MSF Experience in the West African Ebola Outbreak

By the time Ebola epidemic was declared in Guinea on March 22^nd 2014, suspected cases had already been reported from several locations in southeastern Guinea; the outbreak then rapidly spread to the capital, Conakry, and across the border into Liberia. The total number of cases reported to WHO after 3 months (as of 23 June 2014) was 599, with 338 deaths, but by the end of January 2015 had skyrocketed to 22,369 cases. This timeline illustrates the lost opportunities to control the outbreak before the explosion of patient numbers in Liberia and Sierra Leone in August-September 2014. MSF responded to most previous outbreaks of filovirus hemorrhagic fevers, by providing direct medical care as well as outbreak control activities in affected communities. However, the 2014 outbreak in western Africa stretched the capacities of the organization to their limit. During the peak of epidemic, MSF focused mainly on patient care and on training other actors to scale up the response. At its maximum MSF was managing 8 Ebola treatment centers in the 3 most affected countries and currently employs over 4000 staff in Ebola response. In total over 5000 patients with confirmed Ebola have been treated in MSF centers, with an overall case fatality ratio of 56%. To achieve this scale-up and safely accommodate the growing numbers of patients and hundreds of staff, the design of the treatment units had to be re-thought; the resulting changes also allowed for closer clinical monitoring of patients. Better understanding of the clinical and biological disease characteristics also helped with improved care. However, better tools—specifically, potent anti-viral medications and an effective vaccine—are urgently needed, and MSF is engaged in several clinical trials of experimental drugs and vaccines. As the number of patients continues to decrease, and the number of actors involved in clinical management increased, the intervention focus has shifted to outbreak control activities and to restoring and expanding access to general health care, which all but disappeared during the outbreak’s peak.