Publications des membres du Ceped

2022

2021



  • Kameda Koichi (2021) « Molecular Sovereignty: Building a Blood Screening Test for the Brazilian Nation », Medicine Anthropology Theory, 8 (2) (novembre 3), p. 1-25. DOI : 10/gncwbr. http://www.medanthrotheory.org/article/view/5122.
    Résumé : This article interrogates the relationship between the development of national diagnostic technologies and the exercise of sovereignty, by analysing a Brazilian project to produce a nucleic acid test (NAT) for the country’s blood screening programme. The concept of ‘molecular sovereignty’ is proposed to demonstrate that exercising sovereignty demands not only technological resources but also a sufficiently powerful and national imaginary to support local knowledge production as a means of advancing national healthcare priorities. First, this research article contextualises the political importance of blood safety for Brazil during its transition to democracy in the 1980s and the creation of its universal healthcare system. Then, it investigates how adopting the NAT led the state to invest in the production of a national technology. Third, the article unpacks the diagnostic test to consider how certain aspects of the project might ultimately strengthen the ability of global capital to cross national boundaries and create new markets. Lastly, it discusses how the project ended up creating a centralised and ‘closed’ system to avoid leaving the country vulnerable to the entry of global diagnostic companies. This case demonstrates how the molecularisation of blood, through the construction of a unified healthcare system driven by the constitutional right to health, can be deployed to construct imagined communities on the scale of a nation.
    Mots-clés : Blood, Brazil, Diagnostic tests, Global health, Molecularisation, Sovereignty.

  • Kameda Koichi et Barbeitas Mady (2021) « Quelle place pour les tests dans gestion de la COVID-19 au Brésil ? », COVIDAM: la Covid-19 dans les Amériques. https://covidam.institutdesameriques.fr/quelle-place-pour-les-tests-dans-gestion-de-la-covid-19-au-bresil/.
    Résumé : Dès mars 2020, il y a plus d’un an, le directeur de l’Organisation Mondiale de la Santé demandait à tous les pays d’investir davantage dans la réalisation de tests de diagnostic pour contrôler la dissémination du SARS-CoV-2, virus causant la Covid-19. Dans ce contexte, ce billet va analyser plus spécifiquement le cas brésilien pour éclairer le rôle du test de diagnostic dans la réponse à la COVID-19.


  • Kameda Koichi, Barbeitas Mady, Caetano Rosângela, Löwy Ilana, Oliveira Ana Claudia Dias de, Corrêa Marilena Cordeiro Dias Villela et Cassier Maurice (2021) « Testing COVID-19 in Brazil: fragmented efforts and challenges to expand diagnostic capacity at the Brazilian Unified National Health System », Cadernos de Saúde Pública, 37 (3), p. e00277420. DOI : 10.1590/0102-311x00277420. http://www.scielo.br/scielo.php?script=sci_arttext&pid=S0102-311X2021000306001&tlng=en.
    Résumé : Abstract: Since the first recorded case of COVID-19 on February 26, 2020, Brazil has seen an exponential growth in the number of cases and deaths. The national testing approach has been insufficient to correctly use this tool in the support of containing the epidemic in the country. In this communication, we discuss efforts and challenges to scale-up COVID-19 testing at the Brazilian Unified National Health System (SUS). This communication presents the initial results of the research project created to investigate the political, industrial, technological, and regulatory aspects that may affect the diagnostic and testing capacity for COVID-19 in Brazil. The paper draws on the review of academic literature, media publication, and collection of public data on tests purchase and regulation. It enlists initiatives to enhance PCR testing, national production and development of technologies, as well as regulatory measures to fast-track new tests. Our analysis indicates some points of reflection. Firstly, the lack of a consistent national strategy to fight COVID-19 exarcebated supply problems of diagnostic components. If the country was eventually able to circumvent this situation, it still faces a more structural dependency on the importation of diagnostic components. Secondly, the discontinued funding and distribution of tests may have implied health policy fragmentation and the growing importance of local governments and non-state actors to fighting the epidemics within SUS. Finally, initiatives established since the second semester of 2020 have expanded the testing capacity at SUS. However, it has not been sufficient to control the progress of the epidemic in the country. , Resumen: Desde que se registró el primer caso de COVID-19 el 26 de febrero de 2020, Brasil ha visto un crecimiento exponencial en el número de casos y muertes. La estrategia nacional para preconizar el test de diagnóstico ha sido insuficiente en el uso correcto de esta herramienta, con el fin de ayudar a contener la epidemia en el país. Se presentó los esfuerzos y los desafíos para ampliar la realización de pruebas de COVID-19 en el Sistema Único de Salud brasileño (SUS). Este artículo presenta los resultados iniciales del proyecto de investigación sobre los aspectos políticos, industriales, tecnológicos y regulatorios que pueden afectar la capacidad de diagnóstico para la COVID-19 en Brasil. El grupo de investigación realizó una revisión de la literatura académica, medios de comunicación y recogida de datos públicos respecto a la adquisición de tests y su regulación. Se haz referencia a iniciativas para promover la realización de pruebas de PCR, la producción nacional y el desarrollo de tecnologías, así como las medidas regulatorias fast-track para nuevas pruebas. Nuestro análisis indica algunos puntos de reflexión. Primero, la falta de una estrategia nacional consistente para luchar contra la COVID-19 que exacerbó los problemas de sumistro de los componentes de diagnóstico en un primer momento. Se solucionó posteriormente esta situación, aunque se coloque nuevamente en pauta la dependencia estructural del país en la importación de insumos de salud estratégicos. Segundo, la financiación y la distribución de tests de forma descontinuada pueden indicar la fragmentación de la política de salud, así como los gobiernos estaduales, municipales, y atores no estatales asumiendo un rol preponderante en acciones de combate a la epidemia en el SUS. En último, las iniciativas establecidas en el segundo semestre del 2020 contribuyeron para ampliar la capacidad de realización de tests moleculares en el SUS. Sin embargo, esa capacidad no fue suficiente para controlar la epidemia en Brasil. , Resumo: Desde que o primeiro caso de COVID-19 no Brasil foi notificado, em 26 de fevereiro de 2020, o país assiste a um crescimento exponencial no número de casos e mortes. A estratégia nacional de testagem tem sido insuficiente para usar essa ferramenta corretamente no apoio à contenção da epidemia no país. O artigo discute os esforços e desafios para escalonar a testagem para COVID-19 no Sistema Único de Saúde (SUS). O texto apresenta os resultados iniciais de um projeto de pesquisa sobre os aspectos políticos, industriais, tecnológicos e regulatórios que podem afetar a capacidade diagnóstica e de testagem para COVID-19 no Brasil. O estudo se apoia em revisão da literatura cientifica, artigos publicados na mídia e coleta de dados públicos sobre a compra e regulamentação de testes. O texto faz referência a iniciativas para ampliar a testagem de PCR, a produção nacional e o desenvolvimento de tecnologias, além de medidas regulatórias fast-track para novos testes. Nossa análise sugere alguns pontos para reflexão. Primeiro, a falta de uma estratégia nacional consistente para combater a COVID-19 agravou os problemas de fornecimento de reagentes de diagnostico num primeiro momento. Esta situação foi posteriormente resolvida, embora coloque novamente em pauta a dependência estrutural do país na importação de insumos de saúde estratégicos. Em segundo lugar, financiamento e a distribuição de testes, que ocorreram de forma descontinuada, podem indicar a fragmentação da política sanitária, assim como o papel de governos estaduais, municipais e atores não estatais no combate à epidemia no âmbito do SUS. Por último, iniciativas estabelecidas no segundo semestre de 2020 contribuíram para ampliar a capacidade de testagem molecular no SUS. Contudo, essa capacidade não foi suficiente para controlar a epidemia no Brasil.


