It was five years ago this month, with the Ebola epidemic in West Africa in full swing and panic swelling in the United States, that President Barack Obama named me the first U.S. “Ebola czar.” In five months, we largely extinguished that epidemic, won bipartisan congressional approval of massive investments in fighting epidemics at home and abroad, and launched clinical trials of the first vaccine for Ebola. Why was progress possible then, but lacking now?
The answer lies in a tragic combination of new threats emerging and U.S. leadership receding.
The new threats are evident in Congo. Even with a vaccine that is 97 percent effective against Ebola — something that did not exist in 2014 — the current epidemic is uncontained. The possibility of a dangerous spread to nearby nations, or more populous parts of Congo, remains. Why?
Because unlike the conditions in 2014, when Ebola hit relatively stable countries with an openness to outside help, Congo is buffeted by instability, violence and insularity. Responders have been attacked, making it highly difficult to track people exposed to Ebola — the bread and butter of epidemic control.
It would be a mistake to view Congo as a fluke scenario; instead, it is probably the new normal. It is a warning that fighting future epidemics is going to be as much about security concerns, building confidence in communities and working diplomatic channels to enable disease fighters as it is about medical know-how.
An increasingly unstable world is not the only growing risk factor. Climate change stresses ecosystems, forcing humans into greater contact with species that carry diseases, and allowing disease-transmitting insects to flourish in new places. Global connectedness and development — a good thing in general — means that a disease in almost any remote corner of the world can travel to populated cities in less than 24 hours.
At the same time, populist-fueled skepticism of authority is driving anti-vaccine sentiment online and via social media globally. We’ve seen the consequences of this in our country, with more U.S. measles cases in the first half of 2019 than any full year in the past quarter century. If an epidemic hits, will people listen to public health officials giving instructions? Or will today’s tendency toward conspiracy theories and rants about “the deep state” be a critical weakness?
And there’s another problem: a lack of U.S. leadership. While the people of West Africa deserve the bulk of the credit for beating the Ebola epidemic in 2014 and 2015, the massive response mustered by Obama — dispatching almost 10,000 U.S. civilians, spending $5.7 billion overseas and at home, and deploying (for the first time) U.S. troops to fight a disease — made a critical difference.
"Today, the United States no longer leads. Senior U.S. officials have traveled to Congo and said the right things, for which they deserve credit. But a combination of legitimate security concerns, Trump’s hostile view toward Africa (“s---hole countries”) and his isolationist worldview has led to a withdrawal of U.S. personnel from the front line. In addition to using leftover money from the Obama administration’s response, the Trump administration has offered only modest financial support to the World Health Organization’s response to the outbreak: about $20 million — less than what a group of nonprofits have contributed and less than half of British contributions. Additional U.S. funding is being blocked by a statute that the president could waive, but has refused to do so.”
In a circumstance like this one, there is no substitute for leadership at the White House. When John Bolton took over as national security adviser in 2018, he disbanded the National Security Council unit that worked on pandemic prevention and response. The White House has tried to cut investments in global health security, the president only discusses the threat of epidemics when he is stirring fears to bash immigrants and he has a mixed record promoting vaccination.
During the 2014-2015 Ebola response, Donald Trump tweeted that the U.S. effort to fight that epidemic was “nuts” and “dumb.” At the end of that effort — after saving hundreds of thousands of lives in Africa — Obama said it “helped remind the world what made America so exceptional.” Now, as epidemics rage and the risk of a pandemic mounts, the lack of leadership at the White House in confronting this threat feels larger every day.