Guest Host: Steve Roberts

Health care workers, wearing protective suits, leave a high-risk area at the French NGO Medecins Sans Frontieres (Doctors without borders) Elwa hospital on August 30, 2014 in Monrovia.

Health care workers, wearing protective suits, leave a high-risk area at the French NGO Medecins Sans Frontieres (Doctors without borders) Elwa hospital on August 30, 2014 in Monrovia.

The government of Sierra Leone is ordering residents to stay at home for three days later this month. The country-wide quarantine is an effort to help stop the spread of Ebola, but many say this approach could exacerbate the growing threat. The World Health Organization estimates that at least 20,000 people will become infected with the disease. Many believe totals will be far higher. Last week both the U.S. Agency for International Development (USAID) and the World Bank pledged additional aid, but there are enormous logistical challenges both with treating those already sick and tracking those who may have been exposed. Please join us to discuss the Ebola crisis and the international response

Guests

  • Dr. Anthony Fauci Director, National Institute of Allergy and Infectious Diseases at the National Institutes of Health.
  • Sophie Delaunay Executive director, Doctors Without Borders
  • Mvemba Dizolele Foreign policy analyst, writer, independent journalist, Johns Hopkins School of Advanced International Studies
  • Dr. Sheri Fink Reporter, New York Times

Transcript

  • 10:06:54

    MR. STEVE ROBERTSThanks so much for joining us. I'm Steve Roberts of the George Washington University sitting in today for Diane Rehm. She's recovering from a voice treatment and will be back in this chair later this month. The ebola virus has escalated from a troubling outbreak in West Africa to a full-scale humanitarian crisis. Dimensions of the challenge expose critical fault lines in the world's ability to respond and manage public health emergencies.

  • 10:07:18

    MR. STEVE ROBERTSJoining me in the studio to talk about efforts to contain the threat are Dr. Anthony Fauci, frequent guest on this program. He's at the National Institute of Allergy and Infectious Disease at the National Institutes of Health. Mvemba Dizolele with the Johns Hopkins School of Advanced International Studies is also here in the studio. And by phone, from New York, Sophie Delaunay of Doctors Without Borders, which has been a major factor in combating the disease, that organization in West Africa.

  • 10:07:49

    MR. STEVE ROBERTSAnd by phone, from San Francisco, Sheri Fink who has been covering the issue for the New York Times. Good morning to you all. Welcome.

  • 10:07:57

    DR. ANTHONY FAUCIGood morning.

  • 10:07:57

    MR. MVEMBA DIZOLELEGood morning, Steve.

  • 10:07:58

    MS. SOPHIE DELAUNAYGood morning.

  • 10:07:59

    MS. SHERI FINKGood morning, Steve.

  • 10:08:00

    ROBERTSGood morning. And you can join our conversation, as always, 1-800-433-8850. Email is drshow@wamu.org. Our website, www.drshow.org. Tony Fauci, let's start with you. Give us an update. Latest figures I saw, about 2100 deaths, but that's probably an underestimate. Where are we now?

  • 10:08:27

    FAUCIWell, we're at that phase where we're seeing an escalation that's certainly outstripping our current capabilities to deal with this. When you see increases in cases and you look at the patterns, you see that over the last few weeks almost half, between 40 and 50 percent, of all the cases have occurred. You know, that's what we call an exponential increase as opposed to a linear increase and that's a very dangerous situation because if that keeps amplifying itself and increasing by factors without our having a major, major upscaling of the kinds of things that you need to contain this, which are particularly supplies, hospital beds, the ability to isolate, the ability to do contact tracing and proper personal protective equipment for the people who are taking care of these individuals, then you can get it out of control if you don't have that.

  • 10:09:21

    FAUCIAnd that's the reason why I feel very good this morning and yesterday hearing the president making the statement, we're gonna put a considerable amount of more resources and using the expertise and that transportation and other capabilities of the military to help out.

  • 10:09:36

    ROBERTSNow, people thought this disease had been largely controlled. I know Doctors Without Borders closed some of their clinics. What is your best estimate, as a scientist, that has caused this renewed outbreak?

  • 10:09:50

    FAUCIWell, if you look at the history of ebola when it was first recognized in 1976, there have been close to two dozen outbreaks, most of them have been in geographically restricted areas where the ability to do the things that MSF does so well is -- I wouldn't say easy. It's difficult, but you can do it because you can get your arms around the epidemic. Here, we have a situation which got into an area where there were countries with porous borders that didn't have a healthcare system that could deal with it.

  • 10:10:22

    FAUCIAnd importantly, it got into cities where there are large populations, not remote villages. And once that happens, it amplifies the difficulty in doing things like contract tracing and you superimpose upon that all of the other issues of fear, understandable fear, lack of trust in authority and lack of understanding of how the disease spreads. And when you're in a very populous area, that makes it very, very difficult.

