Group ELISA. For qualitative research, in-depth interviews and focus group discussions were being conducted with participants or parents/care providers of paediatric participants.
ETHICS AND DISSEMINATION
Approved by Comité National d'Ethique et de la Santé du Ministère de la santé de RDC, Comité d'Ethique de l'Ecole de Santé Publique de l'Université de Kinshasa, the LSHTM Ethics Committee and the MSF Ethics Review Board. Findings will be presented to stakeholders and conferences. Study data will be made available for open access.
TRIAL REGISTRATION NUMBER
NCT04152486.
Ebola virus disease (EVD) continues to be a significant public health problem in sub-Saharan Africa, especially in the Democratic Republic of the Congo (DRC). Large-scale vaccination during outbreaks may reduce virus transmission. We established a large population-based clinical trial of a heterologous, two-dose prophylactic vaccine during an outbreak in eastern DRC to determine vaccine effectiveness.
METHODS AND ANALYSIS
This open-label, non-randomised, population-based trial enrolled eligible adults and children aged 1 year and above. Participants were offered the two-dose candidate EVD vaccine regimen VAC52150 (Ad26.ZEBOV, Modified Vaccinia Ankara (MVA)-BN-Filo), with the doses being given 56 days apart. After vaccination, serious adverse events (SAEs) were passively recorded until 1 month post dose 2. 1000 safety subset participants were telephoned at 1 month post dose 2 to collect SAEs. 500 pregnancy subset participants were contacted to collect SAEs at D7 and D21 post dose 1 and at D7, 1 month, 3 months and 6 months post dose 2, unless delivery was before these time points. The first 100 infants born to these women were given a clinical examination 3 months post delivery. Due to COVID-19 and temporary suspension of dose 2 vaccinations, at least 50 paediatric and 50 adult participants were enrolled into an immunogenicity subset to examine immune responses following a delayed second dose. Samples collected predose 2 and at 21 days post dose 2 will be tested using the Ebola viruses glycoprotein Filovirus Animal Non-Clinical Group ELISA. For qualitative research, in-depth interviews and focus group discussions were being conducted with participants or parents/care providers of paediatric participants.
ETHICS AND DISSEMINATION
Approved by Comité National d'Ethique et de la Santé du Ministère de la santé de RDC, Comité d'Ethique de l'Ecole de Santé Publique de l'Université de Kinshasa, the LSHTM Ethics Committee and the MSF Ethics Review Board. Findings will be presented to stakeholders and conferences. Study data will be made available for open access.
TRIAL REGISTRATION NUMBER
NCT04152486.
Conference Material > Video (talk)
Roberts N
Epicentre Scientific Day Paris 2021. 2021 June 10
Conference Material > Slide Presentation
Nsaibirni R, Assao B, Roberts N
MSF Scientific Days International 2022. 2022 May 10; DOI:10.57740/jr83-tm74
Conference Material > Abstract
Nsaibirni R, Assao B, Roberts N
MSF Scientific Days International 2022. 2022 May 9; DOI:10.57740/8fze-ds93
INTRODUCTION
In early 2020, Niger’s Ministry of Health (MoH) launched a system for collecting and investigating Covid-19 alerts. This system was paper based and used unstructured data sharing via text messages, hence did not allow for rapid and exhaustive data collection or effective investigation of alerts. Consequently, MSF teams were unable to accurately assess Covid-19 epidemiology in Niger, affecting decision-making about what support to offer and where. Covid-19 patients were not being diagnosed until in the late stages of disease, or would never be diagnosed at all. Hence, MSF teams feared care would not be effective. Epicentre and the MSF Foundation collaborated with Medic, a not-for-profit organisation designing open- source digital tools for healthcare, to develop an electronic tool to improve receipt and investigation of Covid-19 alerts in Niger. We aimed to collect structured data, to increase the number of alerts investigated, and to improve the timeliness and completeness of investigations. This would facilitate earlier diagnosis of symptomatic disease, earlier orientation of patients towards care, and improve accurate and timely epidemiological reporting.
METHODS
The digital platform, Alerte Covid-19, replaced the existing paper-based system. Patients and health workers across Niger were instructed to phone a national MoH hotline to report suspected cases. Each alert was registered on the digital platform; this then guides users to determine if investigation is necessary, and allocates alerts to a regional alert centre. Investigation teams follow up alerts via patient testing, direct patients towards relevant care, and report Covid-19 test results and the outcome of positive cases in the digital platform. The platform links to dashboards to provide an overview of alerts and outcomes at regional and national levels.
ETHICS
This description/evaluation of an 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.
RESULTS
The hotline service handles up to 6,000 calls per day, 5% of which are Covid-19 related and most require investigation. From May 2020 to November 2021, 11,295 Covid19-related alerts were received, of which 10,100 were investigated and 9,386 tested. Timeliness was improved from several days to a few hours and data was more structured and complete.
CONCLUSION
Implementation of Alerte Covid-19 is ongoing. Success of the project to date has triggered further work to develop a digital platform to improve the processing of alerts for other epidemic-prone diseases in Niger. It is hoped this will enable earlier and more effective epidemic responses by MoH and MSF teams. The use of such digital tools is feasible, low-cost, and can impact on epidemic surveillance in low-income settings.
CONFLICTS OF INTEREST
None declared.
In early 2020, Niger’s Ministry of Health (MoH) launched a system for collecting and investigating Covid-19 alerts. This system was paper based and used unstructured data sharing via text messages, hence did not allow for rapid and exhaustive data collection or effective investigation of alerts. Consequently, MSF teams were unable to accurately assess Covid-19 epidemiology in Niger, affecting decision-making about what support to offer and where. Covid-19 patients were not being diagnosed until in the late stages of disease, or would never be diagnosed at all. Hence, MSF teams feared care would not be effective. Epicentre and the MSF Foundation collaborated with Medic, a not-for-profit organisation designing open- source digital tools for healthcare, to develop an electronic tool to improve receipt and investigation of Covid-19 alerts in Niger. We aimed to collect structured data, to increase the number of alerts investigated, and to improve the timeliness and completeness of investigations. This would facilitate earlier diagnosis of symptomatic disease, earlier orientation of patients towards care, and improve accurate and timely epidemiological reporting.
METHODS
The digital platform, Alerte Covid-19, replaced the existing paper-based system. Patients and health workers across Niger were instructed to phone a national MoH hotline to report suspected cases. Each alert was registered on the digital platform; this then guides users to determine if investigation is necessary, and allocates alerts to a regional alert centre. Investigation teams follow up alerts via patient testing, direct patients towards relevant care, and report Covid-19 test results and the outcome of positive cases in the digital platform. The platform links to dashboards to provide an overview of alerts and outcomes at regional and national levels.
ETHICS
This description/evaluation of an 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.
RESULTS
The hotline service handles up to 6,000 calls per day, 5% of which are Covid-19 related and most require investigation. From May 2020 to November 2021, 11,295 Covid19-related alerts were received, of which 10,100 were investigated and 9,386 tested. Timeliness was improved from several days to a few hours and data was more structured and complete.
CONCLUSION
Implementation of Alerte Covid-19 is ongoing. Success of the project to date has triggered further work to develop a digital platform to improve the processing of alerts for other epidemic-prone diseases in Niger. It is hoped this will enable earlier and more effective epidemic responses by MoH and MSF teams. The use of such digital tools is feasible, low-cost, and can impact on epidemic surveillance in low-income settings.
CONFLICTS OF INTEREST
None declared.