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Article ; Online: Intellectual Property and the Politics of Public Good during COVID-19: Framing Law, Institutions, and Ideas during TRIPS Waiver Negotiations at the WTO.

Fischer, Sara E / Vitale, Lucia / Agutu, Akinyi Lisa / Kavanagh, Matthew M

Journal of health politics, policy and law

2023 Volume 49, Issue 1, Page(s) 9–42

Abstract: Context: To facilitate the manufacturing of COVID-19 medical products, in October 2020 India and South Africa proposed a waiver of certain intellectual property (IP) provisions of a World Trade Organization (WTO) agreement. After nearly two years, a ... ...

Abstract	Context: To facilitate the manufacturing of COVID-19 medical products, in October 2020 India and South Africa proposed a waiver of certain intellectual property (IP) provisions of a World Trade Organization (WTO) agreement. After nearly two years, a narrow waiver agreement that did little for vaccine access passed the ministerial despite the pandemic's impact on global trade, which the WTO is mandated to safeguard. Methods: The authors conducted a content analysis of WTO legal texts, key-actor statements, media reporting, and the WTO's procedural framework to explore legal, institutional, and ideational explanations for the delay. Findings: IP waivers are neither legally complex nor unprecedented within WTO law, yet these waiver negotiations exceeded their mandated 90-day negotiation period by approximately 18 months. Waiver opponents and supporters engaged in escalating strategic framing that justified and eventually secured political attention at head-of-state level, sidelining other pandemic solutions. The frames deployed discouraged consensus on a meaningful waiver, which ultimately favored the status quo that opponents preferred. WTO institutional design encouraged drawn-out negotiation while limiting legitimate players in the debate to trade ministers, empowering narrow interest group politics. Conclusions: Despite global political attention, the WTO process contributed little to emergency vaccine production, suggesting a pressing need for reforms aimed at more efficient and equitable multilateral processes.
MeSH term(s)	Humans ; International Cooperation ; Negotiating ; COVID-19/epidemiology ; Commerce ; Politics ; Intellectual Property ; Vaccines
Chemical Substances	Vaccines
Language	English
Publishing date	2023-07-28
Publishing country	United States
Document type	Journal Article
ZDB-ID	752966-1
ISSN	1527-1927 ; 0361-6878
ISSN (online)	1527-1927
ISSN	0361-6878
DOI	10.1215/03616878-10910269
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Article ; Online: Signs of a turning tide in social norms and attitudes toward abortion in Ethiopia: Findings from a qualitative study in four regions.

O'Connell, Kathryn A / Kebede, Addisalem T / Menna, Bereket M / Woldetensay, Mengistu T / Fischer, Sara E / Samandari, Ghazaleh / Kassaw, Jemal K

Reproductive health

2022 Volume 19, Issue Suppl 1, Page(s) 198

Abstract: Background: Despite the 2005 expansion in abortion legal indications in Ethiopia, which provided for abortions in cases of rape, incest, or fetal impairment and other circumstances, nearly half of abortions occurred outside health facilities in 2014. ... ...