  • 10:10:50

    ROBERTSNow, Mvemba Dizolele, one of the warning signs, one of the alarms people have raised is if this spreads to Nigeria, which is a transportation hub for this part of Africa, that it's the global, you know, the global travelers. It's one thing, as Dr. Fauci said, if it's restricted to rural villages. But when people who are infected start traveling, this adds a huge dimension. Talk about the sort of geography of that part of Africa and why that's such a threat.

  • 10:11:22

    DIZOLELEThank you, Steve. You know, the outbreak this time has taken place in an area which we call ECOWAS, the economic union, if you will, of Western African states. And Nigeria is the center of that, the backbone of that. Countries in that organization, citizens of those countries can travel without passport, without visa, so it's been very easy for them to move. But I think as they move, the chances increase between -- the problem is not so much the travel.

  • 10:11:49

    DIZOLELEThe problem is the lack of infrastructure because what the outbreak has done is highlight the problem that we face in Africa with the public health systems. You know, the narrative on Africa for the last few months or even the last two years have been that Africa is rising. Africa has the fastest growing economy in the world. But that narrative misses the point, the discrepancy between the so-called GDP growth rates and investment in public health or public education which actually key element of the welfare of the peoples of those countries.

  • 10:12:25

    ROBERTSNow, Sheri Fink, from the New York Times, you have written about this very subject and the failure of the World Health Organization and other international agencies to really control this outbreak. What's your take on the failure up till now? Why have we seen this spiral out of control, from your perspective?

  • 10:12:54

    FINKWell, I tried to just go back and look almost kind of moment by moment from the time the first cases were identified in March, which was already about three months into the outbreak, it appears, just looking back. Scientists kind of traced it back so they think that somebody may have gotten the virus from a fruit batch back in December. And just try to look at, you know, what were the inflection points, what were the moments where we had a chance, as a world, to sort of stop this from spiraling out of control.

  • 10:13:28

    FINKAnd there were a few things. One is that the responsibility for surveillance for kind of picking up on unusual clusters of disease have been left largely to, you know, countries themselves and these are some of the poorest countries in the world. People are dying all the time of all kinds of things. They have very, you know, not robust health infrastructure, to put it mildly. So we lost that chance because by the time that some of the health institutions in the country of Guinea picked this up and reported it to the WHO, by that point there were dozens of case not only in small villages in a border area where people just crossed back and forth between three countries, Guinea, Liberia, Sierra Leone, but also some case already in Conakry, the capital of Guinea.

  • 10:14:24

    FINKAnd so right from the moment that people started to respond, both the national authorities and internationals, Doctors Without Borders, primarily, as well as WHO sending, you know, some staff to come for weeks at a time, they were starting from behind. And then, after that, it was just one thing after the other. There was a sense on the ground, a lack of sort of firm leadership, people who have responded to previous outbreaks who told me, you know, if we missed one case -- so in other words, you know, the way that we know to tamp this down is that each person who is sick, you go back and you trace their close contacts.

  • 10:15:02

    ROBERTSRight.

  • 10:15:03

    FINKAnd usually, if you miss even one of those contacts and somebody shows up at a treatment center sick, you feel like you're a failure. And this case, the percentage of contacts being traced was as low as 8 percent in April so you just imagine each individual case could spark more and more cases and that's what we saw. So there were missed chances along the way. And what's -- even up until today, and I'm sure Doctors Without Borders can talk about this even more, just a sense of a lack of real leadership and kind of command responsibility on the ground and that's leading to a lot of lost opportunities.

  • 10:15:43

    ROBERTSWell, I want to bring in Sophie Delaunay from Doctors Without Borders. And Sophie, your organization is being given credit today for helping to push the United States, President Obama yesterday making the announcement that he would make available American military help to transport and provide isolation wards and other kinds of facilities and equipment. How important is this development?

  • 10:16:11

    DELAUNAYWell, we definitely welcome the statements from President Obama yesterday, which reflects our desire to see more military assets and capacity on the ground. But I have to say that, first of all, I have to see these statements translated in action. For many months, or six months, we've been calling for the international community to respond to help us respond to this outbreak and as Sheri was eluding to, it took really a lot of time and skepticism to see things move.

  • 10:16:48

    DELAUNAYSo as much we welcome the statement from the U.S. administration, we're also waiting to see how this will translate into concrete capacity on the ground to add new beds, new treatment units and increased logistic capacity and a real chain of command to address this outbreak.

  • 10:17:11

    ROBERTSWhat exactly difference will it make? What are the kinds of things on the ground -- I read that there's a need for these field hospitals and beds and wards that can isolate these cases. Wall Street Journal, this morning, had a front-page story, a heart-breaking story, talking about people coming in taxis, even wheelbarrows to the door of a clinic in Monrovia in Liberia and being turned away 'cause there were no beds. Is this the kind of thing that you need on the ground?

