2015 Lasker~Bloomberg Public Service Award

Sustained and effective frontline responses to health emergencies

The 2015 Lasker~Bloomberg Public Service Award honors Médecins Sans Frontières (MSF) for bold leadership in responding to the recent Ebola outbreak in Africa and for sustained and effective frontline responses to health emergencies. Undeterred by grim and demanding circumstances, its employees and volunteers have worked steadily for decades to fulfill the organization’s mission. Last year, it undertook a monumental task —f ighting a deadly infectious disease that spreads readily — a duty that rightly belongs to the international community, not an outfit that is funded primarily by individual donors.

Since 1971, MSF has provided medical assistance and humanitarian aid to the world’s neediest citizens. The organization delivers drugs, healthcare, and other essential resources to people who suffer from crises of war, famine, natural disasters, and infectious disease. It reaches vast numbers of people in troubled areas, in part because it remains politically neutral.

Joanne Liu, International President of MSF, and staff at the Ebola treatment center in Kailahun, Sierra Leone. Photo by P.K. Lee
Demonstrating continued commitment to its goals even after achieving some of the world’s highest recognition and accolades, including the Nobel Peace Prize (for “pioneering humanitarian work on several continents”), MSF has grown and honed its skills at caring for people under devastating circumstances. In 2014, it treated 2.1 million people for malaria, admitted almost 218,000 severely malnourished children to nutritional programs, and performed 81,700 major surgical interventions. It carried out those activities while battling a viral scourge that imposed unprecedented challenges.

Leading the charge against Ebola

In March 2014, MSF leaders realized that Guinea was facing “an epidemic of a magnitude never before seen.” Ebola had struck. Cases were scattered over a wide area, and infection soon spread to other parts of West Africa, especially Liberia and Sierra Leone.

No vaccine, rapid diagnostic tool, or treatment existed for the disease, which kills 50 percent of its victims. People were terrified. Individuals denied that they were sick, governments denied that their citizens were sick, and the World Health Organization denied the severity of the crisis.

On this bleak backdrop, MSF sprang into action. It sent in experts who had responded to multiple Ebola outbreaks, identified infected people, and built isolation hospitals. The organization imported necessary supplies such as chlorine for decontaminating materials exposed to the virus and protective gear that keeps nurses and doctors safe. Its sanitation experts set up systems to ensure that viral particles did not escape and that waste was disposed of properly.

Staff members did everything. They went out with ambulances to pick up sick individuals, decontaminated houses, oversaw funerals to make sure no one got infected from local burial practices, and traced the epidemic. They trained local healthcare workers and eventually participated in clinical trials of new therapeutic agents.

For the first time, MSF had to build a crematorium. The economic infrastructure had collapsed, and it couldn’t rely on airlines or the usual medical evacuation systems.

In this environment, MSF workers undertook the responsibility to treat patients and contain the epidemic at great risk to themselves. For many months, it was alone in its work. UN agencies were absent or were present in a nominal way, without sending hands-on support. In August 2014, the World Health Organization finally stated that the outbreak was “a public health emergency of international concern.” Still, resources remained slim. When other organizations began stepping up, MSF provided guidelines and trained many of their personnel.

Next steps

More than 11,000 people have lost their lives to Ebola in West Africa, including hundreds of health workers. The epidemic is drawing to a close, but immense challenges remain.

John Mulbah celebrates. Mulbah was the 500th patient to recover from a new MSF facility in Monrovia, Liberia. Photo by Caitlin Ryan
Guinea, Sierra Leone, and Liberia never had fully functioning health systems, and what was there has now crumpled. MSF is building maternity and pediatric hospitals, and it is reviving childhood vaccine programs, which have been on hold for more than a year; it is also treating malaria and other endemic illnesses.

Huge numbers of people are traumatized from the epidemic, so the organization is providing mental health care. Furthermore, some Ebola survivors confront lingering problems from their infections as well as social stigma, and MSF has established clinics to help address these issues.

The organization is also pushing for policies and programs that ensure a robust international response the next time the disease hits. It is backing efforts to ensure the development of vaccines, treatments, and rapid diagnostic tools. Toward that end, it is promoting a system in which knowledge gained from research is shared in an open-source database.

