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Neuraminidase inhibitors for influenza: a call for better research
Editorial
What are the Geneva Conventions for?
Associated Press
On Oct 3, Médecins Sans Frontières (MSF) hospital in Kunduz, northern Afghanistan, was bombed by a Coalition airstrike, killing ten patients including three children, and 12 MSF staff. This is not only the worst casualty for years for MSF in the field, but also a violation of the Geneva Conventions—international humanitarian law that regulates armed conflict and provides protection for non-combatants, the wounded, and medical personnel and units. For Joanne Liu, MSF International President, “This was not just an attack on our hospital—it was an attack on the Geneva Conventions…Even war has rules.” The MSF trauma centre in Kunduz had created, over the past 4 years, a unique space to provide free surgical care, and general, orthopaedic, vascular, plastic, and neurosurgery to all sides of the conflict—including those with conflict-related injuries, for which the numbers have been increasing steadily since 2013. Staff undertook more than 3000 surgical procedures in 2015. Nearly 400 wounded people had been treated the week of the airstrike.
Bart Janssens, MSF Director of Operations told The Lancet, “As a doctor I believe it is a crime when an attack occurs on unarmed medical actors who have zero other objective than to save lives. Either we maintain the idea of the Geneva Conventions and the many medical protections therein or (like in Kunduz) we publicly destroy it.” Despite US President Barack Obama’s apology for the bombing and promise of a full investigation, MSF demands a full transparent and independent international investigation by the International Humanitarian Fact-Finding Commission—a Commission established in the Additional Protocols of the Geneva Conventions specifically to investigate violations of international humanitarian law. The Lancet supports MSF’s call. The Geneva Conventions have been ratified by 196 countries. Yet in reality, in Afghanistan, or Syria, or Gaza, it is too often disrespected. This tragedy in Kunduz is our wake-up call to examine what immunity granted under international law to medical units, personnel on the front line, and patients, really means. The Lancet
GIPHOTOSTOCK/Science Photo Library
Neuraminidase inhibitors for influenza: a call for better research
For the Academy of Medical Sciences and the Wellcome Trust report see http://www. acmedsci.ac.uk/snip/ uploads/561529bcaa173.pdf For the meta-analysis on the efficacy of oseltamivir in seasonal influenza see Lancet 2015; 385: 1729–37
1510
On Oct 8, the Academy of Medical Sciences and the Wellcome Trust (AMS/WT) published a timely report on the use of neuraminidase inhibitor (NAI) antiviral drugs in seasonal and pandemic influenza treatment and prophylaxis. As winter approaches in the UK, the debate about whether the benefit of routine use of NAIs outweighs the risks of side-effects, such as nausea and vomiting continues; a meta-analysis published in The Lancet in January explored this issue in oseltamivir use for seasonal influenza. In a pandemic setting, much of the confusion about NAI efficacy comes from the failure to undertake randomised trials during the 2009 H1N1 pandemic, and with such weaknesses in the evidence base, doctors are largely relying on clinical judgment when prescribing antivirals. In response to a request from the UK Department of Health, the AMS/WT convened an independent group of experts to draw on recent studies and piece together our current knowledge of antivirals in influenza to help to inform future policy decisions. The resulting report provides a fair interpretation of new evidence and
its implication for influenza treatment—mainly that routine use of antivirals is not supported in patients with seasonal influenza unless the individual is seriously ill or the strain is very severe. Antiviral resistance is also taken into account, with an overview of new antiviral drugs in development. Most importantly, the report calls for high quality, adequately powered randomised trials in hospitalised and high-risk patients (pregnant women and children) in a pandemic, including the use of novel approaches that ensure treatment is not denied to those who need it most. It also stresses that observational data should not be deemed inferior to randomised trial data when drawing conclusions, as they are often a better measure of real-life events. Although the report does not explicitly recommend whether or not antivirals should continue to be stockpiled, it shows that scientists and clinicians have learnt from previous mistakes and identifies priorities, such as the need to establish pre-agreed protocols that allow more freedom to take immediate and decisive action at the onset of the next pandemic. The Lancet www.thelancet.com Vol 386 October 17, 2015
What are the Geneva Conventions for?
