TORONTO - The World Health Organization and national governments need to step up their efforts if the West African Ebola outbreak is to be brought under control, the president of the leading aid group in the response warns.
The WHO, in particular, must ratchet up its role, Dr. Joanne Liu, international president of Medecins Sans Frontieres (Doctors Without Borders) said in an interview.
She acknowledged the WHO is stretched, financially, and has had to deal with a seemingly endless string of crises and disease outbreaks this year. But no other agency can do this, Liu said.
"I understand the limits of WHO. The reality is there is no other organization in the world who has the legitimacy and the authority to call for a public health emergency and take the leadership on it. And they need to step up to the plate. That's their role," she said in an interview from Montreal.
"This is their key time to shine. They should just take the opportunity to do it. And they will not be blamed for trying, because everybody knows it's unprecedented in terms of epidemics."
The WHO, which has been criticized for being slow to grasp the seriousness of the situation, declared the Ebola outbreak a public health emergency of international concern earlier this month.
In a commentary published online Wednesday by the New England Journal of Medicine, a number of the agency's scientists estimated that containment efforts will cost at least US$100 million between now and the end of the year. In a separate article, WHO Director-General Margaret Chan warned no one should expect a quick end to the crisis.
"The international community will need to gear up for many more months of massive, co-ordinated, and targeted assistance," she said. "A humane world cannot let the people of West Africa suffer on such an extraordinary scale."
Liu, a Canadian who returned last week from a tour of MSF's operations in the affected countries, indicated her own organization may even be thinking about options it typically does not entertain.
"We're not even excluding having military hospitals. Because to a certain extent to take care of Ebola, you need a high discipline, or what I call a bit of military mind set," she said in an interview.
She declined further comment on the idea when asked if Canada should consider sending its disaster assistance response team — known as DART — to help with the effort.
But Liu stressed that more boots are needed on the ground and said the traditional players in Ebola outbreaks, such as MSF, can't handle this one.
"We need to start to think a little bit out of the box in terms of bringing more capacity. And one of the things we're saying is ... we don't think the usual international aid community will be able to control and contain the epidemic. We need more hands on," Liu said flatly.
"The reality is if we continue at the rate that we are continuing right now, we clearly will not get an upper hand on the epidemic.''
The outbreak, which probably began late last year in Guinea but which was officially confirmed in March, has already far exceeded any previous Ebola epidemic.
In fact, the known cases in this epidemic — 2,473 as of Aug. 18 — have surpassed the combined total of all known Ebola cases that preceded this outbreak, 2,361.
The most recent death toll — 1,350 — has not yet passed the previous tally of known Ebola deaths, 1,548. But both the WHO and MSF believe the recorded numbers for this outbreak underestimate the true toll of the virus's rampage through Guinea, Sierra Leone and Liberia.
A fourth country, Nigeria, has recorded about a dozen cases stemming from an event where a man infected in Liberia brought the virus to Lagos. Authorities hope that event has been contained and the virus has not spread beyond the initial secondary cases.
Liu said some of the manpower needs do not demand physicians and nurses skilled in working in Ebola treatment centres. Case treatment is only one of the pillars of an Ebola response, she said.
Tracing and monitoring contacts of cases — people who might be incubating the virus — is a critical task that is still not being adequately addressed, she said, as is educating and mobilizing communities to identify potential cases early and ensuring burials are conducted safely. Traditional burial rites make funerals trigger events in the spread of Ebola.
Liu said the response also needs more laboratory capacity. Because of the limited operations people can be forced to wait two to three days for a result of a test.
And while the U.S. Centers for Disease Prevention and Control has deployed 50 additional staff to the region, Liu said more epidemiologists are needed.
She bristled, though, when asked what would be on her wish list if the WHO or the United Nations asked her to chart out the response.
"This is not my role as international president to write for them their strategic plan," she said.
"They need to get a grip on the situation. They need to go in the field. They need to walk around. Get their feet wet like I've done. Put their gum boots on and just go around and see what's going on with their eyes and then figure it out."
"But they haven't done that. Where we see them is in the capitals, in the meeting rooms. They need to get in the field, finding out what is the situation."