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'America's Nobel' Goes To Doctors Without Borders

Health workers at an Ebola treatment center, run by Doctors Without Borders, greet man whose family brought him in by wheelbarrow. They suspected that he had the virus. The center is in Foya, Liberia.

The Lasker Award is given for outstanding contributions to medicine and medical research, and is sometimes referred to as "America's Nobel Prize." Since the award was established in 1945, more than 80 laureates have gone on to win the Nobel.

Today, the medical aid group Medicines Sans Frontiers (Doctors Without Borders) is one of four recipients, accepting the award for its contributions to the fight against Ebola. I spoke with the president of the U.S. Board of Directors, Dr. Deane Marchbein, who was in New York for the presentation.

First of all, congratulations on winning the Lasker.

Thank you. But this award is for our colleagues in the field who were on the front lines of the Ebola outbreak since the beginning. So many of them suffered so much and worked so hard to help people. They put in extremely long hours in very hot and dangerous conditions, having to wear hazmat suits inside tents filled with sick patients and with huge lines of people waiting to get in. The hazmat suits you have to put on so carefully and take off even more carefully so that you don't contaminate yourself. It's incredibly dangerous and exhausting work. And many health care workers from local communities died in disproportional numbers. The numbers are just staggering.

I think a lot of people picture Doctors Without Borders as a mostly Western organization, with American and European doctors parachuting into Africa. But that's not exactly the case.

No. First of all, for every foreign doctor there are roughly ten locally hired staff, most of them health care workers. These are the people who were leading the fight against Ebola and providing so much of the most important and dangerous care. Without good local staff, we would not have been able to do much of anything. The international staff come and go, so the local staff provide the institutional memory. I learn more from the local staff members than I do from anyone else, especially about how to communicate with patients.

Secondly, our international staff is global. Many of the doctors who were traveling to West Africa to fight Ebola were from other parts of Africa. Some were from Asia and Australia. And also Europe and North America. It's an incredibly interesting group of people.

Give us a sense of MSF's involvement in the early days of the Ebola outbreak.

We were in Guinea when the first case was identified, and we helped identify the first case. We were involved in direct patient care. We set up treatment centers, we had people on the front lines treating patients. In previous epidemics, there would typically be one case in a remote area, so we would set up a treatment center in that area and the outbreak would be contained. This Ebola outbreak was different because it appeared in many places at once. Unfortunately, our initial effort to get national leaders and the World Health Organization to recognized that this was bigger and different and catastrophic fell on deaf ears.

A lot has been written about the failed international response to Ebola. Do you think the world is now better prepared for the next big outbreak, whether Ebola or something else?

I'm not sure. I know there's a big focus on global health security right now, with the U.S. and other nations investing lots of money in epidemiological responses — tracking the spread of diseases. That's good. But I'm not seeing a focus on who is going to do direct patient care. There's a lot more to an epidemic than just the epidemiology. Research and development needs to step up their game. We need better diagnostic tools. Can you imagine if we had a good point of care diagnostic test for Ebola? Then we could instantly determine who to admit and who to discharge. If we had really effective treatments, that would also be a game changer. Vaccine developments are starting to look promising. MSF is now vaccinating its front-line health care workers, and we hope to have more good data on effectiveness soon. But I'm concerned that these vaccines might be stockpiled in wealthy nations and won't make it to poor and middle income countries. So overall, if you ask if I'm optimistic, I'd say I'm not.

Where do things stand with Ebola now?

The numbers have decreased dramatically. Over the last couple weeks, there have only been one or two new cases per week. We are still following nearly 300 contacts in Sierra Leone and Guinea. We need to get to zero. The tail end of an epidemic is long and difficult. For example, right now what's disturbing is that we're still seeing new cases not related to the contacts we're following. We're still seeing unsafe burials, which says to me we still have a long way to go. We need to focus on education so that people know how to stay safe.

And the long-term effects of Ebola are frightening. So many health care workers died during the outbreak — doctors, nurses, ambulance drivers, midwives. And these are countries that already had fragile medical infrastructures. So, for example, the Ebola outbreak has taken a lot of progress that's been made in maternal mortality and pushed it back twenty years.

What do you see as MSF's role in international health care going forward?

We're used to being the guys on the ground who just do it. We're not used to being the guys in the meeting who establish policy. Ebola and the Lasker Award have now given us visibility that, to be honest, we're not comfortable with. Ebola has pushed us to be visible in ways that we've never had to be before. Going forward, we now have a responsibility to share with others. It's important that we collaborate with other actors. Are we in a position to dictate the international response to medical crises? Absolutely not. But we do have on-the-ground experience that's important. And we have to share that. The Lasker award has given us the forum to engage with others in the global health community in a meaningful way.

This year, NPR won a Peabody Award for its coverage of the Ebola outbreak. I felt conflicted about this. There's something strange about celebrating an award that's grounded in unspeakable suffering. Do you have the same feeling with the Lasker?

Absolutely. We're excited about the recognition. We're deeply appreciative. And, again, this is about the people in the field who were doing the hardest, most dangerous work. But there's also a real feeling of guilt that our success and our fame is a direct result of other people's extreme misery.

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