Lessons Learned and Forgotten in Ebola Response

When first announced in early May, there was concern that the Ebola outbreak in the Democratic Republic of Congo (DRC) would spiral out of control like the 2013-2016 West Africa epidemic that left over 11,000 dead. Although many were focused on the potential international spread of new cases, I was alarmed by how quickly the US had already forgotten the lessons learned from  West Africa’s outbreak just a few years ago.

As a doctor who cared for hundreds of Ebola patients—and in doing so contracted the disease myself in 2014—I know this amnesia amongst politicians who determine global health policy leaves all Americans vulnerable to current and future epidemics.

At the international level, the response to Ebola in the DRC has been much better than it was Guinea, Liberia and Sierra Leone. Responding to criticism that the West African response was slow and inefficient, the international public health community implemented numerous changes to improve epidemic preparedness and response. The WHO reorganized its emergency response offices under the new leadership of Director-General Tedros Adhanom Ghebreyesus. Just days after Ebola was identified in DRC, he was already on the ground directing the response.

The struggle to mobilize financial resources for the West Africa response inspired the development of a novel Pandemic Emergency Financing Facility by the World Bank, which quickly provided $12 million to the response efforts in DRC. In addition, thousands of doses of an Ebola vaccine have been rapidly deployed and the Africa CDC—a new institution established in the aftermath of the West African epidemic—promptly sent epidemiologists to the DRC outbreak.

As a professor who teaches about the “lessons unlearned” in public health emergencies—and as an Ebola survivor myself—the swift and improved international response to the DRC Ebola outbreak is heartening.

Yet as an American, I’m unsettled. Here in the US, the political leadership has forgotten the painful lessons of the West Africa Ebola outbreak, evidenced by insufficient funding for epidemic response and an absence of global health leadership.

Thankfully the improvements at the international level have helped contain the DRC outbreak. However, if it developed into a global epidemic, the US would be poorly positioned to respond and American lives would be at risk.

Despite strong language expressing their commitment to global health preparedness and response, the White House and Capitol Hill’s budget priorities tell a different story.

In a budget proposal on May 8, the same day the DRC outbreak was declared, the White House recommended cutting USAID funds to fight Ebola by $252 million. The poorly-timed and misguided decision said “[t]hese funds remain from the initial outbreak in 2015 and are no longer needed because the Ebola response has largely concluded.”

The West Africa Ebola outbreak is indeed over. However, quickly mobilizing financial resources was one of the biggest challenges early in that outbreak. For that reason, these USAID funds were intentionally set aside as a ‘rainy-day fund’ to provide a contingency reserve when the next epidemic hit. Cutting these funds now—on the very day the DRC outbreak was declared—demonstrates the White House’s staggeringly short-sighted approach to funding epidemic preparedness.

While the Trump Administration is now walking back its proposal to reclaim that $252 million in unspent Ebola funds, skepticism about global health funding isn’t restricted to the White House. Bill Cassidy (R-LA) recently declared that US CDC funding “…doesn’t seem—in a time of scarce resources—a wise use of resources.” As a result of ensuing budget cuts, the CDC—America’s front-line disease detectives in the US and abroad—was forced to cut programs in the same countries where the next epidemic will likely originate and where few resources exist to contain it. After contributing over $5 billion to the West Africa response in 2015, we learned it’s much cheaper and more effective to fight an outbreak at its source—a lesson we’ve seemingly already forgotten.

The West Africa response also demonstrated that the US response to diseases with epidemic potential required committed and qualified leadership. At the beginning of that outbreak, coordination among different government agencies was a significant challenge and delayed the US response. This improved when a biosecurity directorate tasked with leading the US response was established in the National Security Council.

The same week Ebola was identified in the DRC, this leadership position was eliminated under the new National Security Advisor, John Bolton. As a result, “there is currently no senior US government leader designated to lead a US international response, whether it be for Ebola in DRC or any other outbreak that could occur.”

I’m not optimistic this administration will heed the advice to identify the funding and leadership necessary for epidemic response. President Trump and I have strongly disagreed on how the US should tackle epidemics since at least 2014. At that time, he expressed his anger on Twitter that American citizens who were infected while fighting the epidemic in West Africa were being brought back to the US for treatment.

But as someone who saw—and painfully experienced—the havoc that a microscopic virus from a faraway place can do to the human body, I want to prevent everyone from experiencing what we Ebola patients endured.

At a health security panel earlier this year, the principal deputy director of the CDC, Anne Schuchat, MD, said “It’s a few years ago, but people remember Ebola.”

If that’s true, why are we acting like we don’t when it comes to epidemic preparedness and response?

The US cannot forget the lessons learned from our previous public health failures. We need to commit the financial resources to the places where the next epidemic might occur and ensure we have strong global health leadership in place to lead our response.

Craig Spencer is the director of global health in emergency medicine at Columbia University Medical Center and an assistant professor in the Program on Forced Migration and Health at Columbia University Mailman School of Public Health. Twitter @Craig_A_Spencer

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