Abstract	Background: Despite the 2005 expansion in abortion legal indications in Ethiopia, which provided for abortions in cases of rape, incest, or fetal impairment and other circumstances, nearly half of abortions occurred outside health facilities in 2014. The purpose of this study is to explore and understand the social barriers women face in seeking and obtaining quality safe abortion care, as a means to generate evidence that could be used to improve access to and quality of abortion services. Methods: Thirty-two focus group discussions with both men and women were held in four different regions of Ethiopia: Addis Ababa; Amhara; Oromia; and the Southern Nations, Nationalities, and Peoples' Region. The study team recruited participants (n = 193) aged 18-55 in each region using a purposive sample with snowball recruitment techniques. We conducted discussions in Amharic or Afaan Oromo using a semi-structured guide and transcribed and translated them into English for analysis. We used deductive coding and analysis to categorize findings into emergent themes around stigma, barriers, and the changing nature of attitudes around abortion. Results: Despite changes in abortion law, findings show that women with unwanted pregnancies and those seeking abortions are still heavily stigmatized and sanctioned in a number of communities across Ethiopia. Abortion was deemed unacceptable in most cases, though respondents were more tolerant in cases of risk to the mother's life and of rape. We saw promising indications that changes are taking place in Ethiopian society's view of abortion, and several participants indicated progress toward a more supportive environment overall for women seeking abortion care. Still, this progress may be limited by variable knowledge of abortion laws and tightly held gender-based social norms, particularly in rural areas. Most participants noted the importance of education and outreach to improve abortion attitudes and norms. Conclusion: Policymakers should create further awareness in Ethiopia on the availability of quality abortion services in public health facilities and the indications for legal abortion. Such efforts should be based on principles of gender equality, as a means of ensuring enduring changes for women's reproductive choice throughout the country.
MeSH term(s)	Abortion, Induced ; Abortion, Legal ; Abortion, Spontaneous ; Ethiopia ; Female ; Health Knowledge, Attitudes, Practice ; Health Services Accessibility ; Humans ; Male ; Pregnancy ; Social Norms
Language	English
Publishing date	2022-06-13
Publishing country	England
Document type	Journal Article
ZDB-ID	2149029-6
ISSN	1742-4755 ; 1742-4755
ISSN (online)	1742-4755
ISSN	1742-4755
DOI	10.1186/s12978-021-01240-6
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Article ; Online: Evidence-Based, Reality-Driven Colorectal Cancer Screening Guidelines: The Critical Relationship of Adherence to Effectiveness.

Winawer, Sidney J / Fischer, Sara E / Levin, Bernard

JAMA

2016 Volume 315, Issue 19, Page(s) 2065–2066

MeSH term(s)	Advisory Committees ; Colonography, Computed Tomographic ; Colonoscopy/utilization ; Colorectal Neoplasms/diagnosis ; Colorectal Neoplasms/prevention & control ; DNA, Neoplasm/analysis ; Early Detection of Cancer ; Evidence-Based Practice ; Female ; Humans ; Immunochemistry ; Male ; Occult Blood ; Patient Compliance/statistics & numerical data ; Practice Guidelines as Topic ; Randomized Controlled Trials as Topic ; Sigmoidoscopy ; United States
Chemical Substances	DNA, Neoplasm
Language	English
Publishing date	2016-05-17
Publishing country	United States
Document type	Journal Article ; Research Support, Non-U.S. Gov't
ZDB-ID	2958-0
ISSN	1538-3598 ; 0254-9077 ; 0002-9955 ; 0098-7484
ISSN (online)	1538-3598
ISSN	0254-9077 ; 0002-9955 ; 0098-7484
DOI	10.1001/jama.2016.3377
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Article ; Online: Health-Seeking Behavior and Barriers to Care in Patients With Rectal Bleeding in Nigeria.

Alatise, Olusegun I / Fischer, Sara E / Ayandipo, Omobolaji O / Omisore, Akinlolu G / Olatoke, Samuel A / Kingham, T Peter

Journal of global oncology

2017 Volume 3, Issue 6, Page(s) 749–756

Abstract: Purpose Colorectal cancer (CRC) incidence rates are steadily increasing in Nigeria. Organized screening is still largely unused because of financial and logistical barriers; most CRCs are detected by symptoms. One symptom of CRC is rectal bleeding. This ... ...

Abstract	Purpose Colorectal cancer (CRC) incidence rates are steadily increasing in Nigeria. Organized screening is still largely unused because of financial and logistical barriers; most CRCs are detected by symptoms. One symptom of CRC is rectal bleeding. This study sought to determine health-seeking behavior and barriers to care in patients with rectal bleeding in Nigeria. This study also surveyed physicians to determine major breakdowns in access to care. Methods The recruitment process for this study involved patients referred for colonoscopy because of rectal bleeding as well as response to a media advertisement for a free colonoscopy. Physicians were recruited at the African Research Group for Oncology meeting. Patient responses were scored on the basis of knowledge of rectal bleeding. The physician questionnaire was supporting information and mainly descriptive in nature. Results A total of 82 patients and 45 physicians participated in this study. Less than 40% of patients knew that rectal bleeding could be caused by cancer. Major barriers to care were resolution of the symptom (42%), no consideration of the bleeding as problematic (40%), and financial constraint (22%). Education was strongly correlated with knowledge of rectal bleeding and health-seeking behavior. Although physicians regularly saw patients with rectal bleeding, most of them provided a differential diagnosis of hemorrhoids and few referred patients for colonoscopy. Conclusion General awareness about the signs of colorectal cancer is lacking. This demonstrates the strong need for patient education programs about this issue. Physicians should also receive additional training on differentiation of a potential cancer diagnosis from something more benign, such as hemorrhoids.
MeSH term(s)	Adolescent ; Adult ; Aged ; Aged, 80 and over ; Colorectal Neoplasms/diagnosis ; Cross-Sectional Studies ; Female ; Health Behavior ; Humans ; Male ; Middle Aged ; Nigeria ; Patient Acceptance of Health Care ; Pilot Projects ; Rectal Diseases/blood ; Surveys and Questionnaires ; Young Adult
Language	English
Publishing date	2017-02-01
Publishing country	United States
Document type	Journal Article
ISSN	2378-9506
ISSN (online)	2378-9506
DOI	10.1200/JGO.2016.006601
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Article ; Online: Randomized Trial of Facilitated Adherence to Screening Colonoscopy vs Sequential Fecal-Based Blood Test.

