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 The group's response to the epidemic which has so far killed more
than 5,000 people has been widely praised by governments and the
World Health Organization. While Western donors dithered and other
aid groups pulled out, MSF deployed hundreds to the Ebola "hot
zones" and treated more than 3,000 patients.
But the emergency group relied too much on strategies it developed
during smaller previous eruptions of the virus, leading it to make
mistakes as this year's rampant multi-country epidemic pushed it to
its limits, said Jean-Herve Bradol, a member of MSF's internal
think-tank.
"Our response was too orientated toward the management of previous
outbreaks," Bradol, of the Paris-based Centre For Reflection on
Humanitarian Action (CRASH), told Reuters, adding that MSF's public
appeal for vaccine development in September came months too late.
"We wasted time before speaking about a vaccine and treatments...
It's very hard to imagine controlling this epidemic now without a
vaccine."
MSF, known also as Doctors Without Borders, is the only organization
to have worked extensively with Ebola in the last 20 years. When the
outbreak, first identified in March, started to spread, the group
focused on established protocols of isolating patients and tracing
their contacts.
At the same time, the group - treating patients at its six centers
in Guinea, neighboring Liberia and Sierra Leone - criticized the
slowness of the international response and clashed publicly with the
Guinean government and the World Health Organization (WHO), which
accused it of alarmism.
Since then the WHO has been widely criticized for its slow response
to the epidemic and its early reassurances, despite warnings from
MSF. The United Nations health agency has said it will publish a
full review of its handling of the epidemic once it is under
control.
Several companies are now accelerating vaccine trials. Two leading
candidates, made by GlaxoSmithKline and NewLinkGenetics, have
already started trials in Africa and Europe.
Separately, MSF said on Thursday that clinical trials of three
potential new drugs would begin in December in Guinea and Liberia at
medical centers it runs.
The West Africa Ebola epidemic has now infected more than 13,000
people.
ETHICAL TESTS
MSF was founded in 1971 by a group of French doctors and journalists
outraged by the aid community's silence at Nigeria's blockade and
starvation of separatist Biafra.
It prides itself on its speed and independence: with 90 percent of
its $1.3 billion global budget funded by a legion of small
individual donors MSF does not have to seek permission from any
single major backer before acting.
The group has made 'bearing witness' a key part of its remit, from
criticism of the military junta during the 1985 Ethiopian famine to
calls for armed intervention to halt the Rwandan genocide in 1994.
That same attitude extends to self-criticism, said Bradol, noting
that the remit of CRASH is to look at what MSF could have done
better itself.
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The current Ebola outbreak has brought ethical challenges for the
group. When Sierra Leone’s foremost Ebola specialist, Dr. Sheik Umar
Khan, lay dying in July, MSF doctors decided after fraught
discussions not to treat him with an experimental drug, arguing its
effects were unknown and supplies were scarce so it would be unfair
to give him privileged care.
But when international healthcare workers fell ill - including two
European members of MSF's staff - they were evacuated and given such
treatments.
Such incidents sparked debate within MSF over why experimental
treatments were not being offered to patients and its local staff,
an unprecedented 15 of whom have died.
“The CRASH said...if you argue the drugs are not safe because they
are experimental but you give them to the expatriates, that makes no
sense," Bradol said.
FROM ALOOF TO INNOVATIVE
MSF staff complained at the start of the outbreak that other aid
organizations failed to help treat Ebola. But the other aid groups
complained that MSF refused to water down its rigorous safety
protocols by training others.
Since then MSF has shared its blueprint for treatment centers and is
training non-MSF workers in its center in Brussels. It also allowed
staff from other NGOs to shadow its workers and use its logistics
infrastructure.
Henry Gray, an operations coordinator for MSF-Brussels who worked
for two months in Liberia and Sierra Leone, says the outbreak has
also forced the group to innovate, developing watertight body bags
to stop leakage of infected bodily fluids and climate controlled
tents to allow doctors to work longer wearing heavy protective
suits.
MSF has deployed more than 700 foreign staff in total to fight
Ebola, rotating people through on six week stints. With the
operation run at a cost of $50 million MSF staff are paid just
$2,800 for a country manager.
"Nobody does this for the money," said Dr. Darin Portnoy, a
long-time MSF volunteer from New York working at an MSF treatment
center in Monrovia.
(Additional reporting by Pascal Fletcher in Johannesburg, Tom Miles
in Geneva, Ben Hirschler in London, Joe Bavier in Abidjan, James
Harding Giahyue in Monrovia, Saliou Samb in Conakry; Editing by
Sophie Walker)
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