Delivered May 7, 2015, in Seattle, Washington.

 This is the first time MSF is invited to speak at this forum. Thank you for the opportunity.

Internally, MSF is also looking at lessons learned. Over the past thirty years, MSF has responded to multiple Ebola outbreaks. In this most recent and deadliest of outbreaks, MSF treated 35% of all Ebola patients.

We have all seen the pictures and heard the facts for this Ebola outbreak:  11,000 deaths and 26,000 infected. If you caught Ebola you had a 50/50 chance of surviving – even in a clinic or hospital. This was also the first time that Ebola spread from rural to urban areas.

To be frank, this was tough for MSF. Even our most war hardened and experienced doctors and nurses were shocked at how many patients and colleagues were dying.

Within MSF alone, 28 of our colleagues became infected and 14 died. Ebola also killed 2,553 of our patients.

I saw it first hand – from the clinics to the corridors of power. Ebola spun out of control because of a lack of political leadership, will and accountability – not because of insufficient funding, early warning systems, coordination, or medical technologies.

MSF started working on Ebola in March 2014 and called for action to stop the "slaughter" in June. But none came.

This would have never been allowed to happen in Europe or here in the US. But Sierra Leone, Liberia and Guinea have poor infrastructure, porous borders, and are of no major business interest to the world.

The world stood aside while Ebola tore through families, communities and health systems.

From the start of the outbreak: NGOs had programs in country. CDC, WHO and international researchers were doing surveillance on the ground. Even the NIH published about Ebola. But in those deadly early months none raised the alarm and not one was prepared to do hands-on patient care.

It was only when an infected diplomat flew to Nigeria in July and when an American got sick in August that the world woke up and took action to stop Ebola from coming to their countries. 

But thousands were already dead or dying.  Too little, too late.

So what have we learned?

Lesson 1: Operations Above all, we need to put the needs of patients and communities at the core of any response.

We know from experience that for every international doctor or expert deployed, you need ten locals to really make a difference. Any international response is just the tip of the iceberg.

In Lofa County, Liberia, one of the areas we were working in, it was only when community-led initiatives started to limit who could move around and when the Red Cross buried the dead safely and respectfully, that Ebola began to be contained.

Emergency operations means just that – an urgent response. Strengthening surveillance can help, but only if the political alarm bells ring for action.

This needs to happen within days, not months.  

In Sierra Leone, Liberia and Guinea, the slow response of governments, institutional donors, the UN and WHO, caused untold suffering and death.

Lesson 2: Governance and accountability

A fast response will not happen without leadership. And WHO is and should remain the leader in global health. But today it lacks the capacity and expertise to respond to epidemics – be it Ebola in West Africa or cholera in Angola and Haiti.

Equally important is how to set priorities. We must confront hard questions on how Member States and major donors like the Gates Foundation fund and set WHO priorities. This is not always based on what is needed on the ground.  

Lesson 3: R&D

Ebola is just another example of the failure of the R&D system to develop much-needed medicines and diagnostics for neglected diseases.  

Thousands of samples of human tissue, blood and semen have been taken from patients and dead bodies and shipped to South Africa, the US and around the world.

How are these samples being used? Who benefits?

R&D should not just be about finding a miracle drug to defend ourselves in the US or Europe. How will it help families in affected countries?

We need a fundamental change in the R&D system. Outcomes of R&D should be a global public good - adapted to needs of patients, health workers and governments – and made accessible and affordable.

So to conclude   

Ebola is a political failure – not a failure of means.

The reality is that – despite lip service to WHO reform, faster disbursement from the World Bank and private sector interest in R&D – should another Ebola outbreak hit today, our response would probably not be much better.

This is not about preparedness and crisis response modelling – or about massive investments and parallel systems.

It's about putting the needs of patients, communities and health workers first – in country.

The private sector including the Gates Foundation and pharmaceutical companies play a key role on R&D.

Ultimately, Ebola must remain a public responsibility. Global health priorities and emergency response cannot be decided in Seattle.

In the end – it is governments, not private foundations, who are accountable to their citizens. Governments, the World Health Organisation and UN – need to lead, to raise the alarm, take action and be held to account. 

Only then will lives be saved.

Thank you.