  • 10:17:45

    DELAUNAYThis is exactly what we need on the ground. You know, we've put a lot of emphasis on contact tracing in recent weeks because, as it was explained just earlier, it is important to be able to trace the dynamic of the outbreaks and to anticipate where the next cases are gonna appear. At this stage, for us, in a city like Monrovia, it's completely useless to do contact tracing because if you identify new cases, you have zero capacity to absorb them.

  • 10:18:16

    DELAUNAYSo it gives an idea of how problematic the situation is and we need at least an additional 1,000 beds in order to be able to treat the people who are infected with the disease. And when they are infected, they are highly infectious.

  • 10:18:33

    ROBERTSThank you very much. This Steve Roberts and I'll be right back with my guests.

  • 10:20:00

    ROBERTSWelcome back. I'm Steve Roberts sitting in today for Diane. Our subject this hour, the Ebola outbreak in West Africa. My guests, Mr. Anthony Fauci, the National Institutes of Health, Mvemba Dizolele from Johns Hopkins, also the Hoover Institute. By phone from New York, Sophie Delaunay from Doctors Without Borders. And from San Francisco by phone, Sheri Fink has been covering the story for the New York Times.

  • 10:20:24

    ROBERTSWe have some lines open, so please join our conversation, 1-800-433-8850. Would be delighted to have your comments or give us an email at drshow@wamu.org. And our website is www.drshow.org. Tony Fauci, we were talking about the response to provide these facilities, the ability to contact a trace. But in addition to the physical facilities I've been reading that one of the problems is the ability to be able to recruit and train health workers, doctors and others, nurses who read the stories about health workers dying from this disease. And in addition to the facilities that can be put on the ground, is there sufficient personnel to staff them?

  • 10:21:16

    FAUCIWell, to scale up to the point that all of us are talking about, there aren't right now. So we do need to get more personnel. The only way that you're going to get personnel, if you provide them with the tools and the capabilities to do the job in a way that's safe and that's effective. So they go hand in hand, Steve. I think if you get the massive scale-up that's necessary, the thousand beds that Sophie spoke about, the equipment, the ability to transport it in and out, that will greatly alleviate the problem of concern of health workers actually getting into the fray. You don't want to throw them into the fray without equipping them to be in the fray.

  • 10:21:56

    ROBERTSSo they'll feel that they'll have the right equipment to their job well.

  • 10:21:59

    FAUCIExactly.

  • 10:22:00

    ROBERTSAnd they'll be protected. They'll have the safety precautions in place.

  • 10:22:03

    FAUCIPrecisely. Precisely.

  • 10:22:05

    ROBERTSSo that becomes a recruiting device.

  • 10:22:08

    FAUCIThey're totally related to each other. They are completely related to each other.

  • 10:22:12

    ROBERTSNow, Mvemba, I want to ask you about the strategy since you're an expert in West Africa and Sierra Leone. I know you're not a doctor but you're familiar with, you know, the cultural patterns. And this is such a big part of dealing with this disease, um, Sierra Leone says people should stay home for three days but Doctor Without Borders and others said, you know, this strategy is not going to work. Do you have a feel about that?

  • 10:22:42

    DIZOLELEYes. I think – and I'm from the DRC which has had its own outbreaks in the past.

  • 10:22:48

    ROBERTSOf course that's the Democratic Republic of Congo.

  • 10:22:49

    DIZOLELE...Republic of Congo, yeah. You know, we should avoid creating panic because the moment -- you know, Dr. Fauci was talking about this is something that happens, a disease -- it can be managed, can be controlled. But the moment you create a sense of panic in society then people are afraid. People don't trust. We have to remember that in the settings of most African countries, not only is their lack of infrastructure but there is also lack of trust between the government and the people.

  • 10:23:18

    DIZOLELESo already people are wondering what this disease is all about. There's lack of information. And then when you create a sense of panic by either quarantining people or telling them to stay behind for three days or not come out or barb wiring villages, then that only escalates the fear and the sense of desperation among communities and population, which does not help in the end.

  • 10:23:45

    ROBERTSAnd Sophie, you were pointing out that absolutely critical, I know, to any -- combating any infectious disease but particularly Ebola, is gaining the trust of the people. Not only will come for treatment but they'll talk about their contacts. You really need information from people, not just showing up for treatment. And so this question of trust would seem to be critical.

  • 10:24:10

    DELAUNAYYes, it's absolutely critical. And some coercitive measures actually have a tendency to undermine the trust of the communities. As we know, I completely subscribe with what you just said. I think that viruses know no borders and that the type of causative measure that are considered today are not recommended by the World Health Organization simply because they've never been proven as effective measure. And they seriously incapacitate the functioning of the communities in terms of transportation, in terms of being able to access very basic goods.

  • 10:24:45

    DELAUNAYSo as you say, I think it would only serve at stigmatizing the people who are suspected of being infected and exacerbate fear among the community, which is the worst enemy in trying to deal with these types of outbreaks.

