Monday, April 22, 2019 | ePaper


Deadliest Ebola outbreak in Congo

The disease could migrate to other countries

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Ronald A. Klain :
Five years ago, the United States was gripped with fear and awash in news coverage as the worst Ebola outbreak in history spread in West Africa. Today, the world's second-worst outbreak of the deadly disease is underway in Congo, but most Americans seem unaware or unconcerned. Why such a difference?
In some respects, the difference is understandable. The current outbreak - as bad as it is - has seen only a small fraction of the number of Ebola deaths recorded in 2014. That outbreak hit nations - Liberia, Sierra Leone and Guinea - that have sizable diaspora populations in the United States, which sounded alarms about relatives in danger back home; there are far fewer immigrants from Congo in the United States. The 2014 outbreak also caused a stir in the United States because an Ebola-infected patient brought the disease to Dallas, where two nurses involved in his treatment also fell ill: Ebola in America. Nothing similar has happened with the current outbreak, nor - given how few people travel from the affected area - is it likely.
Thus, it is no surprise that pressure for a massive U.S. response such as the one the Obama administration undertook in 2014 - a $6 billion emergency-aid package, more than 10,000 U.S. civilians at work in the region - has not been repeated. Such an effort has also seemed unnecessary to this point. A vaccine for Ebola, developed near the end of the 2014 outbreak, is now available. Through the work of the global vaccine alliance Gavi, nearly 90,000 Congolese have received it. The World Health Organization, which failed miserably during the 2014 outbreak, has new leadership that has responded expertly and aggressively to this outbreak.
Yet, even with these favourable developments, evidence of the current response's success is mixed. Though the WHO recently asserted that the outbreak is being contained and will wind down in six more months, the death toll continues to mount (and until the outbreak is fully extinguished, anything can happen). With more than 100 armed groups in eastern Congo, where the outbreak is most intense, violence has forced several leading response organizations to withdraw; treatment facilities have been attacked. And each day the outbreak continues, the risk of a catastrophic turn - migration of the disease to massive refugee camps in South Sudan, or to the populous Congolese capital of Kinshasa - remains.
I am a Trump administration critic, generally, but I acknowledge that much of its Ebola response so far has been responsible. For example, while Donald Trump on Twitter in 2014 viciously criticized the Obama administration airlift of Ebola-exposed Americans back to the United States for treatment, as president, he allowed such a mission to go forward last December. The United States has contributed millions of dollars to the global response effort, and key administration officials - including Centers for Disease Control and Prevention Director Robert Redfield - have visited the region. The administration announced this last week it is sending 10 more disease-fighting experts to Congo (albeit 200 miles away from the heart of the epidemic).
In sum, the Trump administration has taken the standard measures for buttressing a global health response effort. The problem is that the customary approach may not get the job done this time, just as it would not have in 2014.
A major challenge is a lack of White House leadership. After Ebola was defeated in West Africa in 2015 (and after I left the post of Ebola Response coordinator), President Barack Obama created a special National Security Council team to oversee epidemic preparedness and response on a permanent basis. Trump retained the unit during his first year in office, but on the day that John Bolton took over as national security adviser in 2018, he dismantled the unit and ousted its leader, the widely respected Rear Adm. Timothy Ziemer. Perhaps fighting epidemics didn't fit Bolton's "hard power" view of security.
Fighting Ebola in Congo is the sort of global health challenge that requires White House leadership. Adding significantly more U.S. disease fighters in Congo, and placing them closer to the outbreak, would be dangerous but needs to be considered; the White House has, so far, refused to allow it. Rallying nations in the region to put together a multinational, security-equipped response force needs a White House push. Preparing a vastly expanded response if the epidemic escalates - including potentially a mass vaccination campaign in Congo - requires White House-level resources. That is sadly missing.
More broadly, the kind of outbreak seen in Congo - a deadly mix of disease, conflict, rejection of expert intervention and violence - may be the new normal in global disease fighting. This is especially true as climate change exacerbates risk factors. Instead of ramping up efforts to confront these challenges, the White House recently proposed cutting back U.S. global investment in fighting infectious diseases.
In 2014, there were no simple solutions to an Ebola epidemic that saw 1,000 new cases every week. The Obama administration took unprecedented action to help end that humanitarian crisis. It was risky, controversial and difficult - just as doing so today would be. But when faced with challenges, great nations don't sidestep, they step up.

(Ronald A. Klain; The Washington Post)

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