Sometimes the artifice of writing — metaphors, historical comparisons, the just-so quote — fails. The Ebola outbreak in West Africa demands directness: We are about to witness a human catastrophe that could destroy large portions of a continent and pose a global threat. And the response of the world, including the United States, is feeble, irresponsible and disrespectful of nature’s lethal perils.
U.S. health officials and nonprofit groups are bringing back the same report from the region. In Liberia, the rate of new infections has probably already moved from linear growth to exponential. The same may be true within the next week or so for Sierra Leone and Guinea. The normal countermeasures for an infectious disease — isolation, case investigation, contact tracing — are increasingly irrelevant, given the rate of increase. Local health care infrastructure, which barely existed in the first place, is overwhelmed. People have lost faith in the large clinics, where 50 percent to 60 percent of patients who enter do not leave alive. And those in need of emergency care for other conditions — such as heart attacks or complicated births — are often frightened of clinics and hospitals and are dying without treatment.
The international response is inadequate and disorganized. The World Health Organization (WHO) and the United Nations provide “road maps.” But, according to one infectious disease expert, “there is no one to implement command, control and communications. No one.” Multiple, uncoordinated organizations are attempting to confront a disease that is out of control. “They are quibbling over 25 to 30 bed units,” the expert vents. Meanwhile, the WHO has revised its prediction of new Ebola infections upward to 20,000 by year-end. Other models indicate more like 100,000.
Once the growth of an outbreak becomes exponential, the tools normally at the disposal of health officials have limited value. It may require military airlifts just to deliver sufficient rubber gloves, aprons, soap and buckets to highly affected areas. Doctors Without Borders is calling for the deployment of civilian and military medical teams to provide triage centers, field hospitals with isolation wards, mobile diagnostic labs and systems for the management of corpses.
But who will direct and implement such an effort? The WHO is not an emergency response organization; it is known mainly for bureaucracy and infighting. The United Nations has no epidemic response force comparable to its peacekeeping operations (though perhaps it should). It is hard to imagine a coordinated effort on a sufficient scale that is not organized by the United States.
This is what should be happening: The White House should be instructing officials at the U.S. Agency for International Development, the Centers for Disease Control and Prevention, and the National Institutes of Health to come up with an ambitious plan on a blank chalkboard. The Office of Management and Budget should be approaching House Republican leaders with a proposal to fund that plan, and the White House should be cultivating congressional champions for the measure. A continuing resolution to fund the government will be put together this month. If the Obama administration does not act quickly, it will lose its best chance at securing resources until December.
But, so far, there is no ambitious plan. The OMB has not indicated it will ask for additional resources.
The decision-making process at the White House is, no doubt, clogged with crises. But this is not one foreign policy challenge among many; it is nature out to kill us. Is there really no one on the White House staff willing to confront President Obama with the consequences of inertia?
At the current rate of new infections, affected countries are likely to see civil disorder, economic paralysis and corpses in the streets. The most immediate threat is the rapid spread of the disease in Nigeria. A major outbreak in a sprawling city such as Lagos would be unprecedented, unpredictable and horrific. As a virus multiplies, it also mutates. So far, scientists have not seen any changes in the Ebola virus that are relevant to its biological function. But with more replications, over more months, the risk increases. Scientists quietly fear genetic mutations that would make the virus harder to detect, more resistant to treatment, or (God forbid) easier to transmit. This is not likely, but it is possible.
Health officials are near their wit’s end. “I don’t see any pathway that is easy to implement,” one told me. Easy or hard, it is time for the United States to blaze a path out of this valley of death.