Zauber, Ann G / Winawer, Sidney J / O'Brien, Michael J / Mills, Glenn M / Allen, John I / Feld, Andrew D / Jordan, Paul A / Fleisher, Martin / Orlow, Irene / Meester, Reinier G S / Lansdorp-Vogelaar, Iris / Rutter, Carolyn M / Knudsen, Amy B / Mandelson, Margaret / Shaukat, Aasma / Mendelsohn, Robin B / Hahn, Anne I / Lobaugh, Stephanie M / Soto Palmer, Brittany /

Serrano, Victoria / Kumar, Julie R / Fischer, Sara E / Chen, Jennifer C / Bayuga-Miller, Sharon / Kuk, Deborah / O'Connell, Kelli / Church, Timothy R

Gastroenterology

2023 Volume 165, Issue 1, Page(s) 252–266

Abstract: Background & aims: Colorectal cancer (CRC) screening guidelines include screening colonoscopy and sequential high-sensitivity fecal occult blood testing (HSgFOBT), with expectation of similar effectiveness based on the assumption of similar high ... ...

Abstract	Background & aims: Colorectal cancer (CRC) screening guidelines include screening colonoscopy and sequential high-sensitivity fecal occult blood testing (HSgFOBT), with expectation of similar effectiveness based on the assumption of similar high adherence. However, adherence to screening colonoscopy compared with sequential HSgFOBT has not been reported. In this randomized clinical trial, we assessed adherence and pathology findings for a single screening colonoscopy vs sequential and nonsequential HSgFOBTs. Methods: Participants aged 40-69 years were enrolled at 3 centers representing different clinical settings. Participants were randomized into a single screening colonoscopy arm vs sequential HSgFOBT arm composed of 4-7 rounds. Initial adherence to screening colonoscopy and sequential adherence to HSgFOBT, follow-up colonoscopy for positive HSgFOBT tests, crossover to colonoscopy, and detection of advanced neoplasia or large serrated lesions (ADN-SERs) were measured. Results: There were 3523 participants included in the trial; 1761 and 1762 participants were randomized to the screening colonoscopy and HSgFOBT arms, respectively. Adherence was 1473 (83.6%) for the screening colonoscopy arm vs 1288 (73.1%) for the HSgFOBT arm after 1 round (relative risk [RR], 1.14; 95% CI, 1.10-1.19; P ≤ .001), but only 674 (38.3%) over 4 sequential HSgFOBT rounds (RR, 2.19; 95% CI, 2.05-2.33). Overall adherence to any screening increased to 1558 (88.5%) in the screening colonoscopy arm during the entire study period and 1493 (84.7%) in the HSgFOBT arm (RR, 1.04; 95% CI, 1.02-1.07). Four hundred thirty-six participants (24.7%) crossed over to screening colonoscopy during the first 4 rounds. ADN-SERs were detected in 121 of the 1473 participants (8.2%) in the colonoscopy arm who were adherent to protocol in the first 12 months of the study, whereas detection of ADN-SERs among those who were not sequentially adherent (n = 709) to HSgFOBT was subpar (0.6%) (RR, 14.72; 95% CI, 5.46-39.67) compared with those who were sequentially adherent (3.3%) (n = 647) (RR, 2.52; 95% CI, 1.61-3.98) to HSgFOBT in the first 4 rounds. When including colonoscopies from HSgFOBT patients who were never positive yet crossed over (n = 1483), 5.5% of ADN-SERs were detected (RR, 1.50; 95% CI, 1.15-1.96) in the first 4 rounds. Conclusions: Observed adherence to sequential rounds of HSgFOBT was suboptimal compared with a single screening colonoscopy. Detection of ADN-SERs was inferior when nonsequential HSgFOBT adherence was compared with sequential adherence. However, the greatest number of ADN-SERs was detected among those who crossed over to colonoscopy and opted to receive a colonoscopy. The effectiveness of an HSgFOBT screening program may be enhanced if crossover to screening colonoscopy is permitted. Clinicaltrials: gov, Number: NCT00102011.
MeSH term(s)	Humans ; Occult Blood ; Colonoscopy ; Mass Screening/methods ; Hematologic Tests ; Colorectal Neoplasms/diagnosis ; Early Detection of Cancer/methods
Language	English
Publishing date	2023-03-21
Publishing country	United States
Document type	Randomized Controlled Trial ; Journal Article
ZDB-ID	80112-4
ISSN	1528-0012 ; 0016-5085
ISSN (online)	1528-0012
ISSN	0016-5085
DOI	10.1053/j.gastro.2023.03.206
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Article ; Online: Cost-effectiveness of a multitarget stool DNA test for colorectal cancer screening of Medicare beneficiaries.

