As of August 14, 2014, the Ebola virus has infected an estimated 1,975 individuals across four countries in West Africa, leading to 1,069 deaths (including three Americans). The official reported numbers, frightening as they are, likely vastly underestimate the true magnitude of the outbreak. Ebola has severely impacted the daily life of affected communities, and raised concerns across the globe about its ongoing spread. The fact that this outbreak has led to so many cases and deaths (approximately 45% of all cases of Ebola ever reported have come since March of this year) is concerning for the individuals and families struggling with the disease, and leads to questions regarding the global capacity to detect and respond to such events. It also brings up four key policy questions for the U.S. concerning its engagement with the international community’s efforts to combat Ebola and other emerging infectious disease outbreaks.
Key U.S. Government Accounts for Emerging Infectious Disease Surveillance and Response Capacity Building in Developing Countries, FY2011-FY2015
Whether or not the U.S. response has matched the need is a complex question. As the chart indicates, however, U.S. funding for these programs has remained mostly stable over the last 5 years. The White House, HHS, CDC, USAID, DoD and other agencies, noting the need for greater attention and investment in such programs, did announce in February 2014 the launch of a new “Global Health Security Agenda” meant to catalyze further action by U.S. government and its partners on emerging diseases and global health security. While no additional funding for this effort has been made available yet, the President’s FY2015 budget request does include an additional $45 million to support CDC’s work on the agenda.
In addition, none of the funding had focused on West Africa prior to this Ebola outbreak. USAID/PIOET has focused on central and eastern Africa, along with South America and South and Southeast Asia, while the DoD/CBE program has been primarily focused on former Soviet states along with parts of Asia and central/Eastern Africa. The CDC maintains or is in the process of setting up 10 GDD centers around the globe, though none are in West Africa (the nearest GDD centers are in Egypt and Kenya). This shows the limitations of the current levels of funding and also the inherent difficulty of trying to predict where the next important infectious disease epidemic might spring up, because such outbreaks are by their nature unpredictable. In another recent example, the 2009 H1N1 outbreak emerged from Mexico, not Asia as had been presupposed by epidemiologists and where the global influenza surveillance effort had been primarily focused.
HOW DOES THE EBOLA RESPONSE FIT INTO THE BROADER US GLOBAL HEALTH EFFORT?
The U.S. provides ongoing funding for global health programs in all of the Ebola-affected countries, including (depending on the country) HIV, tuberculosis, malaria, maternal and child health, family planning/reproductive health, and water programs (see Table 1). The $14.55 million made available to combat Ebola this year is equal to just a small proportion (2 percent) of the $625.97 million Nigeria received in U.S. global health assistance in FY2013, though it also represents a funding level almost thirty times as large as U.S. global health assistance to Sierra Leone.
Table 1. U.S. Global Health Assistance to Ebola-Affected Countries, FY2013 Total and by Program Area
CAN THE U.S. HELP COUNTRIES GET AHEAD OF THE CURRENT OUTBREAK OR WILL THIS REMAIN A CATCH UP GAME?
The international response so far has not been able to meet the needs of the countries facing this Ebola outbreak. By many accounts, there remains a serious lack of basic supplies, protective gear, and laboratory capacity, and an insufficient number of health workers to put into place all of pieces of the response that will be necessary to contain this outbreak. There remains an urgent need to fill these gaps, that the U.S., along with other countries and multilateral organizations, can help address with continuing and expanded support as needed. Given the attention to this topic, as Congress and the Administration consider what comes after addressing the immediate needs in West Africa they face a uniquely powerful and opportune moment to focus on the key questions and debates that have been raised by the outbreak and response.