Lessons from “The Doctors Without Borders Experience: Patients as People and not Biohazards”

By Madeline Roty

Avril Benoit from Médecins Sans Frontières (MSF) opened the ASM Biothreats Conference by taking a step back from the micro level of a cell and focusing on the macro level of global health. Ms. Benoit is the Executive Director of the U.S. Management Team for MSF, more commonly known as Doctors Without Borders. In addition to the work being done by MSF, Benoit discussed the limitations and challenges hindering its mission. She challenged the audience of students, policymakers, scientists, and innovators, to be committed to humanitarianism over political and financial motivations and to promote human engagement before technology.

MSF is a non-profit medical humanitarian organization that primarily provides medical care to the most vulnerable in society, including those experiencing displacement, conflict and violence, or disasters. Because it is an organization primarily funded by private donors, MSF maintains more independence in decision-making. Fueled by the belief  that “every person is deserving of healthcare,” independence means MSF can “take enormous risks” to deploy personnel to regions other organizations cannot, especially in areas of conflict. In addition to providing medical care and supplies, MSF has epidemiologists, media personnel, and a research and development team.

For its relevance, Benoit did make a point to address MSF’s response to the emerging coronavirus outbreak. Unfortunately, most of the need is in China, and China has traditionally been resistant to accepting assistance from independent actors. MSF is standing by and continuing to assess for situations in which it could help provide care or supplies. It is also monitoring refugee camps for potential outbreaks and has specialists in the region in constant communication with other response networks.

Benoit discussed several examples to not only elucidate the work being done by MSF but also to demonstrate the challenges of working in these regions. Antimicrobial resistance is also a growing threat around the world. It is an especially difficult challenge in places like Africa and the Middle East where malaria and tuberculosis are becoming increasingly resistant to antibiotics. Though MSF is testing pilot solutions to make therapies for these diseases more manageable and effective, they are not widely available. Outbreaks of preventable disease in refugee camps and areas of conflicts are a major problem that often receive little attention and resources because they are not a problem in the United States or Europe and there is little money or recognition in researching these diseases. In 2018, there was an outbreak of diphtheria in Rohingya refugee camps in Myanmar. Yemen experienced an outbreak of diphtheria as well, following an outbreak of cholera. A measles outbreak in the Democratic Republic of the Congo (DRC) gets less attention than the Ebola outbreak, despite the fact that is has claimed the lives of over 6,000 people.

Benoit devoted most of her talk to the outbreaks of Ebola in West Africa and the DRC. During the 2014 West African Ebola outbreak, MSF was overwhelmed. Patients were turned away. MSF even took the “unprecedented step” of calling for military support. Despite MSF’s attempts to sound the alarm, it was not until Ebola cases were reported in the United States that people started to pay attention.

MSF is now criticizing the international response to DRC Ebola outbreak. During the 2014 outbreak, the international response resulted in the rapid development of medical countermeasures (MCMs) to stop the outbreak. Six years later, there are viable vaccines and therapeutics. And yet the second largest outbreak of Ebola ever recorded continues to burden the DRC due to failures in distributing the MCMs. Benoit questioned the value of research and technology if the community in most need is unable to access the results.

The lack of MCMs is only one issue preventing the containment of the outbreak. A history of violence between the state and militias has created an unsafe setting and eroded community trust in the government.  The community also perceives MSF as a supporter of state response, resulting in mistrust and fractured relationships. Armed men have even attacked two Ebola treatment centers. Benoit, rather than blame the attackers, adopted an empathetic perspective. The government uses the attacks as examples of resistance, but the government is doing things that should not be happening. For example, a family wanted a traditional burial for their deceased loved one. However, due to the risk for transmission during the traditional burial, the authorities told the family it would not be possible. As tensions rose, the authorities took the body without telling the family. Patients have also been forced into the centers at gunpoint. These situations are inhumane and foster increased violence, which exacerbates the outbreak rather than controls it.

Benoit’s talk was insightful and a nice departure from the typically very technical topics discussed at the conference. However, she did not recommend any specific steps the audience could take to increase their ability to focus on “more humanitarian” efforts. Many people may want to focus on neglected diseases but cannot find the funding. Others are deeply entrenched in their work or are mandated to work on certain diseases. She should have included suggestions that individuals could take now without abandoning current academic or career pursuits such as advocating for better policies, educating the next generation, or volunteering time and talents.

The lesson of her talk: Humanitarian motivations should hold as much sway as political and financial motivations. We will never be ahead of biothreats, but we need to invest in understanding the people who would benefit the most from research and development to address health inequalities, improve health outcomes in vulnerable populations, and have the greatest impact on society.