Viral Attitudes: A Conference Apart

What a difference a day makes? Try two hundred and forty-five.

Exactly that many days lay between the attitudes observed to the Ebola virus research updates from the annual Médecins Sans Frontières (MSF) Scientific Day held in May of 2014, to the ‘Topics in Infection’ conference held by the Royal Society of Tropical Medicine & Hygiene at the end of last month. On both occasions I felt a comforting warmth of familiarity humbled by a dose of realism and inadequacy, seated amongst academic and clinical kingpins, barely visible from my rung of the ladder despite our agreed passions.

At the first conference I was officially on representative duties for an NGO – First Aid Africa – who aims to provide sustainable skills in emergency life-saving skills across rural East Africa.  That didn’t matter in this auditorium. Here, I was invisible.

There were two updates dedicated to the thread-like virus that day, carefully scheduled at the point of reawakening from the graveyard shift; the contagion of yawns reaching their conclusion. A strong-jawed and dark-haired American man took the stage and began by depicting the operational difficulties facing MSF in rural West Africa. Here, communities viewed the white Doctors in their protective glory with nothing but apprehension. The facts and figures were laid bare, and they weren’t particularly big. He offered a little of that American ‘Hoo-ha!’ in his rhetoric, as if to condemn us of our own disinterest as much as the suffering caused by this virus in remote regions of Gueckedou in Guinea.

I silently observed my fellow tropical disease enthusiasts as the second of the speakers prepared himself, fumbling with his pointer (not remotely a euphemism) and some sheets of important paper. I could hear the dissenters stirring, questioning the need for two talks on a disease which had barely registered a hiccup in the endeavours of MSF over the past 12 months, inclusive of operations in Syria and Sudan. He spoke of the ongoing clinical research and the analysis of transmission dynamics, carrying the drama well through his youth and bouncy rhetoric which most likely declared itself out of the pride and enjoyment he felt in sharing his work.

His final graph appeared, and his charisma was equalled by a gruff of indifference from the audience.

“Why is he even allowed to show us this? It’s a sample size of 16!” came a whisper with little intent for secrecy from behind me. I turned, only to meet the raised eyebrows of an olive-skinned, thirty-something woman with L’Oreal-Ad-worthy brunette hair.

The sniggers spread across our troop in an outbreak of their own. The voices of rebellion roused to grind down the bold naivety of the charismatic stage performer. Clearly there were other, more pertinent subjects to focus on. As the second speaker wound down his spiel, we – the crowd – offered our obligatory applause and little else.

As expected, the talks closed by the formation of a panel consisting of our speakers and other relevant personnel, ready to face our questioning. The crowd returned with an onslaught of cynicism, broken only by the laughter drawn when the American banged his fists defiantly to declare “The International community sat around and watched while we, MSF, stepped up to the plate!”

This is, of-course, true. The work of MSF throughout the current outbreak has been exemplary and it is testing to imagine that the progress being made to curb the outbreak, including the influx of experimental vaccines to Sierra Leone, could have been achieved without their leadership and co-ordination. The World Health Organisation have been caught out by the co-discover of the virus, Professor Peter Piot, indicating a failure to act in earnestness to the first official lab confirmation in back in March 2014. On the 23^rd May, the day of this MSF Scientific update, there had been less than 500 confirmed cases of Ebola across Guinea, Sierra Leone and Liberia. Exactly 8 months later that figure had magnified to 21,797 across six countries.

Accordingly, the RSMTH conference last month ‘Topics in Infection’ opened with gusto. Three talks contextualised the Ebola Virus through a need for ongoing research in outbreak scenarios, to understand its’ clinical and pathological profile and to map its’ zoonotic niche. The crowd were drawn in from the start. For many, this update was everything they had come for.

It is undoubtedly a shame that our attitudes have taken so long to alter. As an international community of self-professed ‘do-gooders’, we have been humbled. We have learned much along the way to delivering an experimental Ebola vaccine to Liberia which is due to be tested in roughly 30,000 people. The first speaker encouraged us to listen in on further movements and consider research ventures with Plasmapheresis; testing Ebola convalescent blood for post-exposure prophylaxis. There is still much to learn before the next conference I attend.