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The Ebola challenge

As the Senate considers President Obama’s request for $6.2 billion to combat Ebola, the questions of US leadership and the international response are critical. On Wednesday, the Brookings Institution hosted a conversation with Rajiv Shah, Administrator of USAID and Eric Postel, Assistant to the Administrator for Africa, to discuss the topic. The moderator was Strobe Talbott, President of the Brookings Institution.

In March, the Ebola outbreak appeared to be on the path to being mitigated, but urban transmission exploded and by May the transmission rates were as high as 2.5 for infected persons. This decimated the health care systems in Sierra Leone, Guinea and Liberia, none of which have yet to recover. Shah noted that one of the biggest obstacles is the unpredictability of when or where the next outbreak will be.

In addressing the US role, Shah echoed the sentiments of President Obama, who in a letter to Congress stated

My foremost priority is to protect the health and safety of Americans, and this request supports all necessary steps to fortify our domestic health system and prevent any outbreaks at home…Over the longer term, my administration recognizes that the best way to prevent additional cases at home will be to contain and eliminate the epidemic at its source in Africa.

Shah believes controlling the virus at the source is the only way to guarantee the safety and security of the American people.

Another issue is the setback the Ebola outbreak will cause in the region. According to Postel, preliminary data shows that there has been a significant impact, specifically in the growth of the affected nations. This has been caused many factors such as halts in investments and the flight of expatriates from host countries. While one attendee posed the question of how to incentivize foreigners from curtailing their time in these countries, neither had a solution.

The president of the World Bank recently announced the need for at least 5,000 more health workers in Sierre Leone, Guinea and Liberia. However, quarantine practices for returning health care workers and the growing fear of infection are creating obstacles. The appearance of Ebola in Mali suggests the epidemic is not slowing down.

Shah mentioned the training of thousands of health workers in West Africa in order to thwart the further spread of the disease however there have been numerous reports of inadequate materials and training for health care workers within West Africa. This dissatisfaction with the conditions was met with an estimated 100,000 members of National Nurses United (NNU), from California to the Philippines, taking part in global “strikes and vigils to highlight perceived failings” surrounding the international response to Ebola.

With the death toll surpassing 5,000 in Sierra Leone, Liberia and Guinea there is a responsibility from international community to allocate the proper funding and resources to ensure the necessary precautions are being taken and the appropriate measures are being put in place. The Ebola crisis must be met with monetary as well as physical assistance in order to effectively combat the deadly disease.

Ebola in perspective

On Monday, the Heritage foundation hosted for a discussion of Ebola policy options, domestic and international, Robert Kodiac, the Managing Director of RPK Consulting, Charlotte Florence, a Research Associate for Economic Freedom in Africa and the Middle East at the Heritage Foundation, Tevi Troy, President of the American Health Policy Institute and Tara O’Toole, former Under Secretary of the Science and and Technology Directorate of the Department of Homeland Security. The event was moderated by Steven Bucci, Director of the Douglas and Sarah Allison Center for Foreign and National Security Policy. The video of the event is at the end of this post. Or you can watch Jon Stewart’s short version, which covers some of the same points:

Epidemics have had less prevalence in the last century in part due to the advancement of medical science, sanitary practices, and antibiotics. However, the West African nations of Sierra Leone, Guinea, and Liberia have seen upwards of 4,900 deaths from Ebola, spreading in what Florence believes to be a “perfect storm.” While very few cases have struck the United States, the Ebola scare has swept through the country. The hysteria has reached the far corners of the country, fueled by incessant media coverage of the virus. In Maine, an elementary school teacher was put on paid leave for up to 21 days after parents expressed concern over a recent trip she took to Dallas, where the first case of Ebola was diagnosed and subsequently two nurses were infected.

Kodiac notes this visceral reaction to Ebola but believes more important is domestic preparedness. The 2.8 trillion dollar health care industry only spends 1% or so on domestic health care preparedness. This is a minimal amount for medical responses to potential pandemics. While Kodiac believes that Ebola can be managed due to the relatively confined areas of exposure, there must be a bigger push to limit the spread of disease not only in the United States but globally. Combating the disease in the three most affected Western African states will prove challenging. Florence cites behavior and cultural practices that have spread of Ebola, especially procedures surrounding the disposal of the deceased.

She also notes that allocation of resources to combat Ebola has caused loss of focus on malaria, tuberculosis and other critical issues in Africa. In addition, farmers are not producing at the rates they previously were, markets are closed and as a result there is a fear of food shortages. While Sierre Leone has historically been one of the fastest growing economies in Africa, it is projected the country will experience no growth in the upcoming year.

Troy looked at four areas that need to be addressed: detection, development, deployment and directives. The United States and the rest of the world were slow to react to Ebola. Countermeasures such as vaccines have not become commercially available. We should have questions about deployment of the US military and the rules of engagement. The “woefully ignorant” perspective of the Department of Homeland Security has hindered progress.

O’Toole notes that all epidemics start slowly and are not explosions. The situation will get worse before it gets better due to the failure of preparedness and lack of rapid diagnostic methods. Epidemics always “engender fear,” because people have a “hard time understanding the unpredictability of disease.” Ebola will not disappear within the upcoming months or in the next year.

The numerous calls for a ban on travel to those who have visited high-risk Ebola countries are misguided, the panelists thought. The advantages do not outweigh the costs. Implementation of a travel ban would not only discourage travel for health care workers but potentially damage relationships with restricted countries. All panelist agreed the US needs improved capabilities and cooperation with the global community.

Here is the video of the event: