Doctors Without Borders chief: World losing battle with Ebola now
While the world is preoccupied with Islamic State or political games around Ukraine, there’s another threat emerging from the West Africa - where people are dying by hundreds, reaped by the deadliest Ebola epidemic to be ever known to mankind. Efforts to contain it end in a failure, and the vaccine is nonexistent yet. Are we seeing another pandemic slowly growing up to strike at mankind? What should be done to stop it? What does it mean to be a doctor in a place where death reigns? We try to find out this together with the head of the Médecins Sans Frontières - Doctors Without Borders. Dr. Joanne Liu is on Sophie&Co today.
Sophie Shevardnadze: Dr. Joanne Liu, head of International NGO, Médecins Sans Frontières, also known as “Doctors without Borders” - welcome to the program, it’s really great to have you with us today. Now, you recently arrived back from Liberia, which is ravaged by Ebola - but you also worked in other epidemic-affected areas, like Haiti, for example - how is this one different?
Joanne Liu: I think what is different in terms of Western Africa and what's’ going on in the three mostly affected countries is the, I would say, the ravage of the illness. Basically, the Ebola epidemics has affected all state infrastructure of the countries, mostly in Liberia. So, we don’t have health care centers that are running properly in the city of Monrovia, people don’t have access to the basic health care - because health care workers became infected and some of them have died. So, that’s how it has somehow affected the whole healthcare system. But, what else is different is the fact that we are dealing with a disease that right now is rapidly spreading. In the past we used to deal with this kind of epidemic in some remote rural areas, and then very quickly it would die out by itself, because a chain of transmission was really short. Now, that it has reached a capital, like Monrovia, with1.3 mn people, the chain of transmission is much quicker, and then, what we have seen recently - it’s a thousand new infected cases that are recorded over the last 2 weeks, meaning that we have about 25% of the cases of Ebola that happened in the last two weeks and we were dealing with this epidemic in the last 6 months.
SS: So, is it fair to say that this Ebola epidemic is the gravest you have encountered as someone who is heading an NGO and is dealing with epidemics all the time?
JL: I think, with respect to hemorrhagic fever, this is the biggest and the most unprecedented Ebola epidemic that we have seen. In terms of magnitude, in terms of spread, in terms of people being infected - and the fact that we are really right now facing the unknown on how to tackle at best this epidemic.
SS: I saw videos of you wearing a protective gear and all - how worried were you about actually being infected, were you scared?
JL: It’s a fair question, and I think that everyone who goes in any Ebola environment has to overcome their own fear - but I think it’s the same thing when we go to any other context, where are risking your life. I would say, the main difference that I see is when you are in a country like South Sudan, or a Central African Republic, you can see some “firing” and at one point, there’s a pause in terms of ‘firing’. What happened in country with Ebola is that there’s no downtime - you were always exposed, and that can be really straining on the mental.
SS: But is there any way a doctors who are there to save people can protect themselves, to insure that they’re not affect?
JL: There are some basic rules in terms of protection. When you are in Ebola-management centers, we have very strict rules in terms of how the personnel needs to protect themselves, and this is why we call this “Protective Personal Ebola Gear” - so, there’s a full routine on how to put on this equipment, there’s a full routine on how to remove it in many steps. The way we’re working in MSF is that we have basically a dresser-coach, who gives you order to make sure that you don’t miss one step and you don’t infect yourself while you’re undressing. So, if you’re following that, you’re fine. I think, the other challenge is when you are in the community and you would do some care on the community. It’s how much you should protect yourself - but the reality is: A. someone is not infected until he has symptoms, and B. it’s contagious via body fluids, meaning that you’re not in contact with anybody’s fluids, you will not get the illness. So, when we talk about the body fluids, we talk about if someone has some ejection from the body, vomit, diarrhea or sweat….
SS: Here’s another question which from my understanding is another huge problem with tackling the disease. Did you feel like the people there trusted you? How desperate did you feel they were for your help?
JL: I think that Ebola is always a challenge, wherever it comes. This one is more challenging because it spreads so quickly. There is three ways of intervening with Ebola, these are what I call “The Three Pillars of Intervention”. The first one is the community mobilization and education, telling them what is a symptom, when to do consultation, and in what to use as universal precaution and of washing regularly. The second pillar is in terms of surveillance - getting the data to find out about the magnitude and as well working on breaking the chain of transmission, which means doing the contact briefing with people who have been in contact with someone infected, making sure that we have save burials to avoid more contamination. And the third pillar is in terms of caring for patient with Ebola in isolation center. And so, that’s how we need to respond to it. What is going on right now is that out of those three pillars we haven’t done enough, and the community mobilization needs to be done hand-in-hand - and it’s with the community mobilization and education we will get acceptance, and so we had our times of challenges in some areas.