Advocacy

Throughout the crisis, MSF has advocated on many levels. From the first days of the epidemic, it has spoken out about counterproductive activities on the ground and issued an unrelenting cry for the world to join the struggle against the deadly disease. It described the dire situation and called for governments and international agencies to provide trained medical personnel. The World Health Organization and its constituent countries are finally beginning to come to grips with what is needed. In May, it announced that it would create a $100M fund that will support an international rapid response system for future outbreaks.

Since its inception, MSF has tackled the world’s most overwhelming disasters that affect the planet’s most marginalized people, and its activities during the last 18 months have demonstrated its exceptional perseverance and effectiveness. The organization spearheaded the campaign against Ebola and modeled how to combat dangerous infections that might some day threaten everyone on Earth.

by Evelyn Strauss 

Award presentation by Barbara Barrett

 

Médecins Sans Frontières

Acceptance remarks, 2015 Lasker Awards Ceremony

Our work for Ebola patients in West Africa — recognized by this Lasker-Bloomberg Award — would not be possible without the selfless determination and dedication of our national staff from the affected countries. 

Through countless acts of courage, more than 4000 men and women have cared for Ebola patients in West Africa. Alongside some 1300 international workers, they have fought day in and day out for 18 months, at great personal risk.

Fourteen of them tragically lost their lives.  And it is in their cherished memory that I accept this award. 

They and so many others needlessly perished. Our response, while generating many accolades, ultimately illustrates a broad failure. 

There have been 24 Ebola outbreaks since its discovery 40 years ago. Yet in this latest one, people were literally dying at our feet because there were no treatments and no vaccines. The absence of any point-of-care diagnostic test for Ebola meant that health systems nearly ground to a halt absent the ability to safely triage patients.

Yes, the world finally mobilized, but much too late, and only when a handful of Ebola cases emerged in the West. And rather than initially focusing on the source of the epidemic, and attending to the core needs of those most affected, measures were enacted to protect borders, trade, and economic security.

Indeed, the international epidemic response system is largely broken.

There are simply no interventions for a number of regularly occurring epidemics. Measles is today ravaging parts of the Democratic Republic of Congo. It, along with cholera, meningitis, and other vaccine-preventable diseases, claim thousands annually. This is MSF’s daily field reality. 

Ebola has only reinforced the fact that global health security cannot be disconnected from individual health security. Global health security requires putting those most at risk at the center of any epidemic response. Enforcing quarantines and imposing travel bans only exacerbate outbreaks.

The lack of effective treatments and vaccines also escalate the toll.  

Ebola exposed a global research and development infrastructure that is unfit for purpose: saving lives.

We should be conducting safety studies and agonizing over ethical frameworks in the inter-epidemic phase, not after outbreaks. This would allow fast-track use of experimental drugs and vaccines during an outbreak and efficiency trials as an epidemic peaks. Yet, all too often, we scramble to act only as an epidemic peters out. We must act upstream of epidemics, not at the tail end. Needless lives are lost by the failure to manage the R&D timeline.  

Just as a global health security response must be guided by the actual needs of actual patients, so too must biomedical research. The Lasker Awards testify to the tremendous strides made in medical science, yet the alarming gaps in R&D on emerging infectious diseases, neglected diseases, even anti-microbial resistance, leave patients facing the greatest disease burdens by the wayside.  

How is this possible — today — in the 21st century?

Innovative solutions, along with radical new thinking, are required.

For Ebola, MSF is supporting the creation of an internationally coordinated and regulated network of biobanks, in which the roughly 100,000 blood samples collected during the epidemic by an assortment of foreign laboratories can be made accessible for R&D on Ebola diagnostics, treatments, and vaccines.

On the ground, so many have done so much to try to fill the massive gaps. So many of them have perished.

Their deaths must rally us to act during the 'down times', before epidemics explode. This is where many of you, here today, can make a unique difference.

Thank you.

 

Interview with Alfred Sommer and Darin Portnoy

Video Credit: Flora Lichtman