July 28, 2014

MSF published 150 articles in medical journals in 2013 on topics such as HIV/AIDS, tuberculosis, malaria, cholera, and neglected tropical diseases. Drawing on MSF’s field experience, these papers “add to the global evidence base that advances best practice,” says Dr. Patricia Kahn, MSF-USA’s medical editor. They help MSF improve its own work and can also contribute to national and international guidelines for diagnosing, treating, and preventing diseases.

For example: after the huge cholera outbreak in Haiti in 2010, the World Health Organization established a stockpile of an orally-administered cholera vaccine for use in emergencies. “Haiti has had a big impact on global thinking regarding the oral cholera vaccine,” says Dr. David Olson, MSF’s deputy medical director. “Everybody was so helpless to deal with the outbreak, it sort of sharpened the mind.”

There was not much literature on its use in epidemic settings, however, and the global community remained unsure of how to incorporate vaccine use during outbreaks. But then, in 2012, MSF responded to a cholera outbreak in Guinea by working with the Ministry of Health to carry out a mass vaccination campaign using the oral vaccine. It was one of the first times it had been used in response to a sudden outbreak. Initial results were encouraging. Over the next few weeks, teams vaccinated more than three-quarters of the population in two districts where cholera first appeared.

Last year, MSF published a study in the open source journal PLoS Medicine that used its experience in Guinea to show that the vaccine could be administered quickly to a large population at a reasonable cost. While cholera vaccinations are not 100 percent effective, and they are no substitute for clean water and medical treatment, they may save lives when used in the right way. (In the coming months, MSF will publish another paper on the overall impact of the campaign.)

Before the paper, though, there was the medical action. In Guinea, MSF was in a position to try something few other global health agencies could. “Someone has to take that first step,” says Olson. “Even if it’s imperfect, it’s the first building block in trying to construct a more perfect way of doing these things.”

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