Naber, Steffie K / Knudsen, Amy B / Zauber, Ann G / Rutter, Carolyn M / Fischer, Sara E / Pabiniak, Chester J / Soto, Brittany / Kuntz, Karen M / Lansdorp-Vogelaar, Iris

PloS one

2019 Volume 14, Issue 9, Page(s) e0220234

Abstract: Background: In 2014, the Centers for Medicare and Medicaid Services (CMS) began covering a multitarget stool DNA (mtSDNA) test for colorectal cancer (CRC) screening of Medicare beneficiaries. In this study, we evaluated whether mtSDNA testing is a cost- ... ...

Abstract	Background: In 2014, the Centers for Medicare and Medicaid Services (CMS) began covering a multitarget stool DNA (mtSDNA) test for colorectal cancer (CRC) screening of Medicare beneficiaries. In this study, we evaluated whether mtSDNA testing is a cost-effective alternative to other CRC screening strategies reimbursed by CMS, and if not, under what conditions it could be. Methods: We use three independently-developed microsimulation models to simulate a cohort of previously unscreened US 65-year-olds who are screened with triennial mtSDNA testing, or one of six other reimbursed screening strategies. Main outcome measures are discounted life-years gained (LYG) and lifetime costs (CMS perspective), threshold reimbursement rates, and threshold adherence rates. Outcomes are expressed as the median and range across models. Results: Compared to no screening, triennial mtSDNA screening resulted in 82 (range: 79-88) LYG per 1,000 simulated individuals. This was more than for five-yearly sigmoidoscopy (80 (range: 71-89) LYG), but fewer than for every other simulated strategy. At its 2017 reimbursement rate of $512, mtSDNA was the most costly strategy, and even if adherence were 30% higher than with other strategies, it would not be a cost-effective alternative. At a substantially reduced reimbursement rate ($6-18), two models found that triennial mtSDNA testing was an efficient and potentially cost-effective screening option. Conclusions: Compared to no screening, triennial mtSDNA screening reduces CRC incidence and mortality at acceptable costs. However, compared to nearly all other CRC screening strategies reimbursed by CMS it is less effective and considerably more costly, making it an inefficient screening option.
MeSH term(s)	Aged ; Aged, 80 and over ; Biomarkers, Tumor ; Circulating Tumor DNA ; Colorectal Neoplasms/diagnosis ; Colorectal Neoplasms/epidemiology ; Colorectal Neoplasms/genetics ; Cost-Benefit Analysis ; DNA, Neoplasm ; Early Detection of Cancer/economics ; Early Detection of Cancer/methods ; Feces/chemistry ; Female ; Humans ; Male ; Mass Screening/economics ; Mass Screening/methods ; Medicare ; Sensitivity and Specificity ; United States/epidemiology
Chemical Substances	Biomarkers, Tumor ; Circulating Tumor DNA ; DNA, Neoplasm
Language	English
Publishing date	2019-09-04
Publishing country	United States
Document type	Journal Article ; Research Support, N.I.H., Extramural ; Research Support, U.S. Gov't, Non-P.H.S.
ZDB-ID	2267670-3
ISSN	1932-6203 ; 1932-6203
ISSN (online)	1932-6203
ISSN	1932-6203
DOI	10.1371/journal.pone.0220234
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Article ; Online: Establishing a Cancer Research Consortium in Low- and Middle-Income Countries: Challenges Faced and Lessons Learned.

