Ebola Perspectives

The staff and faculty at the National Center for Disaster Preparedness bring a diverse set of expertise to contemporary issues in disaster preparedness, response and recovery. As the Ebola outbreak continues to evolve, their perspectives will be shared here in support of a broader national dialogue.


November 13, 2014

Regional Outbreak, Global Impacts

Lessons for confronting future outbreaks and why the President’s proposal for emergency Ebola funds is a step in the right direction.

Figure 1: West Africa’s air traffic connections with the rest of the world

Figure 1 (click to enlarge)

Globalization has presented unprecedented challenges to the prevention and control of disease outbreaks. While diseases such as smallpox and measles were already able to travel around the globe within a year by the time of the European colonization of the Americas [1], in today’s interconnected world infectious diseases can reach virtually any location within days. Every week, tens of thousands of passengers arrive to and leave from West Africa, the epicenter of the ongoing Ebola epidemic (Figure 1). Even more strikingly, the time sufficient for a disease to reach any location around the world is often shorter than its incubation period [2]. For instance, the Ebola virus has an incubation period of 2-21 days after infection [3] which, as the recent U.S. cases have demonstrated, can often result in exposing many more individuals before the patient is diagnosed with the disease. Not surprisingly, Ebola has caused multiple deaths in Western countries (Figure 2) and even countries like Denmark where risk was thought to be ‘negligible’ [4] have had suspected cases.

Figure 2: Ebola cases reported outside of countries with Ebola outbreaks

Figure 2 (click to enlarge)

Although the current outbreak is likely to remain restricted to isolated cases in the United States, it has presented an opportunity to learn important lessons about confronting future outbreaks of this and greater magnitude. The nation’s ability to rapidly and effectively respond to such threats will require a comprehensive long term approach that incorporates improved domestic preparedness with considerations of the key stakeholders involved and various local and global factors that may exert complex influence on the disease epidemiology.

First, ensuring domestic hospital preparedness will be of paramount importance. The Ebola outbreak revealed substantial gaps in preparedness that call for urgent measures. For instance, although the level of hospital preparedness to Ebola is difficult to assess, a survey of 700 nurses at over 250 hospitals around the country revealed that 80 percent were unaware of a hospital policy regarding the admission of suspected Ebola patients as of last month [5]. About 18,000 nurses at Kaiser Permanente-owned hospitals and clinics in California went on strike this Tuesday over a perceived lack of equipment and training to adequately respond to potential Ebola cases [6].  

Guinea Ebola West AfricaNext, as the current situation in Liberia, Sierra Leone and Guinea clearly demonstrates, fragile health systems don’t have the capacity to effectively respond to emergencies like Ebola. Furthermore, the unprecedented Ebola outbreaks in these countries have led to the collapse of the local health systems and have evolved into humanitarian emergencies that will have long lasting and devastating consequences for public health, education and economic development [7,8,9].  Beyond the moral obligation to assist countries affected by Ebola, the United States can benefit from such actions because reducing impacts in the affected countries is essential for minimizing the likelihood for new cases at home. Therefore, an ongoing commitment to strengthening weak public health systems in developing countries, with particular focus on disease surveillance and response capacity [10] will likely be especially beneficial in confronting future outbreaks of this kind.

Finally, while globalization has brought many new challenges, new opportunities are also emerging for confronting future health emergencies. In particular, global and cross-sectorial partnerships play an increasingly important role in the Ebola outbreak response and technological advances are improving surveillance capacity.  Governments and NGOs are developing collaborations to create treatment and testing facilities and send health care workers to the affected countries and partnerships involving biopharmaceutical companies are being realized [11,12] to facilitate more rapid vaccine and drug development. IBM has recently launched an initiative to create a ‘cloud-based Ebola Open Data Repository’, in order to provide governments, researchers and NGOs with access to openly available data that can be helpful in improving disease surveillance and response [13].

