Doctors Without Borders staff members carry a deceased Ebola patient to the morgue. Sierra Leone, December 2014. © Anna Surinyach
2. Why was this outbreak different?
“Never had Ebola outbreaks happened in so many countries at the same time. The virus spread in Guinea, Sierra Leone and Liberia, but there were also cases in Senegal, Mali and Nigeria. It was also the first time that Western countries, like Italy, Spain, the UK, and the USA, had cases of Ebola.
The scale of this epidemic was absolutely unheard of. When it was finally over, in March 2016, more than 28.000 people had been reported to be infected, of which 11 000 died. Before this epidemic, the largest Ebola outbreak had 425 infected people! Everybody, including Doctors Without Borders, was completely overwhelmed by this outbreak.”
3. Was the response to the outbreak different too?
“For almost six months, the world tried to ignore this outbreak. Only by the end of the summer of 2014, other governments and aid organisations finally started to help.
At the time, there were no treatments for Ebola. Patients would be admitted in an Ebola clinic, mainly to avoid they would infect other people. In earlier outbreaks, a family member could accompany the patient. But in 2014, to admit the huge number of patients, very big structures had to be built. The safety procedures had to be extremely strict, and it was impossible to allow family members. This large-scale approach scared patients and their families.
By the end of 2014, dozens of aid organisations, most of them unexperienced with Ebola, were involved in different aspects of the response. The coordination of all those organisations, in multiple places in multiple countries, was extremely challenging. Some governments turned to authoritarian tactics to force patients and their family into compliance. That scared them even more.
The focus on the patients and their families, that had been so key to contain previous outbreaks, was completely lost in the enormous machine that the Ebola response had become.”
Even if big hospitals became the symbols of the Ebola outbreak in West-Africa, outreach activities to the affected communities remained very important. Teams would not work in the controlled environment of the hospital, but had to be flexible and adapt to the situation, when picking up patients, supporting families and disinfecting houses. Liberia, December 2014. © Yann Libessart/MSF
With so many new, inexperienced staff working on Ebola, Doctors Without Borders had to tighten its security rules. Properly putting on and off the Personal Protective Equipment was a crucial part of it. Staff would never do this alone, but always with support from colleagues, to check if the suit was absolutely safe. Guinea, April 2014. © Amandine Colin/MSF
Medical doctor and epidemiologist Michel Van Herp explains to the population in Guinea what is Ebola and how to avoid transmission, in March 2018. Going to affected villages to talk to them, explain what the disease is and ask them about their concerns, was considered vital in the outbreaks before the West-African one. Guinea, March 2014. © Joffrey Monnier/MSF
4. Did we learn anything from it?
“Many of the things that we consider ‘lessons learned’ are things we knew before 2014, but that were forgotten. But we have also learned new things. We learned how we could take a simple, oral swab of dead people, to test whether they had died of Ebola. This allowed us to better understand the dynamics of the epidemic.
We also organised clinical studies and discovered a good vaccine against the Zaire strain of Ebola. And we learned from organising the clinical studies, so we were faster during the 2018 outbreak in the DRC. In DRC, we found treatments with antibodies for the Zaire strain of Ebola.”
Jackson Naimah, a team leader at Doctors Without Borders' Ebola Treatment Centre in Monrovia, Liberia, adresses the UN Security Council in New York, describing the urgent need to address the Ebola crisis in the region. It took a very long time before the UN, other governments and other aid agencies started helping the three most affected countries Guinea, Liberia and Sierra Leone. Liberia, September 2014. © Morgana Wingard
5. What needs to happen for the future?
"There are very concrete things we can improve. We should again allow a family member to accompany a patient in the Ebola clinic. We can protect them better now, with vaccination and drugs for pre-exposure prophylaxis.
Very sick patients should receive an antibody treatment much faster. Antibodies can be real lifesavers and the sooner a patient receives them, the better they work. We must adapt our models to make the best use of this option. And we need to continue looking for other treatments. The Ebola virus can provoke an inflammatory response that is so strong that it can kill the patient. If we had a drug to calm down that inflammatory response, we would save more Ebola patients.
We also must improve the follow-up of patients after their recovery. The virus can linger in the brain, the eyes, and the testes of survivors. Another type of drugs, antivirals, can clean up the virus from these places. And six months after their full recovery, Ebola survivors should get a shot of the vaccine, to give their immune system another boost.
In the last ten years, we have certainly made errors when we responded to Ebola outbreaks. Some errors were forced, some were unforced. But in general, we clearly have made progress, and there are good options for even more progress. The odds for a patient with Ebola in the next outbreak will be much better than they were ten years ago.”
