The best way to spend the $6.2 billion Congress set aside to fight Ebola

December 12, 2014

Ebola treatment facility specifically built for medical workers who become infected is seen in a U.S. Army handout picture in Monrovia

If we have learned anything from the Ebola epidemic, it’s that managing and treating infectious disease globally and at home is a continual commitment — not just the latest issue in the news cycle. As we search for a vaccine, rapid diagnostic test or wonder drug, the best-known strategy is still containment and access to adequate healthcare resources. The chink in our infectious-disease armor is preparedness and training, not the lack of a blockbuster drug.

The White House’s recent Emergency Funding Request to Enhance the U.S. Government’s Response to Ebola would provide $6.2 billion. Given what we have learned, we must demand that Congress be a good steward of this money and ensure it is directed toward solutions that can end the Ebola outbreak now — while improving surveillance and rapid response to prevent outbreaks in the future.

Given that we have always had the resources for containment, the West’s failure in addressing this outbreak should be taken as a serious lesson. The list of rapidly transmissible and potentially lethal infectious diseases is not short, and the price of not being prepared is not cheap. In the three Ebola-endemic African countries, there have been more than 17,000 reported cases and more than 6,000 deaths.

U.S. Army soldiers from the 101st Airborne Division, who are earmarked for the fight against Ebola, train before their deployment to West Africa, at Fort Campbell

But while reported infection rates have slowed significantly since their peak in Liberia and Guinea, we are still seeing growth in the number of cases in Sierra Leone. So the time to start learning from our mistakes is now — not the next outbreak.

U.S. strategy needs to shift toward training community-based non-medical personnel to deliver basic care and resources and away from expensive solutions with more limited impact. The United States, in partnership with West African governments, can strengthen health systems and limit disease outbreaks by investing in community health systems, with the key agents of change being community health workers.

These workers are recruited locally and then trained, equipped, compensated and deployed to tackle public health crises in a matter of months — not years. Making this a reality would be a rapid, cost-effective use of U.S. dollars. Around the world, community health workers have proven critical in preventing the spread of HIV/AIDS, increasing immunization uptake and fighting the top killers of children — pneumonia, malaria and diarrhea.

Already in this epidemic we are seeing organizations in Liberia working with local governments in Rivercess and Grand Gedeh counties to train and equip community health workers to educate households on preventing infection, referring potentially infected patients to isolation units and conducting contact tracing. In a few months, these workers have limited the spread of Ebola beyond Liberia’s border, increased surveillance and response capacity and normalized health services. Amid the havoc wreaked by Ebola in remote villages, community health workers have also continued to deliver the “routine” care needed in these areas, treating more than 4,000 children for malaria, pneumonia and diarrhea.

It may seem pedantic or overly simplistic to advocate for access to basic healthcare and deployment of community health workers. But the countries most affected and potentially devastated by public health epidemics like Ebola are those least capable of supporting even basic human needs. They rank among the lowest on nearly every human-development measure, and the state of their healthcare infrastructure before this crisis could at best be described as “poor.” Ebola has since decimated what little existing health services these countries had, including access to immunizations and skilled attendants at births.

Health worker wearing protective equipment is disinfected outside the Island Clinic in Monrovia, where patients are treated for Ebola

Building hospitals and training doctors is essential, but in the short term this strategy is too expensive and too time consuming. Ebola-endemic countries need solutions that will put an end to this outbreak in months, not years, while preventing the next outbreak and restoring existing health services. What we need are innovative, life-saving grassroots solutions that can be scaled up quickly and cost-effectively in the hardest-hit countries. Community health workers are an integral part of this type of solution.

The brave and dedicated health workers in West Africa deserve our thanks for keeping this deadly disease at bay. But Ebola is still a real threat, and they cannot continue this work alone. They need support and infrastructure.

U.S. leadership on Ebola matters because it is not just about Ebola. It is about the future of U.S. global health diplomacy — for which the demand will only grow in years to come.

Providing foreign aid for preparedness and resources is imperative. But how we do it is equally crucial — it is our calling card around the globe.

With Ebola and all other public-health crises, the message needs to be that the United States is here to help. We want to do it, though, in a cost-effective, high-yielding and empowering way that makes sense to the countries we are supporting.

They will appreciate Washington meeting them where they are and leaving them better off than when we arrived.


PHOTO (TOP): The ward of the Monrovia Medical Unit, an Ebola treatment facility specifically built for medical workers who become infected while caring for patients, November 4, 2014.. REUTERS/U.S. Army/Sgt. 1st Class Nathan Hoskins/Handout via Reuters

PHOTO (INSERT 1): James Knight of U.S. Army Medical Research Institute of Infectious Diseases trains Army soldiers from the 101st Airborne Division, who are earmarked for the fight against Ebola, before their deployment to West Africa, at Fort Campbell, Kentucky, October 9, 2014. REUTERS/Harrison McClary

PHOTO (INSERT 2): A healthcare worker wearing protective equipment is disinfected outside the Island Clinic in Monrovia, where patients are treated for Ebola, September 30, 2014. REUTERS/Christopher Black/World Health Organization/Handout via Reuters


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Well reasoned and intelligent discussion. Now watch the lobbyists harangue reps from BOTH parties (most of whom are lawyers and know didily about medicine) to spend the dollars on expensive, non-productive, high-overhead “solutions”.

Posted by SuefromSault | Report as abusive