Nitze Fellow Delaunay Talks About Adaptations in Global Health

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Sophie Delaunay, the U.S. director of Doctors Without Borders/ Médecins Sans Frontières (MSF), returned to St. Mary’s for the third time in her capacity as the Nitze Senior Fellow 2011-2012 to deliver her final lecture, “Adapting to Recent Developments in Global Health.”

Michael Taber, Assistant Professor of Philosophy and the Director of the Nitze Scholars Program, prefaced Delaunay’s lecture by saying he planned for her to come in April so that she could enjoy the springtime St. Mary’s scenery. “Earlier this afternoon,” he said, “I pushed her kayak out into the river.”

“There’s nothing as satisfying as closing an MSF mission because it is completed,” he said later. “And here is Sophie Delaunay, completing her mission.”

Delaunay opened her lecture by commenting on her time at St. Mary’s, and said “I have really been impressed by the progressive thinking of this institution, and the people here who are genuinely interested in what is going on outside of their world.”

“If we are going to talk about adapting ourselves to developments in global health, then we have to know what we are adapting ourselves to,” said Delaunay of the concerns of MSF and other humanitarian organizations about global health.

Some of these conditions include a diversity of players such as private organizations like the Melinda Gates Foundation who have contributed $1.5 billion per year just for global health. “This has led to a lot of awareness of policies and change in mentality and research even though there’s no cure for AIDS at the moment, yet there has been a lot of efforts in this direction,” said Delaunay. However, she noted that neglected tropical diseases that ravage specific populations will not get the same treatment.

“HIV definitely has been a catalyst for changing this whole dynamic,” Delaunay continued. “Doctors all over the world will tell you they never practiced medicine the same way after [the beginning of the AIDS outbreak].”

“[AIDS] has definitely humanized the relationship between practitioner and patient,” said Delaunay, “and it has forced practitioners to change their approach” to include psychological and legal aspects of the disease.

Delaunay explained that because most of the people infected by the HIV/AIDS epidemic were marginalized populations like sex workers and homosexuals, the disease has done much to improve the human rights conditions of these groups, whose stigmatization led doctors to keep a tight lid on confidentiality.

While the effects of AIDS have been devastating, Delaunay reported the good policy changes that have come out of it. “It has also contributed to our protection of the [MSF] staff,” she said, “as every country has changed their policies for health staff exposure to blood contamination.”

“When working in resource-limited countries, the challenge is about access, availability of drugs, affordability, and adaptability” said Delaunay about MSF’s main goals. HIV and TB (tuberculosis), according to Delaunay, have been two emblematic health issues that illustrate these difficulties. Both HIV and TB do not have any direct treatment, and Delaunay said that drug-resistant TB will be one of the major issues that face doctors in the coming decade.

Delaunay explained how MSF has affordable but outdated first-line drugs used in developed countries that were effective used in poorer countries after the organization was able to decrease the price, but there are now drugs that are more effective but more expensive.  The catch is that these drugs are needed more because those in third-world countries have developed a resistance to these drugs.

The creation of available, easy-to-use, and reliable point of care tests for use in other resource-poor countries has been another struggle for MSF. “Most of the research that goes into developing tests and diagnostic material goes into tests that could be used in modern environments,” said Delaunay.

Expensive vaccines recommended by the World Health Organization and sold by pharmaceutical companies are another issue that MSF struggles with, as they try to provide these vaccines to treat those who live where a specific disease is the most widespread. “The privatization of aid has its disadvantages,” said Delaunay, “because it could mean that global health will become more profit-driven. However, the financial resources of the private sector have made global health a priority.”

“The existing instruments that have been put in place in order to facilitate access are totally underutilized,” continued Delaunay. She used the example of a compulsory license, which gives countries a license to develop, manufacture, and sell drugs in their generic form, which dramatically reduces the price and allows for greater coverage.

However, she said “they are very rarely used, and when it is used by some countries they actually face a lot of tension from other countries for doing so. Tylenol is on a blacklist by the U.S. government for having too many compulsory licenses.”

In order to challenge the status quo, Delaunay said that first and foremost MSF has to carry out its mission of treating patients so they can identify problems in the medical field. “Sometimes, we treat patients in a provocative way,” she continued. When a $25,000 treatment for Hepatitis C was on the market, MSF decided to use a less expensive Egyptian treatment  to “challenge the market,” according to Delaunay.

MSF also publishes regular research to “demonstrate what’s needed in the field, what would be ideal, what we see as the failing mechanisms, and how we should address them, “ said Delaunay.

At the end of her lecture, Delaunay shared her thoughts about working in the humanitarian field with her audience. “If you want to work at a non-profit, choose the one you like,” she said, “One is no better than another, and choose the one that you identify with.”

After attending Delaunay’s three lectures, first-year Mary Margaret Addison said “I found her to be very inspiring in her work, especially because she didn’t start out thinking she would work for an organization like MSF. She opened my eyes to a lot of logistical and ethical issues in medicine that I wasn’t aware of before.”

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