SS: I guess, what I’m asking is do you still see situations in countries like Liberia, where shamans, for examples, and the likes of shamans, are more respected than educated doctors, the conventional doctors?
JL: Right. This is not something I saw first-hand, I’ve heard some stories about that, never been able to verify, but I think that this is something somehow that we need to respect - but I think that right, there is a good understanding of what’s going on to a certain extent, there’s still a lot of fear, and I would say that now our challenge is translate this fear into vigilance and not panic. Community acceptance is key, talking to the elders, the leaders of the community or prefecture is key, and this is what we have done, and in some places, where initially we were rejected, today people don’t want us to leave.
SS: Now, here’s some measures that some countries are introducing: for example, Sierra-Leone is introducing prison sentences for people who hide their sick relatives. Is that likely to help, in your opinion?
JL: I think that those kind of measures are really tough decision and it’s really difficult to predict how it will unfold and whether it will create more panic. We have a lot of reservation in those kind of measures, we have shared our concerns, but we respect the government’s decision.
SS: But also, why do you think some are still reluctant to send their sick ones to the hospital? Why are they prone to hide them more than make them get some help?
JL: I think if people realize this is the last moment of the loved-one, they want to accompany this person, doing that by themselves; in the places where you have only people in spacesuits around - it may be something difficult. And this is why we are really trying in our isolation center to make it more human and give some sort of an access to the family members. But it’s our hypothesis.
SS: Now, you’ve also spoken of the total collapse of infrastructure and health systems in affected states. How is that possible to get that under control?
JL: Right now, it’s a huge task, because when you face an Ebola epidemic, the people who are at the beginning, who are at the forefront, are really the health personnel, and we often see health personnel being infected, some of them will die, and some of them will infect other people and their patients in centers. And so this is why we had a collapse of the healthcare structure. Today we need to reopen healthcare centers with good infection controls, train the health personnel to protect themselves, and this is a huge task because right now, for example, in Monrovia, we don’t have any of the big hospitals open and running, and we seen some very dramatic stories, like the one of, I think, a dozen, pregnant women that were walking around Monrovia, the capital of Liberia, looking for safe place to deliver, and couldn't find any places and ended up coming to our Ebola-management center at the end of the day. By the time they reached us, their babies were dead. This is really dramatic situation and we need to restore basic health care access.
SS: I’m just going to show our viewers a map, so they have a clear idea of what I’m talking about. The virus has spread from rural areas to some of Africa’s biggest cities. There were Ebola epidemics in 1995, in 2002, 2003, 2007 - why has this one become worse?
JL: This Ebola epidemics has become worse because, we think - and this is our hypothesis - in fact it was concentrated in rural area, in remote villages, where the chain of transmission would die off very quickly, because people were not mobile, it was small village, so the chain of transmission stops. Now, that it has reached big city, where there’s a lot of people, dense population, and living conditions as well difficult in terms of weather and sanitation - then the chain of transmission is much faster and actually, we don’t have a model of forecast figures right now.
SS: As you’ve said, the chain of transmission is very fast, and if we look at the map of Ebola outbreak, some countries are seriously affected, and then we have the others that are clear of the disease - how’s that work, why is that?
JL: The thing is, right now it’s affecting three major countries: Liberia, Sierra-Leone and Guinea, we have to appreciate that epidemics at different stages in that different countries. In Guinea, we are at the third peak of cases since March, in Sierra-Leone we’re still seeing growing numbers of cases, and in reality we don’t have full visibility on the number of cases. We know there’s a lot of death in the communities. In Liberia we have a little bit more of visibility, but again, what we know, is that there’s an acceleration in the chain of transmission: we had a lot of cases over the last few weeks. About the other countries around, there may be some rumors, we don’t know - we ask people to be vigilant, to really scale up in terms of education of their health care workers, and to be prepared if it ever happens. So, the reality is that it reminds me a little bit of what happened in Haiti with cholera - if you have a country that has a health care structure that was weak for different reasons, when the epidemic of that high level of contagiousness comes, it somehow, I would say, moves really fast and so this is most likely what is happening in West Africa.
SS: The bigger question is, of course, I’ve heard your address the UN, where you’ve said that the world has lost the fight against Ebola. Why do you believe that?
JL: Why I did that? I said the world is losing the battle against Ebola - it’s the fact that we’ve been working in the West Africa for the last 6 months, we’ve been opening Ebola-management centers, we have 5 of them, we have 2000 staff on the ground, and every day, for the last many weeks, we have to turn back home the patients that have Ebola, because we don’t have enough isolation beds in our centers. Everyday we are picking up dead bodies at our doorsteps, because the families are coming and leaving their loved ones at our doorsteps, because they want us to care safely about their bodies. This is why we say we’re losing the battle. This should not happen. People should be able to consult and have access to isolation bed when they are infected, and if they have to do the last journey, they should be able to do it with dignity, and this is not happening.