  • Kameda Koichi, Kelly Ann H, Lezaun Javier et Löwy Ilana (2021) « Imperfect diagnosis: The truncated legacies of Zika testing », Social Studies of Science (août 31), p. 030631272110354. DOI : 10.1177/03063127211035492. http://journals.sagepub.com/doi/10.1177/03063127211035492.
    Résumé : When the Zika virus burst onto the international scene in the second half of 2015, the development of diagnostic tools was seen as an urgent global health priority. Diagnostic capacity was restricted to a small number of reference laboratories, and none of the few available molecular or serological tests had been validated for extensive use in an outbreak setting. In the early weeks of the crisis, key funders stepped in to accelerate research and development efforts, and the WHO took responsibility for steering diagnostic standardization, a role it had successfully played during the West Africa Ebola virus outbreak. Yet when the WHO declared the end of the Zika Public Health Emergency of International Concern in November 2016, diagnostic capacity remained patchy, and few tools were available at the scale required in the countries that bore the brunt of the epidemic, particularly Brazil. This article analyses the limited impact of global R&D efforts on the availability of Zika diagnostic options where they were most needed and for those most vulnerable: women who might have been exposed to the virus during their pregnancy and children born with suspected congenital Zika syndrome. The truncated legacies of testing during the Zika crisis reveal some of the fault lines in the global health enterprise, particularly the limits of ‘emergency R&D’ to operate in geopolitical contexts that do not conform to the ideal type of a humanitarian crisis, or to tackle technical issues that are inextricably linked to domestic struggles over the scope and distribution of biological citizenship. Diagnostic shortcomings, we argue, lie at the heart of the stunning transformation, in less than two years, in the status of Zika: from international public health emergency to neglected disease.


  • Kameda Koïchi et Kessel Nils (2021) « Quels consensus ?: La sécurité transfusionnelle en Allemagne et au Brésil », Cahiers Droit, Sciences & Technologies, 12, p. 97-115. DOI : 10.4000/cdst.3483. http://journals.openedition.org/cdst/3483.
    Résumé : Le présent article s’intéresse à l’émergence du consensus sur l’introduction du dépistage génomique viral (DGV ou nucleic acid based test - NAT) dans deux pays, l’Allemagne et le Brésil. L’introduction du DGV vers la fin des années 1990 en Europe puis une décennie plus tard au Brésil s’inscrit ainsi dans un ensemble de processus transnationaux : une menace virale identifiée, la disponibilité d’un ensemble de technologies mobilisant la polymerase-chain-réaction (PCR) ainsi que des normes scientifiques, technologiques et juridiques internationales relatives à la production et à la circulation du sang et à la transfusion de ses produits dérivés. L’article poursuit trois objectifs : d’abord il vise à décrire les formes et les contenus des consensus qui ont émergé dans les deux pays respectifs. Puis, nous nous intéressons à la manière dont le consensus est le résultat d’une coopération étroite entre acteurs établis. Enfin, en prolongement des questionnements de Marie-Angèle Hermitte, cet article analyse comment les processus « technoscientifiques » (Dominique Pestre) et l’évolution du droit sont intriqués et s’influencent mutuellement dans l’émergence d’un consensus.
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