Joanne Liu, the international president of Médecins sans frontières (Doctors Without Borders), returned last week from a 10-day trip to Sierra Leone, Guinea and Liberia, the centre of an unprecedented Ebola outbreak that has killed at least 1,350, according to the World Health Organization. What Dr. Liu, a Canadian pediatrician, saw on her West-African tour stunned her. The health-care system has collapsed in the areas worst hit by the crisis, meaning that even basic infection-control supplies like gloves and body bags are hard to come by. Dr. Liu is calling on the WHO to dramatically step up its efforts to combat a viral hemorrhagic fever that, as she points out, often leads to heart-breaking deaths in isolation wards, with victims separated from the people they love.
Why do you think the international response has not been adequate to the size of this crisis?
I think it’s multifactorial. First of all, right now we already have a few crises called level 3 in the world, which is the highest level in terms of emergency for the UN to intervene. People did not expect this kind of evolution [of the Ebola outbreak.] If you look at the past, most of the epidemics that we’ve had were in isolated, remote villages. Basically, when it happened it was self-contained within a few weeks because the chain of transmission was stopped pretty quickly. What happened here is we have cases in urban settings. We’ve never faced that before. [And] when it’s something remote, something difficult to understand, it’s hard to get people’s interest. But with the fact that we had some foreigners infected, that drew a lot of attention. All of sudden, people said, ‘Oh my god, it’s knocking at my doorstep.’ All of sudden, people are paying attention.
Those cases of foreigners being infected in West Africa also drew attention to experimental medicines. What do you make of the WHO decision to support, in theory, providing experimental medicines in the Ebola outbreak? Is it helpful?
There’s never been enough research and development in trying to find either a vaccine or treatment for Ebola. There were some, but this will probably be a catalyst in that respect, which is something that we welcome. I think [the WHO] has done it a bit under pressure. To be realistic, for this epidemic, it’s unlikely that it’s going to make a difference in terms of the course of events.
In the case of the 1,000 Canadian vaccines being offered here, what do you see as the potential value, if any, of having an experimental vaccine that could be available to a much larger number of people than any of the other experimental treatments we’re discussing?
The thing is, we know very little about this vaccine. It hasn’t been tried on humans so it’s very difficult to have a point of view on this. We are having, actually, an [internal MSF] task-force meeting on this [Wednesday] in Geneva.
What’s the conclusion you’re hoping to come to? Is it just about the provision of the Canadian vaccine?
No, it’s just for us to have a greater guideline in terms of what we’re ready to do. Because the reality is doing clinical trials is a huge production. It’s not just you gave [the drugs] and this is it. There’s going to be some blood tests that will be done, some monitoring, we need to be clear what the criteria is for using it. It needs to be well-framed. If it’s not well-framed, first of all it’s going to be hard to draw conclusions. Second of all, you might put some of the patients at risk.
Has MSF at any point in this crisis considered pulling out of Ebola-affected areas? Some other aid organizations have pulled their people out.
Right now we are really stretched and we’ve been telling the world that we have limits. The thing is, somehow, people are hearing it but they’re not understanding what it means. But the reality is we won’t be able to scale up more than what we’re doing right now. We’re absolutely exposing ourselves because we’re breaking new ground in terms of our response capacity, having big centres for Ebola. This has never been done before. Are we doing the right things? We know it’s more risky. Is it a risk we should take? We are questioning ourselves on a daily basis.
What are some of the basic supplies that people on the ground are lacking right now to care for Ebola patients?
Generally speaking, they are right now missing everything. Just to take a very simple example, like in Liberia, there’s the Ebola crisis, the epidemic, and there’s what I call the emergency within the emergency, which is the fact that the medical health-care facilities have all shut down in Monrovia. We need to be able to restore basic health-care access as soon as possible. Right now, my team has written to me this week to say this is completely appalling. We’ve got six pregnant women who end up coming to our centre after walking around for hours in Monrovia because they couldn’t find a place to deliver their baby. By the time they got in our centre, which was not the right place to be, the baby was dead. This is the type of thing we’re facing on a daily basis.