Infectious But Not Invincible

12 Sep 2021

In the more than 70 countries where we work, Doctors Without Borders / Médecins Sans Frontières’ (MSF) teams committed substantial resources to developing dedicated COVID-19 projects and accompanied ministries of health in preparing for and/or facing the pandemic.

Overshadowed by COVID-19, our field teams continue to face health crises that affect our patients every year, which we cannot neglect. This is why despite the pandemic, we worked on maintaining essential healthcare services in our existing programmes.

In early 2020, our teams saw a 40% jump in measles cases in the Rohingya refugee camps in Cox’s Bazar, with 120 patients admitted to Doctors Without Borders’ isolation wards and more than 900 people treated as outpatients in January alone.

Millions of people still die each year from infectious diseases that are preventable or can be treated. Three of these diseases are particularly prevalent in Southeast Asia: measles, tuberculosis, and hepatitis C.

Hepatitis C: The Silent Killer


What is hepatitis C?

Hepatitis is the inflammation of the liver. There are 5 types: A, B, C, D & E. Of these, hepatitis C caused by the hepatitis C virus or HCV is the deadliest. Over 71 million people, mostly from low- and middle-income countries, are infected, but are unaware and go untreated for years. This is why HCV is called the ‘silent killer’. However, this disease is CURABLE.

How do you get HCV?

HCV is a blood-borne virus, which you can get through

  • a blood transfusion;
  • unsafe drug injection;
  • unsafe healthcare settings;
  • sexual practices that lead to exposure to blood; and
  • mother to foetus transmission during pregnancy (less common).

Go to a doctor immediately if you: fever, fatigue, loss of appetite, yellowing of the skin and eyes, dark urine, nausea, and vomiting.

Can HCV kill you?

HCV is one of deadliest forms of hepatitis. In 2019, nearly 300,000 people died from HCV, mostly from complications like cirrhosis and liver cancer. For every 100 people infected with HCV, about five to 25 will develop cirrhosis in the next 10 to 20 years. How can you prevent or treat HCV?

Go to a healthcare facility that practices proper infection prevention and control measures; andUse condoms correctly during sex. How is Doctors Without Borders responding to HCV?

Doctors Without Borders treats people with HCV in several countries such as Iran, Myanmar, Ukraine, Pakistan, India and Cambodia.

Doctors Without Borders is pushing for direct-acting antivirals (DAAs) that are safe and effective in the treatment of HCV infection. But, DAAs are often very expensive and costly. By the end of 2019, 48 million people lack access to safer, more tolerable and more effective DAAs to treat their HCV infection.

The Drugs for Neglected Diseases Initiative (DNDi), which Doctors Without Borders helped establish, led several clinical trials of DAAs ravidasvir (RDV) and sofusbuvir (SOF) in Malaysia in 2016. The results indicate that the RDV/SOF combination is comparable to the very best HCV therapies available today. In June, 2021, Malaysia approved the use of Ravida® (ravidasvir), which is indicated in combination with other medicinal products for the treatment of HCV infection in adults. This is the outcome of years of collaboration between DNDi and the Malaysian government to reduce barriers in access and affordability of HCV drugs for patients in Malaysia.

Measeles: Resurgence of a preventable disease


What is measles?

Measles is a highly contagious viral disease. One person with measles can infect 12 to 18 other people. It mostly affects young children, but it is highly preventable with vaccines. While most children have uncomplicated measles, around 10% to 40% have complications like ear infection, pneumonia, or other respiratory infections.

How do you get measles?

Measles is an airborne disease. People in low-income countries, especially children, are at highest risk for measles. It can be devastating when combined with malnutrition or malaria.

Can measles kill you? Measles can be very severe, even fatal, for children under the age of five, especially those living in crowded places, or those who are malnourished or HIV-positive. In one in every 1,000 cases, a child will have encephalitis, an inflammation of the brain. In low-income countries, around 3 to 6% of cases end in death, with the mortality rate going as high as 30%.

How can you prevent or treat measles?

There is no medicine or treatment made specifically to treat measles. Patients usually take paracetamol for headaches, and ointment for eye infections. You only need antibiotics if there are secondary bacterial infections, like pneumonia or an ear infection. What’s important is preventing complications and treating symptoms.

The best way to prevent measles is through vaccination. Most children are given the combined measles, mumps and rubella (MMR) vaccine. It is recommended for all children to receive two doses of the MMR vaccine. If you do get measles and you recover, you will have antibodies that will make you immune from the virus.

What is Doctors Without Borders doing about measles?

Doctors Without Borders has vaccinated some 28 million children against measles since 2006, and conducts vaccination campaigns every year, in a wide range of countries like the Democratic Republic of Congo and Central African Republic.

Doctors Without Borders also works to address measles outbreaks in Chad, Niger, Nigeria and Bangladesh. Outbreaks happen in places with weak public vaccination systems and low vaccination coverage, including in areas of conflict and among high numbers of people living in close quarters, such as refugee camps.

Tuberculosis: An old and ongoing epidemic


What is tuberculosis?

TB is an infectious disease caused by a bacteria, and has been around for thousands of years. It mainly affects the lungs and is often confused with pneumonia, because they have common signs and symptoms. TB recovery is very slow, and treatment lasts at least six months.

How do you get tuberculosis? The TB bacteria is passed through the air. But some are at greater risk, such as people living in crowded conditions, those with weak immune systems, poor health or poor diet due to lifestyle and other problems. It’s also very possible to catch TB more than once.

Can tuberculosis kill you?

TB can be fatal if not treated properly. If you do not finish the recommended treatment, you can also develop drug-resistant TB, or DR-TB, which is more difficult to treat. Treatment is also more difficult if you are immunocompromised, or you have another condition like HIV or diabetes.

How can you prevent or treat tuberculosis?

If you have latent TB infection, you may need medication to reduce risks of developing TB disease later.

If you have TB disease, treatment will take at least six months, possibly as long as one year. It is very important that you complete the course of treatment, and take the drugs exactly as you are told. Otherwise, the bacteria may become difficult to treat and may result in DR-TB.

What is Doctors Without Borders doing about tuberculosis?

Doctors Without Borders provides TB care in various settings, such as conflict areas, refugee camps and prison settings. There are also projects integrating HIV and TB or diabetes services,DR-TB treatment etc. In Papua New Guinea, TB is the second-highest cause of death; since 2014, Doctors Without Borders has treated more than 7,100 patients with drug-sensitive TB and over 200 with drug-resistant TB. In the Philippines, Doctors Without Borders is opening a project on patient education and screening in the urban slums of Tondo, Manila.

Critical to TB care is access to medication. When bedaquiline was first authorised for use in 2012, it was the first DR-TB drug to be developed in more than 40 years. But by late 2018, only 28,700 people had received it worldwide.

Doctors Without Borders spoke out in 2018 to urge Johnson & Johnson (J&J), the pharmaceutical corporation that holds patents on bedaquiline, to ensure affordable access to the drug for everyone who needs it to survive. In July 2020, J&J announced a reduced price of US$1.50. Doctors Without Borders is still calling on J&J to further reduce the price of bedaquiline and offer it to all countries with a high DR-TB burden, so that more lives can be saved.