March 28, 2020


Ebola Should Have Immunized the United States to the Coronavirus: What Washington Failed to Learn From the National Security Council's Ebola Report (Christopher Kirchhoff March 28, 2020, Foreign Affairs)

Even before the Ebola epidemic ended, the U.S. government began pursuing a three-pronged strategy to contain a more dangerous outbreak. First, it doubled down on the Global Health Security Agenda, an initiative the Obama administration launched before the Ebola crisis to expand capabilities around the world to prevent, detect, and rapidly respond to infectious disease threats. Through this initiative, the United States forged partnerships with over 60 countries around the world and used $1 billion of the Ebola Response Supplemental passed by Congress in December 2014 to establish dozens of specialty labs around the world to detect novel outbreaks and to organize country-by-country programs to deepen preparedness.

The strategy's second prong was to further build out the network of hospitals and testing centers in the United States designated to treat Ebola and to increase the size of the national medical stockpile with more of the personal protective equipment and materials needed to fight highly lethal pathogens.  

The third prong was to designate a health emergency response coordinator and create a new Directorate for Global Health Security and Biodefense within the National Security Council. It would be the job of this White House office to monitor biological threats and coordinate future responses. Crucially, this office would lead post-Ebola reforms, using its perch in the White House to ensure structural changes within agencies and departments.

Between 2017 and 2019, each prong of this strategy fell away like wheels off a bus.
Because combating a dangerous pathogen requires the close cooperation of parts of the government that don't ordinarily work together, increasing U.S. capacity would necessitate a willingness to direct changes that might go against the culture of federal departments, agencies, and the U.S. military. It would require cajoling Congress to increase budgets, add mandates, and adjust missions. And given the magnitude of the changes, it would require the personal leadership of the president. The seriousness of the threat of an infectious disease led the outgoing Obama national security team to include an influenza pandemic scenario in a joint exercise held with the incoming Trump team. To ensure that the new Global Health Security and Biodefense Directorate's mission would survive into the new administration intact, the outgoing White House team selected a career civil servant--a respected Pentagon biodefense expert named Elizabeth Cameron--to lead it, providing continuity from one administration to the next.

As 2017 turned to 2018 and 2018 turned to 2019, each prong of this strategy fell away like wheels off a bus. When the money provided by the Ebola Response Supplemental ran out, the new administration continued to fund the Global Health Security Agenda. But the overall budget for the Centers for Disease Control was cut, and no robust, new investments were made in greater deployable capability in the United States or other countries. At home, the envisioned expansion of the original 35-hospital Ebola Treatment Network did not take place; the $259 million appropriated for the network in 2014 was not followed by meaningful infusions of funds, setting it on track to expire in May 2020 and leading the Department of Health and Human Services to warn in November 2017 that "the current capacity of this system is not likely to be sufficient for many types of infectious disease outbreaks (e.g., pandemic influenza and other respiratory pathogens)." Nor was the national medical stockpile significantly bolstered. Congressional leaders passed budgets that had none of the vision or scale of the $5.4 billion Ebola Response Supplemental.

The third prong of the strategy was the last to go. In his first month as National Security Adviser, John Bolton shuttered the new NSC Directorate for Global Health Security and Biodefense. Its leader departed the NSC staff just one day after the WHO declared a new outbreak of Ebola in the Democratic Republic of the Congo that to date has killed over 5,000 people.

Historians looking back at the period between the Ebola and COVID-19 outbreaks will note a haunting sequence to events.

Posted by at March 28, 2020 1:42 PM