  • 10:25:00

    ROBERTSNow, another key variable, Sophie, that I've been reading about are local burial customs that the -- this is a virus that is transmitted by bodily fluids, vomit or blood, urine and that when someone dies from this, the custom in this country is for the relatives to wash the body. And that this can be -- as important as this is from a cultural and a family point of view, that this can be very dangerous in terms of spreading the disease. And so you're also dealing with sort of other kinds of cultural dimensions as well.

  • 10:25:41

    DELAUNAYExactly because those rituals play a critical role in the transmission. So what we've tried to do was really to humanize as much as possible the medical care that we provide which, as you all know, it's mostly palliative care at this moment in the absence of any treatment, but also to humanize the burials and the contacts with the families. So we are involved with the community.

  • 10:26:05

    DELAUNAYWe try to provide with the necessary information, but also protection. Hygiene kits and so on to the families so that they can perform their ritual, while minimizing the risk of transmitting the disease.

  • 10:26:20

    ROBERTSAlso there's been a lot of news, Sheri Fink, in the last couple of days. There were reports just today about advances in vaccines. And several have been tested. There was a report just this morning that one has had some promising results, not yet tested on humans. How promising is this dimension?

  • 10:26:48

    FINKWell, it's going to take a little while but the efforts are really ramping up. And last week the World Health Organization gathered about 200 experts from around the world to discuss and kind of set out which are the ones we want to fast track, which vaccines and which treatments. And the good news is that starting this month, two of the vaccines are being tried. They've had, as you said, good results in nonhuman primates but need to be tested in humans.

  • 10:27:17

    FINKSo several dozen just volunteers from the U.S., the UK, Mali, which shares a border with Guinea, they're going to be sort of doing initial safety tests and looking at the immune responses in humans. And then if all goes well, the GlaxoSmithKline and the NIH have kind of bumped up the efforts on one of the two vaccines. They expect it could have maybe even 10,000 doses by the end of the year, as well as there's also several hundred doses of a Canadian vaccine that's also going to be tried.

  • 10:27:54

    FINKAnd what the WHO has said is they will immediately try to make those available to, as you said, you know, the frontline health workers who are really -- who you really need to give that security to. And that was based on a group of ethicists who got together and talked about, you know, how do we make this decision, who gets a vaccine first? Who gets treatments first?

  • 10:28:16

    FINKBut it's being fast tracked, it's being prioritized but if we can't even get, you know, sort of the regular palliative care and supportive care that can really even increase survival, you know, even something like keeping people hydrated, we can see just how much effort it's going to take to roll out vaccines and treatments.

  • 10:28:37

    ROBERTSTony Fauci, of course NIH right on the frontlines here.

  • 10:28:39

    FAUCIYeah, well, we're actually doing the trial she's talking about. One of the things we've really got to be careful of is that when people hear about vaccines that look good in animals and going into early phase one that we're doing just up the road in Bethesda right now, phase one for safety, you cannot make the assumption that that is effective. Because many, many, many more vaccines and other interventions that look good in animals turn out to have absolutely no efficacy in humans. And in fact, some can even do harm.

  • 10:29:08

    FAUCISo although we are now escalating and trying to get this done as quickly and as expeditiously as possible, we want to make sure we don't make an assumption that when something passes a phase one trial that it is now an effective vaccine. And when you're talking about distributing it to thousands and thousands of people, you want to make sure you do it within the context of being able to get information to determine actually if it works and if it's safe. Because the worst possible thing that you can do is to have a vaccine that actually not only is not safe but actually makes people worse.

  • 10:29:43

    FAUCISo there's a delicate balance. And it's something we're struggling with about getting a vaccine to the health workers who need the extra added layer of protection. If in fact it is effective, at the same time is that we find out if it is effective -- we had a very discouraging experience over the past year with an HIV vaccine which looked very good in animals, was safe in phase one, induced the right kind of response. And when we put it in the trial it actually increased the risk of acquiring HIV by 41 percent.

  • 10:30:19

    FAUCISo as a person who's developing the vaccine with many of my colleagues, we will go as quickly as we can and get it out as quickly as we can. But right now today the escalation of the preventive measures of personal protective equipment, the isolation, contact tracing, equipment and beds is the thing that's going to turn around this epidemic, not necessarily a vaccine or a drug.

  • 10:30:46

    ROBERTSAnd also, we've all read this phrase Zmapp which is apparently a pharmaceutical treatment for the disease. Is that proven to be useful at all?

  • 10:30:58

    FAUCINo, we don't know. That's the point. It's been given empirically to seven people. That number makes it impossible to determine if it works. The data in the animal looked quite encouraging but, Steve, I don't want to seem too overly cautious, but I've had so many experiences of things that looked terrific in animals and turned out not to work. And yet people are so -- I wouldn't say desperate, that's too dramatic a word -- but people are so concerned about getting something done that they immediately assume that this particular intervention, this Zmapp works.

