Fiocruz and Doctors Without Borders debate the pandemic and upcoming emergencies

Some solutions found by Fiocruz for certain health issues in Brazil, including during the pandemic, could work as a basis for response in other countries. This was one of the conclusions of a group of representatives of Doctors Without Borders (DWB or MSF, in the acronym in portuguese), who visited the Foundation last monday (May 16). They discussed issues such as production and access to vaccines and medicines, effects of COVID-19 on public and global health, and the challenges to reduce inequalities in possible new health emergencies.

In the meetings, in addition to the debate, the main lines of action of Fiocruz were presented (photo: Pedro Paulo Gonçalves)

During the day, meetings were held at the Immunobiological Technology Institute (Bio-Manguinhos/Fiocruz) and at the Fiocruz Global Health Center (Cris/Fiocruz) with Foundation researchers and directors. At the meetings, in addition to the discussion itself, participants presented Fiocruz’s main lines of operation. Among the intentions of MSF in this visit is the mapping of how countries are preparing for upcoming pandemics, bringing in, as collaboration, what they evaluate in their projects and concerns regarding organization from the humanitarian standpoint.

After getting to know a little more about Fiocruz, Maria Guevara, international medical secretary of MSF, stated she identified the fields in which MSF and the Foundation can establish partnerships. “Fiocruz has these different pillars. We can work together in many areas, such as with Bio-Manguinhos and with the research of the Global Health Observatory [Cris]”, she said, before adding that “we have principles in common, such as the way in which we attempt to respond to inequalities throughout the world. When we share values, we can look for solutions together. [This may result in] a beautiful cooperation”.

Guevara came accompanied by Nathalie Ernoult, vice-director of analysis and advocacy of the Access Campaign; Felipe Carvalho, the regional coordinator of the Access Campaign; Jennifer Marx, director of the Brazilian medical unit; and Clara Alves, specialized in humanitarian issues and advocacy for the organization. In the morning, they met at Bio-Manguinhos with the unit’s director, Mauricio Zuma, vice-director for Technological Development Sotiris Missailidis, and the manager of the Technological Development project for the mRNA vaccine against COVID-19, Patrícia Neves.

At the occasion, the unit’s portfolio was presented, together with its lines of operation in innovation, emphasizing the development of the mRNA vaccine. The project will work as a hub for the World Health Organization (WHO) in Latin America and it drew the attention of the delegation. While speaking about this and other projects and about the partnerships developed by Bio-Manguinhos to fight COVID-19, Zuma highlighted: “We have created good perspectives with international organizations and with the WHO, and we are now attempting to organize our portfolio to better contribute with international necessities. It is a very happy occasion, to have you here, so you can better get to know our portfolio and our projects, such as the mRNA vaccine, which opens possibilities for other phytopharmaceuticals. We are in a very good position to discuss future collaborations and how we can support international programs”, said Zuma.

Nathalie Ernoult highlighted that MSF “fights against difficulty in access to vaccines”. On this issue, Zuma emphasized the need to support the local production of vaccines, and the fact that the development of the mRNA vaccine includes the commitment to transferring technology. “We need a regional production and we are attempting to fulfill this role in Latin America”, said the director.

Ernoult said she was impressed with the public model of innovation development presented by Fiocruz, as well as with its sharing, which could be a possible area for collaboration. “I believe there is much we can do to support them at a global level.” The Analysis and Advocacy vice-director of the MSF’s Access Campaign also identified shared issues for which both Fiocruz and MSF seek answers. She also emphasized the fact that initiatives developed by the Foundation may serve as inspiration for other countries.

During the day, a meeting was held in Bio-Manguinhos/Fiocruz (photo: Pedro Paulo Gonçalves)

Effects of the pandemic

At a meeting with researcher Margareth Dalcolmo, of the Sergio Arouca National School of Public Health (Ensp/Fiocruz), the group discussed the effects of the pandemic, such as on chronic diseases, and the challenges to reducing inequalities in access to treatments and diagnosis, among other topics. Dalcolmo, a pulmonologist, also mentioned ongoing studies she is a part of, such as on treatments and vaccines against COVID-19, and her collaborations with the WHO. They discussed treatment protocols for tuberculosis in Brazil and in the countries where MSF operates. “It is very important for us to reduce treatment time, and to reduce the suffering of people who have to face it”, Dalcolmo said. She also highlighted how the pandemic had an impact on the diagnosis of tuberculosis in the country, as many services that deal with this disease did not work, or worked in an irregular regimen, during this period.

In the afternoon, the group had a series of meetings with members of different Fiocruz institutions, for a more detailed view of the Foundation’s activities in different parts of the country and its evaluation of the global situation. Christovam Barcellos, the coordinator of the National Observatory of Climate and Health, described how the group established sentinel areas in five Brazilian regions, to provide warnings on diseases such as zika, and brought together research lines in an attempt to develop early alerts. He also emphasized the importance of the participation of civil society to collect information.

Barcellos drew attention to the fact that endemic tropical diseases end up combining with chronic non-communicable diseases, creating a complex mix, and raised an alert for the vulnerability of populations in international border areas, such as that between the state of Amapá and the French Guiana. The MSF group showed interest in Planetary Health and in how climate changes have been affecting health.
With Cris/Fiocruz researchers, they discussed aspects of the Treaty on Pandemics, the G-20, and climate change and health. The group showed interest in the analysis of BRICS actions (the group formed by Brazil, Russia, India, China, and South Africa) regarding vaccines and of the situation in Asia. During the occasion, Guevara received from Pedro Burger, vice-coordinator of Cris/Fiocruz, the most recent edition of the book Health diplomacy: global responses to the pandemic, published by the center last December.

At the meeting with Christoph Milewski, director of the Institute of Science and Technology in Biomodels (ICTB/Fiocruz), they discussed innovations for humanitarian contexts. Jennifer Marx wanted to know more about the digital tools that can be used or adapted for the surveillance and diagnosis of diseases such as malaria. Milewski mentioned the example of an app that uses answers to questions in order to do initial triage, to know whether the symptoms of a certain patient can be related to dengue fever or another disease. According to the ICTB director, there are at least five apps that could be used or adapted for use by MSF. “We must understand the needs of MSF and figure out how we can help”, he said. Upon leaving, the group showed interest in holding new meetings.