Fischer, Sara E / Alatise, Olusegun I / Komolafe, Akinwunmi O / Katung, Aba I / Egberongbe, Adedeji A / Olatoke, Samuel A / Agodirin, Olayide S / Kolawole, Oladapo A / Olaofe, Olaejerinde O / Ayandipo, Omobolaji O / Rotimi, Olorunda / Brennan, Murray F / Kingham, T Peter

Annals of surgical oncology

2016 Volume 24, Issue 3, Page(s) 627–631

Abstract: Purpose: There is an increasing effort in the global public health community to strengthen research capacity in low- and middle-income countries, but there is no consensus on how best to approach such endeavors. Successful consortia that perform ... ...

Abstract	Purpose: There is an increasing effort in the global public health community to strengthen research capacity in low- and middle-income countries, but there is no consensus on how best to approach such endeavors. Successful consortia that perform research on HIV/AIDS and other infectious diseases exist, but few papers have been published detailing the challenges faced and lessons learned in setting up and running a successful research consortium. Methods: Members of the African Research Group for Oncology (ARGO) participated in generating lessons learned regarding the foundation and maintenance of a cancer research consortium in Nigeria. Results: Drawing on our experience of founding ARGO, we describe steps and key factors needed to establish a successful collaborative consortium between researchers from both high- and low-income countries. In addition, we present challenges we encountered in building our consortium, and how we managed those challenges. Although our research group is focused primarily on cancer, many of our lessons learned can be applied more widely in biomedical or public health research in low-income countries. Conclusions: As the need for cancer care in LMICs continues to grow, the ability to create sustainable, innovative, collaborative research groups will become vital. Assessing the successes and failures that occur in creating and sustaining research consortia in LMICs is important for expansion of research and training capacity in LMICs.
MeSH term(s)	Biomedical Research/organization & administration ; Capacity Building ; Cooperative Behavior ; Developing Countries ; Humans ; International Cooperation ; Neoplasms ; Nigeria ; Organizations/economics ; Organizations/organization & administration ; Program Development ; Workforce
Language	English
Publishing date	2016-10-14
Publishing country	United States
Document type	Journal Article
ZDB-ID	1200469-8
ISSN	1534-4681 ; 1068-9265
ISSN (online)	1534-4681
ISSN	1068-9265
DOI	10.1245/s10434-016-5624-2
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Article ; Online: Estimation of Benefits, Burden, and Harms of Colorectal Cancer Screening Strategies: Modeling Study for the US Preventive Services Task Force.

Knudsen, Amy B / Zauber, Ann G / Rutter, Carolyn M / Naber, Steffie K / Doria-Rose, V Paul / Pabiniak, Chester / Johanson, Colden / Fischer, Sara E / Lansdorp-Vogelaar, Iris / Kuntz, Karen M

JAMA

2016 Volume 315, Issue 23, Page(s) 2595–2609

Abstract: Importance: The US Preventive Services Task Force (USPSTF) is updating its 2008 colorectal cancer (CRC) screening recommendations.: Objective: To inform the USPSTF by modeling the benefits, burden, and harms of CRC screening strategies; estimating ... ...