  • 10:31:34

    FAUCII hope it works. I really do hope it works but as soon as it went into a couple of people, it was all over the newspapers that this was kind of a miraculous turnaround. We don't know that. You haven't proven that it works yet.

  • 10:31:48

    ROBERTSNow Mvemba Dizolele, one of the dimensions that has not gotten that much attention but is critical here is the economic impact on West Africa. This is not just about people getting sick, as significant as and as concerning as that it. This is having all sorts of echoes on the transportation system and the food supplies. And that's one of the reasons why this is getting so much attention.

  • 10:32:16

    DIZOLELECorrect. You know, food security's still an issue in most African countries. And the countries that we're talking about now in the ecosystem of West Africa even more so. You know, Liberia just coming out of a conflict -- long-time conflicts, Sierra Leone the same. Guinea's been unstable for a long time. Just went to their first democratic elections a few months ago.

  • 10:32:40

    DIZOLELESo as you look at the situation, most of these cases are in the rural areas. That's where they started, in rural areas at the bread baskets of urban areas in places like Guinea and places like Sierra Leone. Once we isolate the food-producing communities, then it's very hard to feed the people in the cities who are themselves also very affected by the disease.

  • 10:33:02

    ROBERTSI'm Steve Roberts and you're listening to "The Diane Rehm Show." In addition to that, in addition to the food security, it's also affecting transportation systems and other dimensions of the economy.

  • 10:33:15

    DIZOLELECorrect, because the roads are closed in some areas. You know, only the press or the military or health workers are allowed to go through in an attempt to control the flow of the -- or the outbreak itself. So as they do this, that even the labor is restricted.

  • 10:33:31

    ROBERTSSure.

  • 10:33:31

    DIZOLELEIn places like Liberia where they just stay at home, then who's doing the work if it's only health workers that are out there? The economy needs more than health workers.

  • 10:33:41

    ROBERTSRight, just grinds to a halt.

  • 10:33:41

    DIZOLELESo it paralyzes economies across the region.

  • 10:33:45

    ROBERTSNow, Sophie, I want to ask you another question because Doctors Without Borders has been so effective in operating in some very difficult situations around the world. But when you're talking about ramping up the international presence with the announcement by the president of American Aid and the World Health Organization becoming more involved, from your experience, are the governments, the countries affected here going to allow this kind of presence? Is it going to be a tension or are they going to welcome just any kind of help they can find?

  • 10:34:23

    DELAUNAYWell, we'll see. And we see what kind of response is actually provided on the ground effectively from which countries, et cetera. What is clear is that it's a difficult step. And it has a political cost for those countries to go as far as accepting some foreign military assets. But at the same time, the ministries of health of these countries have responded to the best of their capacity. In countries like Liberia, they fully acknowledge that the situation is out of control and are not able alone to deal with this outbreak.

  • 10:35:01

    DELAUNAYThey have welcomed the help of the MSF not just in providing some support on the ground, but also some technical support to other aid workers and some advocacy calls for additional prevention. So I think that we're facing with an exceptional situation. And my hope is that the leadership in these countries will be reasonable enough to accept and encourage and correlate in a smooth manner the aid that is coming -- finally coming to help them in those countries.

  • 10:35:40

    DELAUNAYBut I'd like to add one more thing about the indirect effects of the ebola outbreak which is on the health system. As you know, the ebola outbreak has already claimed the life of 120 health staff. This configuring of population is massively affected by the outbreak. And it has -- it lead to the closure of health facilities, which means that not only we know that the 20,000 deaths from ebola is underestimated, but we don't know to what extent all those in those countries who are seeking health care have been affected by the lack of health care. Any complicated delivery, any cerebral malaria at this moment happening in this country is putting the people in danger because of the closure of health facilities.

  • 10:36:27

    ROBERTSMvemba, this is basically what you were saying, that everything's connected.

  • 10:36:30

    DIZOLELECorrect.

  • 10:36:30

    ROBERTSYou know, that if the roads close, if the health -- if the economy starts slowing down, if the agriculture produce can't get to market, I mean, and then the health systems start collapsing and the treatment for other diseases starts to diminish, I mean, everything connects to everything else.

  • 10:36:51

    DIZOLELEEverything is connected. And this is why I think in public policy perspective it's a wake-up call for all of these countries, you know. It's a wake-up call for those of us who cover the region in the sense of what kind of stories we're pushing out. You know, the public health sectors in most of these countries are in bad shape. And I think this is a time for us to start pushing for capacity building, institution building, Steve.

  • 10:37:16

    ROBERTSWe're going to be right back to continue with your phone calls, with your emails. Please do. We still have some lines open. I'm Steve Roberts sitting in today for Diane while she's away getting a voice treatment. And I'll be back with my guests in just a moment, so stay with us.