Associated Press
On Oct 3, Médecins Sans Frontières (MSF) hospital in Kunduz, northern Afghanistan, was bombed by a Coalition airstrike, killing ten patients including three children, and 12 MSF staff. This is not only the worst casualty for years for MSF in the field, but also a violation of the Geneva Conventions—international humanitarian law that regulates armed conflict and provides protection for non-combatants, the wounded, and medical personnel and units. For Joanne Liu, MSF International President, “This was not just an attack on our hospital—it was an attack on the Geneva Conventions…Even war has rules.” The MSF trauma centre in Kunduz had created, over the past 4 years, a unique space to provide free surgical care, and general, orthopaedic, vascular, plastic, and neurosurgery to all sides of the conflict—including those with conflict-related injuries, for which the numbers have been increasing steadily since 2013. Staff undertook more than 3000 surgical procedures in 2015. Nearly 400 wounded people had been treated the week of the airstrike.
Bart Janssens, MSF Director of Operations told The Lancet, “As a doctor I believe it is a crime when an attack occurs on unarmed medical actors who have zero other objective than to save lives. Either we maintain the idea of the Geneva Conventions and the many medical protections therein or (like in Kunduz) we publicly destroy it.” Despite US President Barack Obama’s apology for the bombing and promise of a full investigation, MSF demands a full transparent and independent international investigation by the International Humanitarian Fact-Finding Commission—a Commission established in the Additional Protocols of the Geneva Conventions specifically to investigate violations of international humanitarian law. The Lancet supports MSF’s call. The Geneva Conventions have been ratified by 196 countries. Yet in reality, in Afghanistan, or Syria, or Gaza, it is too often disrespected. This tragedy in Kunduz is our wake-up call to examine what immunity granted under international law to medical units, personnel on the front line, and patients, really means. The Lancet
GIPHOTOSTOCK/Science Photo Library
Neuraminidase inhibitors for influenza: a call for better research
For the Academy of Medical Sciences and the Wellcome Trust report see http://www. acmedsci.ac.uk/snip/ uploads/561529bcaa173.pdf For the meta-analysis on the efficacy of oseltamivir in seasonal influenza see Lancet 2015; 385: 1729–37
1510
On Oct 8, the Academy of Medical Sciences and the Wellcome Trust (AMS/WT) published a timely report on the use of neuraminidase inhibitor (NAI) antiviral drugs in seasonal and pandemic influenza treatment and prophylaxis. As winter approaches in the UK, the debate about whether the benefit of routine use of NAIs outweighs the risks of side-effects, such as nausea and vomiting continues; a meta-analysis published in The Lancet in January explored this issue in oseltamivir use for seasonal influenza. In a pandemic setting, much of the confusion about NAI efficacy comes from the failure to undertake randomised trials during the 2009 H1N1 pandemic, and with such weaknesses in the evidence base, doctors are largely relying on clinical judgment when prescribing antivirals. In response to a request from the UK Department of Health, the AMS/WT convened an independent group of experts to draw on recent studies and piece together our current knowledge of antivirals in influenza to help to inform future policy decisions. The resulting report provides a fair interpretation of new evidence and
its implication for influenza treatment—mainly that routine use of antivirals is not supported in patients with seasonal influenza unless the individual is seriously ill or the strain is very severe. Antiviral resistance is also taken into account, with an overview of new antiviral drugs in development. Most importantly, the report calls for high quality, adequately powered randomised trials in hospitalised and high-risk patients (pregnant women and children) in a pandemic, including the use of novel approaches that ensure treatment is not denied to those who need it most. It also stresses that observational data should not be deemed inferior to randomised trial data when drawing conclusions, as they are often a better measure of real-life events. Although the report does not explicitly recommend whether or not antivirals should continue to be stockpiled, it shows that scientists and clinicians have learnt from previous mistakes and identifies priorities, such as the need to establish pre-agreed protocols that allow more freedom to take immediate and decisive action at the onset of the next pandemic. The Lancet www.thelancet.com Vol 386 October 17, 2015