National Institutes of Health
Wednesday Afternoon Lecture Series

Lecture Summary:
Use of the word "innovation" troubled the first people we spoke to at Médecins Sans Frontières (MSF) . When we talked to them about "innovation", their minds turned to "invention," along the lines of inventing a therapeutic drug or diagnostic test. They seemed to doubt that it was possible to attribute innovations to MSF. This is indicative of the widely shared view that sees humanitarian medicine as charitable medicine that procures outdated tools (vaccines, diagnostics and drugs) developed in rich countries in favor of a new generation of medical products. Humanitarian medicine is considered on par with other types of activities that cleverly put reclaimed goods to use in situations of extreme need.

Although the contexts within which humanitarian medical assistance is deployed often lead to a simplification of treatment protocols, this does not in any way imply recourse to rudimentary procedures and practices. They might involve using a simple diagnostic test for non-severe malaria, instead of a microscope. Rapid tests provide a biological confirmation (or not) of diagnosis in just a few minutes and without having to call on a laboratory. Just a few drops of blood on a small apparatus are all that is required. Results can be interpreted with the naked eye and without any special training. This rapid test is the result of recent progress in immunology. It is a scientific tool that is both more sophisticated and simpler than the microscope.

The same applies to the use of fixed-dose combination treatments adopted by MSF in the treatment of AIDS and malaria. Being relieved of the obligation to take many tablets during the day is one of a series of measures that increases the treatment’s success by increasing the chances that the patients will correctly follow the procedure. Combining several active ingredients into a single tablet is no simple task. The science behind it requires formal research and development before the therapeutic benefits can be reaped. These two examples show that medicine dispensed to those in need as practiced by MSF is not cut-price medicine. It uses up-to-date technologies and medical and surgical equipment that meet the standards prevailing in technologically advanced countries. There can be no doubt that, in line with our initial hypothesis, MSF has played, and continues to play, a part in driving the process of innovation.

Current recommendations for reducing malaria-related morbidity and mortality are based on the use of impregnated mosquito nets and insecticide sprays inside living quarters, as well as intermittent prophylactic treatment for pregnant women, biological confirmation of the diagnosis and combination treatment using an artemisinine derivative (ACT). However, during the 1990s, it was vital to use studies meeting international scientific standards to establish the superiority of combinations including an artemisinine derivative over other drug types, in order to make the decision to change protocols in the face of increasing resistance throughout the African continent. There was also a need to create an economic model that would make it affordable for African states.

MSF opened the way to proper diagnosis and effective treatment, by incorporating diagnostic tests and treatments including an artemisinine derivative (ACT) into its practices, as well as by lobbying to ensure that such techniques were affordable to the public health systems of African countries. Humanitarian situations (refugees from war zones, victims of neglected diseases), the changing mindsets and vagaries of mediation (the passage from Asia to Africa, from Chinese science to international standards, from one economic model to another, etc.) remind us that the source of medical progress does not always lie in an ultra-sophisticated research laboratory, but that it can sometimes occur thanks to the porous nature of borders and to unplanned meetings between refugees, scientists and practitioners.

Lecture Objectives:
1. To give an overview, through the example of malaria tests and treatments, of the key steps of a medical innovation in humanitarian settings.

2: To introduce the fact that key global health sectors are nowadays dependant on medical research carried out by charities.

3: To contribute to the critical review of medical research based on charity work by presenting the experiences of MSF.