  • 10:39:58

    ROBERTSWelcome back. I'm Steve Roberts sitting in today for Diane. Our subject this hour, the Ebola outbreak in West Africa. Dr. Anthony Fauci of the National Institutes of Health is with me, Mvemba Dizolele from Johns Hopkins and the Hoover Institute, Sophie Delaunay from Doctors Without Borders, Sheri Fink of The New York Times. And we're now starting to get a lot of emails here. And let me say that a number of people have written in saying, how can we help? Where can we make donations? Where can we contribute that will have the biggest impact. Sophie, tell people how they can contribute to your organization.

  • 10:40:33

    DELAUNAYWell, there are basically three ways they can contribute. They're welcome to donate to the organization, to our emergency fund. And, you know, not just for Ebola, but at the time we're talking about Ebola. We're also dealing with major emergencies in Central African Republic, in south Sudan, in Syria, that are not widely reported these days, but that account for thousands of people in need of assistance at the moment. A second way that they can help is if they have any experience in dealing with highly infectious environments, they are welcome to offer their support as volunteers.

  • 10:41:16

    DELAUNAYAnd we organize trainings every two weeks in Brussels, Ebola trainings for -- not just for MSF volunteers, but for any organizations who want to train their volunteers so that they can increase their capacity on the ground. The CDC has attended these trainings -- this training and is replicating it in Atlanta at the moment. So there are ways to mobilize additional human resources and provide them with the necessary training. And the third way, of course, is to support our appeal for additional mobilization on the battle states.

  • 10:41:50

    DELAUNAYWe believe that these crises cannot be dealt with by non-governmental organizations alone. It's impossible. It is clearly -- it requires the state -- a state response. And I know that it may sound quite counterintuitive for an organization like MSF to call for military assist. But we know in every disaster this is the military that is usually the best equipped to respond to those types of crises, especially when we have to deal with biohazard issues.

  • 10:42:22

    ROBERTSSure.

  • 10:42:22

    DELAUNAYWe know that they have the capacity and the technology for it.

  • 10:42:26

    ROBERTSNow, we will post on our website, www.drshow.org, several other links and places. But Tony, you -- what would be your recommendation for folks who -- the Red Cross, you mentioned.

  • 10:42:42

    FAUCIYeah, just what Sophie said. There's the Red Cross, there's UNICEF. Partners in Health is starting to have a presence on the ground in Liberia. There are a number of -- and we'll get that to you so you can put it up on the site.

  • 10:42:53

    ROBERTSWe -- and we will put it on the site and make sure that those of you who are listening will have that opportunity. Another question, Tony, that a lot of our listeners are asking -- please give an example of how the virus is transmitted to caregivers who are aware of precautions and who avoid direct contact with bodily fluids. For example, is it saliva getting into the eyes of a caregiver or a medical professional? How is the Ebola virus so easily infecting even professionals, if it requires direct access into bodily fluids?

  • 10:43:26

    FAUCIYeah. Well, a substantial proportion of the infections that we're hearing back from my team and the CDC team and the NRF, MSF colleagues, is not people who are well trained, who have personal protective equipment, who have violation of protocol. It's generally someone coming into contact with someone, taking care of them in a setting before they even know they have Ebola. It's an unusual situation that someone follows all the protocol, the way MSF has done for years, and winds up getting infected. The mechanisms that might happen, there are several I'm sure, Sophie could address that because of her people.

  • 10:44:04

    FAUCIBut from the people that I have spoken to and seen and discussed with, is that there is a fatigue factor. I mean, if you go and get all of these isolation suits that I myself have been in, in very good conditions, in a good hospital where you have 20 people taking care of one or two people, and you're in the suit for a half an hour or 25 minutes, as opposed to with 100-plus degree weather and being fatigued and dehydrated, there's a possibility even when you're taking the equipment off that you might inadvertently not take it off properly and then just rub your eye or rub your mouth or something like that. That's the way it is.

  • 10:44:39

    FAUCIBut people who follow protocol -- and MSF has an extraordinarily good record of when following the protocol, not getting infected.

  • 10:44:47

    ROBERTSLet's turn to some of our callers. And the first one is Margaret. We're delighted to have you with us. What's on your mind? You're from Long Island, N.Y. Margaret? Margaret, are you there? She's not there. Okay, let's go to Tom in Washington, D.C. Tom, welcome.

  • 10:45:19

    TOMHey, thanks for taking my call. I've been studying a lot of my life...

  • 10:45:26

    ROBERTSHe's cut out on us. Okay, Daniel in Towlett, Texas. Daniel, welcome to the show.

  • 10:45:36

    DANIELThank you for having me. Hopefully third time is a charm.

  • 10:45:38

    ROBERTS(laugh) Sorry.

  • 10:45:39

    DANIELI just -- I wanted to post a general question. I've been listening a little bit to the conversation and I wanted to figure out, say that the vaccines that we started and we fast-tracked looks promising all the way to phase II, phase III, phase IV. Say that what -- Obama's statement comes true and he does provide aid to the countries affected and that we receive the equipment that we need. The timeline looks like it'll be six-plus months out. By then, what's the situation going to be like?