Abstract	Importance: The US Preventive Services Task Force (USPSTF) is updating its 2008 colorectal cancer (CRC) screening recommendations. Objective: To inform the USPSTF by modeling the benefits, burden, and harms of CRC screening strategies; estimating the optimal ages to begin and end screening; and identifying a set of model-recommendable strategies that provide similar life-years gained (LYG) and a comparable balance between LYG and screening burden. Design, setting, and participants: Comparative modeling with 3 microsimulation models of a hypothetical cohort of previously unscreened US 40-year-olds with no prior CRC diagnosis. Exposures: Screening with sensitive guaiac-based fecal occult blood testing, fecal immunochemical testing (FIT), multitarget stool DNA testing, flexible sigmoidoscopy with or without stool testing, computed tomographic colonography (CTC), or colonoscopy starting at age 45, 50, or 55 years and ending at age 75, 80, or 85 years. Screening intervals varied by modality. Full adherence for all strategies was assumed. Main outcomes and measures: Life-years gained compared with no screening (benefit), lifetime number of colonoscopies required (burden), lifetime number of colonoscopy complications (harms), and ratios of incremental burden and benefit (efficiency ratios) per 1000 40-year-olds. Results: The screening strategies provided LYG in the range of 152 to 313 per 1000 40-year-olds. Lifetime colonoscopy burden per 1000 persons ranged from fewer than 900 (FIT every 3 years from ages 55-75 years) to more than 7500 (colonoscopy screening every 5 years from ages 45-85 years). Harm from screening was at most 23 complications per 1000 persons screened. Strategies with screening beginning at age 50 years generally provided more LYG as well as more additional LYG per additional colonoscopy than strategies with screening beginning at age 55 years. There were limited empirical data to support a start age of 45 years. For persons adequately screened up to age 75 years, additional screening yielded small increases in LYG relative to the increase in colonoscopy burden. With screening from ages 50 to 75 years, 4 strategies yielded a comparable balance of screening burden and similar LYG (median LYG per 1000 across the models): colonoscopy every 10 years (270 LYG); sigmoidoscopy every 10 years with annual FIT (256 LYG); CTC every 5 years (248 LYG); and annual FIT (244 LYG). Conclusions and relevance: In this microsimulation modeling study of a previously unscreened population undergoing CRC screening that assumed 100% adherence, the strategies of colonoscopy every 10 years, annual FIT, sigmoidoscopy every 10 years with annual FIT, and CTC every 5 years performed from ages 50 through 75 years provided similar LYG and a comparable balance of benefit and screening burden.
MeSH term(s)	Adenoma/diagnosis ; Adult ; Advisory Committees ; Age Factors ; Aged ; Aged, 80 and over ; Cohort Studies ; Colonography, Computed Tomographic ; Colonoscopy/adverse effects ; Colonoscopy/statistics & numerical data ; Colorectal Neoplasms/diagnosis ; DNA/analysis ; Early Detection of Cancer/methods ; Feces/chemistry ; Humans ; Immunohistochemistry ; Middle Aged ; Models, Theoretical ; Occult Blood ; Preventive Health Services ; Quality-Adjusted Life Years ; Sensitivity and Specificity ; Sigmoidoscopy ; Time Factors ; United States
Chemical Substances	DNA (9007-49-2)
Language	English
Publishing date	2016-07-11
Publishing country	United States
Document type	Comparative Study ; Journal Article ; Research Support, N.I.H., Extramural ; Research Support, U.S. Gov't, P.H.S.
ZDB-ID	2958-0
ISSN	1538-3598 ; 0254-9077 ; 0002-9955 ; 0098-7484
ISSN (online)	1538-3598
ISSN	0254-9077 ; 0002-9955 ; 0098-7484
DOI	10.1001/jama.2016.6828
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Article ; Online: Adenoma Prevalence in Blacks and Whites Having Equal Adherence To Screening Colonoscopy: The National Colonoscopy Study.

Clinical gastroenterology and hepatology : the official clinical practice journal of the American Gastroenterological Association

2017 Volume 15, Issue 9, Page(s) 1469–1470

MeSH term(s)	Adenoma/epidemiology ; African Continental Ancestry Group ; Colonic Neoplasms/epidemiology ; Colonoscopy ; Early Detection of Cancer ; European Continental Ancestry Group ; Humans ; Prevalence ; United States/epidemiology
Language	English
Publishing date	2017-04-15
Publishing country	United States
Document type	Comparative Study ; Journal Article ; Research Support, N.I.H., Extramural ; Research Support, Non-U.S. Gov't
ZDB-ID	2119789-1
ISSN	1542-7714 ; 1542-3565
ISSN (online)	1542-7714
ISSN	1542-3565
DOI	10.1016/j.cgh.2017.04.014
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