SS: Now, if you turn on any news station around the world, the headlines are running Ukraine and ISIS as their first stories. Do you believe Ebola is a greater international threat?
JL: I don’t like to compare different contexts, but I really think that today the Ebola epidemic is an international concern, as it has been called by the WHO on 8th of August. I think it’s everyone’s business. If we don’t contain the Ebola epidemic in the more the most concerned countries, or regionally, it would have a major impact in terms of economy, in terms of human life loss, and we’re going to pay the cost of that for years to come. So, I really urge all the members of the world to consider to come up and bring help in the field. I really do think as well that it’s really strange that today the know-how how to tackle an Ebola epidemic is in the hands of the international private organisation. I think every nation should develop a know-how how to deal with highly contagious disease.
SS: But why do you think people aren’t giving, the international community isn’t giving enough to battle this disease if its that grave?
JL: I think the reality is that there are many crises in the world right now. I people are having difficulty to pay attention to all the crises, but it’s difficult to get a reality check about what is the magnitude of the epidemic when we just look at some of the cold figures or think “oh, 4700 people infected, about half of them died - well, compared to other context it is not that bad” - but the reality is that this is only the tip of the iceberg. First of all, we know that the figures underestimate it, we have only 20% visibility of the number of cases, we know the potential of this Ebola epidemic to the rest of African continent and we know as well that a biologic threat like is something that will probably come again and everybody should develop a know-how on how to deal with it.
SS: John Ashton, a senior UK health official, he condemned the pharmaceutical industry for not caring about Ebola since the potential market for a vaccine is not profitable or not profitable enough - is that the case?
JL: There’s always this sort of issue about research and development of new vaccine or new treatment. I think that this is something that we can overcome, we need to put pressure on pharmaceutical companies to make sure what would be developed, and I think that right now the vaccine is key to be developed as soon as possible, it’s needs to be tested to make sure it’s safe and it’s efficient - but the other things is that once we know that it is that good, we have to make sure that it’s going to be available in the production line, and so, the question about intellectual property should not be an obstacle for accessibility to this vaccine to come.
SS: Now, the current outbreak is happening in the volatile region that has seen the rise of terrorists, like Boko Haram - back in 1992, there was a Japanese cult group as well that collected samples of the Ebola virus from Africa allegedly planning to use it in a terror attack. Now, does Ebola pose a potential terror risk? I’m trying to figure out if that’s going to speed up the search for an effective antidote?
JL: Everybody has different scenario, and I would say, conspiracy plot scenario in their mind - I think it’s very difficult for me, as a medical doctor to position myself on it. My take on this is that I think there’s going to be other biological diseases that are highly infectious that probably will spread to other countries in the future, and getting a know-how on how to deal with that is paramount.
SS: I guess what I’m trying to find is how close are we to a vaccine as of right now - I know that back in 2010 the U.S. department of Defence signed $140 mn dollar contract with a company called “Techmira” to develop the Ebola treatment. Are we any closer now?
JL: Right now there’s a huge momentum in terms of research and development of the vaccine. There are different companies that are working on the prototype, so I’m pretty hopeful that something will be tested pretty soon, and, again, I think it’s not the question of finding the vaccine, but it’s to make sure that it is safe and efficient, and after that, that it is accessible.
SS: Just few more questions about the ways of tackling these things. For example, president Obama has indicated he’s prepared to send troops to help combat the outbreak. How soldiers could help in this kind of situation?
JL: In my UN remark, one of the things I’ve said is that we need civilian or military asset with a good chain of command that could deploy rapidly in a big number and have discipline - because that’s what it needs to treat and care for Ebola patients. So, I think that somehow they are responding to one of our appeals. When we see natural disaster we never question when some army comes and deploys - we have disaster response, and often it’s military, and they often do a very good job.
SS: But, if we look at the things the way they are right now - what are the prospects, what’s going to happen? Is it going to get any worse? Is it going to get better?
JL: I wish I could answer you, and as I’ve said in the beginning of my interview, we are in the uncharted waters, we are in the unknown, and it’s difficult. The thing that I know is the fact that if we don’t deploy right now, more assets, more workforce, and more isolation beds for infected patients - we will not be able to control and contain this epidemic. Every day that we wait it’s lost lives, but in addition it complexifies in terms of how we need to deploy in response. We know that every 3 weeks, more or less, the number of cases are doubling, so it’s exponential.
SS: Joanne Liu, thank you so much for this wonderful insight, very interesting, very helpful. I do agree the whole world should reunite to fight and contain this horrific epidemic. Thanks a lot for what you’re doing to help that. We were talking to Dr. Joanne Liu, who’s the head of the international NGO, Médecins Sans Frontières also known as Doctors without Borders - we were talking about Ebola epidemic, the last outbreak, what can be done to contain it, and how, and how the international community should pay more attention to grave issues like Ebola.