  • 10:46:11

    DANIELWhat's the -- what's the infected population, that we realize that it's still growing because we're not getting the appropriate information, and the distrust that we have from the communities, not helping us get ahead of this? What's going to be the numbers looking like then and what are we doing right now in order for situations not to get worse?

  • 10:46:31

    ROBERTSOkay. Sophie, do you want to take that one?

  • 10:46:34

    DELAUNAYYeah, I can take part of it and let Tony answer the real timeline. This is clear for us, you know -- as much as we welcome the debate on experimental treatments and vaccines, and we are part of the discussions with the group of experts -- that for us the main priority at this stage is really to ramp up the response on the ground. Because we know that, if successful, none of these treatments or vaccines will be available before six months to two years. So the most important thing at the moment is really to have boots on the ground and to be able to increase the capacity of treatment.

  • 10:47:10

    ROBERTSAnd Tony, to the caller's question about what it's going to look like in six months.

  • 10:47:14

    FAUCIWell, first of all, I totally agree with what Sophie is saying. We've got to get away from thinking that we're just going to hold our breath and wait for vaccines and drugs. The implementation of infection control is going to be the way to do it. And you have to scale it up the way it's being planned right now, to underscore that. What's it going to look like is going to depend on whether or not these issues get really implemented and implemented quickly. If you look at the curves of the increases, Steve, it's very concerning. So let's say we don't do any better than we're doing now. We're seeing that almost half of the cases, total, have occurred within the last few weeks.

  • 10:47:59

    FAUCIThat means that the curve is on what we call an exponential increase. And if you do a mathematical modeling...

  • 10:48:05

    ROBERTSRight.

  • 10:48:05

    FAUCI...which have their little faults because it depends on some assumptions, you can be talking about 10,000 cases by the end of September -- reported cases. And as Sophie and Sheri and others have said, we're likely underreporting them. So it is so critical to implement that on-the-ground control of infection. And although we're trying very hard with regard to vaccines and drugs, that is not the answer. It's getting the boots and the beds and the equipment on the ground.

  • 10:48:39

    ROBERTSLet's turn to Veda in Reston, W.V. Veda, are you there?

  • 10:48:47

    VEDAHello?

  • 10:48:48

    ROBERTSHello. You're on the air. Welcome.

  • 10:48:50

    VEDAThank you. Thank you. I'm actually in Reston, Va., northern Virginia.

  • 10:48:53

    ROBERTSRight. Okay. Go ahead, please.

  • 10:48:56

    VEDAYes. I just want to thank "The Diane Rehm Show" for covering this. I'm originally from Liberia and my mother is currently working at JFK in Monrovia -- that's the tertiary referral hospital, the only one in Monrovia. And I want to stress the sense of urgency, that from March to the end of July, there were 160 Ebola deaths. In the month of August, that number shot up to over 1,000. Out of the 2,000 dead -- over 2,000 dead of Ebola, 1,000 -- over 1,000 individuals were Liberians. And I cannot stress enough -- I know we don't want to alarm. But we do need to let folks know how dire, dire, dire the situation is.

  • 10:49:37

    VEDASo my question is, realistically -- realistically, and I know that it's difficult given the political situation on the ground. Everyone is sort of tiptoeing around this. But the question is, is the Liberian government working closely enough with the American government so there can truly be boots on the ground within the next week? It is that serious. It is that dire. There are only two counties -- counties are the equivalent of states in terms of political divisions in Liberia -- Lofa County and Montserrado, where we have isolation centers in the entire country. For a population of four million people, we have less than 500 beds to take care of those affected with this disease. It is dire. I cannot stress enough how dire the situation is.

  • 10:50:26

    VEDAI'm currently working with a group called Project Liberia -- Ebola. We are Liberians, grassroots community-based organization. We've been trying with a lot of other groups throughout the country, Liberian-based groups, to try and get what's needed on the ground. But I'm calling just to sound the alarm. Because we cannot be complacent. We cannot be comfortable about this. This is serious. And as the gentlemen said, we're talking about an exponential spread in this disease. People are dying, you know, 500 a week. It's out of control. The government is doing their best. But the fact of the matter is they're just simply in over their heads. And we need boots on the ground.

  • 10:51:03

    ROBERTSRight. Thank you. And I hope your mom stays safe.

  • 10:51:08

    VEDAThank you.

  • 10:51:09

    ROBERTSThanks for the call. Mvemba, what's your response to this very passionate and obviously very emotional call?

  • 10:51:15

    DIZOLELEIt's very hard to -- it's very hard to add any more to the alert that she's sounding, the alarm that she's sounding. I think we have discussed this. That's what we've been discussing. Maybe Tony can add to it in terms -- but, I mean, but she described the situation as is. So I'm not sure if we can add more.

