Last week, President Obama announced that the vast majority of United States troops deployed to fight Ebola in West Africa would be home within 60 days, and he announced the next phase of the Ebola response: the move from containment to eradication. It was also my last week as the government’s first Ebola response coordinator, a position that gave me the chance to reflect on what has been done, and what remains to be done.
Thanks to Mr. Obama’s leadership, tremendous progress against Ebola has been made in recent months: Caseloads in West Africa are down 85 percent, and we have put in place measures to protect the United States without needless quarantines or travel bans. In an era of skepticism toward government, the country’s Ebola response is proof that our government can work, and a reminder that there are some things that only government can do.
Only government can screen arriving passengers and subject them to mandatory symptom checks; send 3,000 troops to West Africa to catalyze a global response; inspect and certify that hospitals are ready to treat an Ebola patient; and subsidize years of scientific research on vaccines for rare diseases — like Ebola — that have no apparent commercial use so they are potentially ready when the need does emerge.
But even as America takes pride in the job we have done, it is also important to remember that the job is far from done.
We must get to zero Ebola in West Africa. Ebola is like a forest fire: It is not extinguished until the last ember is snuffed out. While Liberia is seeing only a handful of new cases each week, the situation in Guinea remains worrisome, and caseloads in Sierra Leone remain too high. Even a small number of remaining cases could reignite the epidemic, infect health care workers and enable more mutations of the virus. We cannot let up in the fight against Ebola until the last patient is identified, isolated, and treated — and that is still months away.
We also have to end the stigma associated with Ebola patients and responders. There are now almost 10,000 Ebola survivors in West Africa. Too many are ostracized from their communities. We should train these survivors (who are now immune from the disease) as future Ebola responders, giving them income, purpose and validation. In the United States, too many Ebola responders have returned from serving in West Africa only to face, and have their families face, irrational fears. The remaining states that still impose quarantines on these dedicated workers should abandon these policies.
Most importantly, the global community’s tardy reaction to the Ebola outbreak, the early stumbles, and incoherent leadership by the World Health Organization compel us to ask whether we will be better prepared for the next Ebola outbreak. And, as bad as this epidemic has been, it could pale in comparison to greater threats in the future. Ebola is hard to transmit, has telltale symptoms before patients are highly contagious, and has not exploded in poverty-stricken global megacities.
What will happen when we face an inevitable global pandemic that is more easily transmitted, less easy to detect, and rampant in the world’s most densely populated areas? With today’s global interconnectedness, a 2018 repeat of the 1918 Spanish flu could kill 100 million people or more — 10,000 times the 10,000 lives Ebola has taken — and the world would not have the months it needed with Ebola to get the response together.
In the United States, we painfully learned last summer that vast sums spent on medical preparedness after 9/11 and the subsequent anthrax attacks failed to produce a health care system ready for Ebola. In December, Congress gave us a chance to get it right, by appropriating billions of dollars for the Ebola domestic response and preparations. We must make sure that our public health system uses the remainder of these funds to deal with what is left of this Ebola epidemic and to prepare for future threats.
The world needs to do a better job of quickly detecting and responding to future outbreaks in unlikely places. The President’s Global Health Security Agenda, the government’s strategy to combat infection disease around the world, will help. But vulnerable countries, including those in Africa, need their own version of our Centers for Disease Control and Prevention, so that they are not so dependent on ours.
For the hardest task of front-line epidemic fighting, our planet is too reliant on courageous and talented — but underfunded, under-equipped and volunteer-dependent — nongovernmental organizations. The world needs a permanent standing force — or a ready reserve that can be quickly organized — of public health emergency responders who have the training, gear and resources to race into a region in the early phases of epidemic control. The United States military cannot do that job every time; future outbreaks might occur in countries where our troops will not be welcomed as they were in West Africa.
Leaders of the Group of 7 nations discussed proposals for such a “white helmet” battalion last year, and should continue work on this proposal before the urgency of the current crisis fades. Another important idea is a public health brigade operated by the African Union. Finally, the World Health Organization — which has justifiably been critical of its early failings in the Ebola epidemic — must be reformed so that it can respond rapidly and with the proper personnel and equipment.
The fearful days of last fall are behind us. Beating the epidemic in West Africa is now achievable. But as we finish the job and embrace the survivors and responders, we must also prepare for the next epidemic, before it is upon us.
Ron Klain, a former chief of staff to Vice Presidents Al Gore and Joseph R. Biden Jr., was the White House Ebola response coordinator from Oct. 17 to Feb. 13.