This is the daily choice that Medicin Sans Frontieres (MSF) staff face. It has fallen on MSF, a charity, to lead the treatment of Ebola in West Africa – which, as ODI’s Executive Director Kevin Watkins noted at yesterday’s event on the Ebola crisis, points to a shameful lack of investment in the global public good of public health.
The international community is stepping up – but the numbers keep rising
The panellists at yesterday’s discussion were clear that while there has been a step change in the international response, the numbers of people affected just keep rising, with cases now in most parts of Sierra Leone and Liberia.
Over the past two weeks we’ve seen new commitments from the US, UK and Cuba. 30 volunteer professionals went to help in Liberia through the African Union. For the first time ever the UN Security Council has met to consider a public health emergency, and has approved the creation of the United Nations Mission for Ebola Emergency Response (UNMEER).
But the American Center for Disease Control (CDC) – not an organisation noted for scare-mongering – projects that even with actions being taken to reduce the current high transmission rates, the number of new daily cases in Liberia will soon exceed the planned new capacity. The US plans for 1,700 beds would allow for around 250 new cases to be admitted each day; the CDC projects there will be 3,000 new cases every day by early December.
Without the resources to ensure safe treatment, the plan won’t work
So are the plans in place enough? I asked this question at the discussion, and the clear reply was ‘no’. While the new World Health Organization roadmap is a good document, there are severe doubts about the capacity of the international community to implement this plan.
The key problem is getting resources in place to treat people safely outside of specialised facilities. In Liberia, there was originally an emphasis on home care, providing gloves and aprons to carers. This strategy was always unlikely to reduce infection rates. If skilled health workers protected by a fully body plastic germ warfare suit are still at risk, what protection do gloves offer? This is now being replaced by community centres offering ‘basic’ (read: minimal) care, called, without a trace of irony ‘care centres’.
MSF has already commented on the strategy of moving thousands of contagious people to places where they could expect no treatment in a country with an already overstretched health service with little logistical capacity: ‘this is not going to work’.
Yesterday MSF UK’s Executive Director Vickie Hawkins was clearly sceptical that the proposed small community centres – with 4-6 beds – could be sufficiently resourced to ensure safe treatment. But without safe treatment any centre simply becomes a source of re-infection. And unsafe centres will further reduce the low levels of public confidence so that those infected will not come forward at all.
Wrong plan, at the wrong scale
At DFID’s ‘Defeating Ebola in Sierra Leone’ conference tomorrow, hopefully more support for the UK’s plan will be secured. But there are two broader sets of questions that also need to be urgently addressed.
First, is the planned approach right – and in particular what should be the role of the UK military in all of this? At the moment, the plan seems to be for the military to help build the 90-bed hospital but not to run it. MSF has long been calling for the military to be more involved: yesterday Vickie Hawkins reiterated that only the army has experience of operating in the needed command and control manner. MSF’s call is shocking from a charity that fiercely guards its neutrality and speaks to the urgency of the crisis. Yet the UK government so far seems to be ignoring this plea.
Second, is the scale of the plan adequate and is the funding in place? The UN have estimated that $1 billion is needed. To date only a third of this has been funded. New health centres and protective gear, treatment for the sick and disinfectant for the dead all cost money – but they also need numbers of health care workers and others which simply don't exist at the moment.
If transmission rates are not dramatically slowed, CDC projects 1.4 million infected people by the end of January – 1 million people are at risk of death within the next four months.
Right now, the message from frontline doctors, Sierra Leoneans and the charity leading the global response is that we don’t yet have the right approach – at the right scale – to contain this crisis.