  • 10:51:32

    ROBERTSLet's turn to another caller. Before that, let me say, your are listening -- I'm Steve Roberts and you're listening to "The Diane Rehm Show." And let me turn to another caller. Dorcas in Lancaster, Pa. I gather you also have a personal connection to the area.

  • 10:51:54

    DORCASYes, I do. Yes, and I want to...

  • 10:51:55

    ROBERTSWell, please go ahead. We're happy to have you.

  • 10:51:57

    DORCASYeah, thank you. I want to thank "The Diane Rehm Show." It's always been an excellent show and I always listen. And I'm really grateful for organizations like, you know, Doctors Without Borders and all these other organizations that are helping our country. What I'm calling about is passionately pleading for, you know, just like the last caller said, the dire of the situation. But we have an organization, a clinic in fact, that we -- that is in Koinadugu district, the largest district in Sierra Leone -- that currently reports no outbreak of Ebola.

  • 10:52:29

    DORCASAnd the reason for this, we believe, is because of our immediate action that we have started implementing. And that is that we -- through the clinic and other organizations and well wishers in Koinadugu district -- have put a program together called Tippy-Tap, you know, which is just a basic local materials that we have that we put chlorine in water to help people wash their hands. Since a program like the Nasara clinic has been involved in this particular Tippy-Tap promotion, building it in every house, just so that people can wash their hands before they, you know, right after their toilet or before preparing food, or even just greeting people. We believe that had played a great impact.

  • 10:53:15

    DORCASNow, my question to the panel is, is there any way that, you know, these organizations who are large in the areas can work with small NGOs, which is the Nasara clinic in Kabala, that has been involved in this Tippy-Tap, because the people trust, you know, our staff that have been there and can implement any suggestions as well as the radio education that we are given. They can travel to these areas. The people trust them...

  • 10:53:44

    ROBERTSRight.

  • 10:53:44

    DORCAS...and they will implement, you know, the educational things...

  • 10:53:49

    ROBERTSRight.

  • 10:53:49

    DORCAS...that we are promoting.

  • 10:53:50

    ROBERTSThank you.

  • 10:53:50

    DORCASSo, you know, we have this site, seedsalone, S-E-E-D-S-A-L-O-N-E.com that they can go to and get more information so we can work together.

  • 10:53:59

    ROBERTSS-U -- make sure you send an email to us with those particulars and we'll put it up on our website as well. Sophie, you were talking earlier about the question of trust being so important. Mvemba made that same question. What about Dorcas' point about partnering with some of these local organizations?

  • 10:54:24

    DELAUNAYWell, it's clear that we do welcome all local organizations and use the consensus. And let's not forget that the major responders on the ground at the moment are national staff and local communities. MSF, our organization, is hiring 2,000 staff as we speak. Ninety percent of them are actually nationals from those countries. So it's -- they play a tremendous role in the response. And they have an ability unlike any other organizations to do community awareness, to help for the distribution of disinfection kits.

  • 10:55:03

    DELAUNAYI would say that the main problem at this stage is more the coordination of the response, the chain of command, and how to guide the willingness of small organizations like this one to be able to do a proper job and to target the appropriate communities and so on. This is the most difficult because we, as an organization, are very busy in trying to set up the health centers...

  • 10:55:32

    ROBERTSRight.

  • 10:55:33

    DELAUNAY...and also to train some other organizations, it's very difficult to take care of the coordination as well.

  • 10:55:40

    ROBERTSSure. Sheri Fink -- Sheri Fink, I want to bring you in here, because one of the questions here is whether -- given the very passionate and deeply-felt callers we've had -- whether the world is paying enough attention. There's a lot of other things happening this summer. There was the issue in Ukraine. The president is going to be talking this week about the coordinated international response to ISIS. From your journalistic point of view, are you getting -- having trouble getting people to pay attention to this? Is it being overshadowed by other world events?

  • 10:56:15

    FINKI think that it -- there is so much going on in the world. And that is one of the challenges to all of the responders as well, because there -- it's sort of a time of crisis all over the world -- to send people to do response. But I do think people are paying attention because of the fear factor. And it -- hopefully, we can turn that from a, you know, a non-constructive kind of fear to a constructive understanding that infectious diseases can cross borders, that we're all -- it just shows us that we're all human and that there's a real cost to neglecting to address issues like this. I mean some of these hospitals -- the main hospital in Conakry, Guinea, where this all started...

  • 10:56:59

    ROBERTSThat's going to have to be the last word, Sheri. But thank you very much for that. Sheri Fink of The New York Times, Sophie Delaunay, Doctors Without Borders, Mvemba Dizolele from Johns Hopkins, Tony Fauci from the National Institute of Health. I'm Steve Roberts sitting in today for Diane. And thank you, all of our wonderful listeners and callers, for spending an hour of your morning with us.

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