Ebola TrainingIn a globalized society, the success or failure of the nation’s ability to respond to such health emergencies will depend on our health system’s preparedness, as well as our commitment to strengthening health systems worldwide and fostering successful collaborations with stakeholders from government, non-profit and industry domestically and abroad. The President’s proposal [14] for $6.18 billion in emergency funds to contain and end the Ebola outbreak is a step in the right direction. The proposal that aims to improve domestic preparedness, enhance global capacity to swiftly and effectively respond to future disease outbreaks and accelerate drug and vaccine development will not only serve the goal of ending the current Ebola outbreak but will also provide a solid foundation for meeting challenges of this or greater magnitude in the future.

Author: Elisaveta Petkova, Research Associate

October 23, 2014

The Business Community Prepares for Ebola

As Ebola continues to grab the public’s attention, the political and the clinical aspects are commanding the largest headlines in the media. This is understandable for coverage of an infectious disease outbreak in an election year. Beyond the sensational and the clinical, however, there is also coverage that touches upon the vulnerability and potential benefit of a well-coordinated response with the business community. While the term “public-private partnership” is used frequently in our national Homeland Security dialogue, the current Ebola Outbreak in West Africa and its impacts domestically offer a glimpse of how a disease outbreak and our business communities intersect. In some ways the relationship is direct, whereas in others it is less obvious but similarly important.

Ebola Training Photo GalleryIn addition to corporate donations and social responsibility campaigns, there are also significant business implications in manufacturing goods to support the response. This is most pressing currently with the development of pharmaceuticals [1] [2] [3] and equipment to protect healthcare workers against bodily fluid exposure [4]. In particular is the sudden surge in demand for the development and manufacturing of products in a business environment that favors highly efficient, just-in-time production and delivery systems in non-emergency times. Companies can, and are, surging to meet this need, but from a step behind if relationships are not pre-established with public health and emergency managers in anticipation of scenarios like this one. There is also a business case for this, in that any unmet demand results in an opportunity cost by having an insufficient supply to meet customer orders.

In the impacted areas of West Africa, there are stories of companies and trade organizations taking steps to protect their staff and their livelihoods. A rubber plantation in Liberia has created a rare sanctuary from Ebola with robust medical support and evidence-based infection control procedures. As the disease has been defeated within their corporate community, they are carefully opening up their services to those affected outside of the plantation workers and their families [5]. Ghana and Ivory Coast, which account for half of the world’s cocoa production, have not been directly affected by cases of Ebola. However cocoa as a commodity has surged on concerns of what a disruption to the flow of production from small farms in these countries would have on the world’s supply of chocolate [6]. Cocoa producers, recognizing the threat, have taken steps to increase short-term production [7] and to provide support to the fight against Ebola [8]. These examples illustrate how companies can meet humanitarian and economic interests with their operations.

Employees at a foreign exchange brokerage sit at a computer terminal under electric boards flashing the current figures of Japanese yen against dollar and stock market in Tokyo, Thursday, Oct. 2, 2014. Asian stocks fell Thursday amid worries about the strength of U.S. and European recoveries and the first American case of Ebola. Japan's Nikkei 225 index lost 1.7 percent to 15,815.45 points. (AP Photo/Shuji Kajiyama)Businesses are also looking at preparedness programs to keep their workers safe, and if necessary, compensated if they become exposed or ill [9]. It is important for businesses to protect their most valuable asset, and also to provide access to information and assure job security for the individuals employed by them. Companies are also recognizing the risk that faces them if business is disrupted. In response to this, insurance brokers have developed policies to cover revenue interruptions related to Ebola and other outbreaks [10]. This allows a business to manage the uncertainty that situations like this present. It is also important to the tax-payer that businesses have this as part of their contingency planning without requiring government intervention and/or having to resort to closures and lay-offs.

In the reality of global supply chains, community-based manufacturing, and privatized health services, being bottom-line oriented and humanitarian do not need to be in conflict with each other. In fact, these objectives are often in line with each other when the full impact of prevention and effective response is appropriately valued. With the many teachable moments that Ebola is presenting us with, the nature of our business communities as partners in response is deserving of a more robust understanding. A more thorough articulation of the value that is created through these collaborations can speak to the interests of both the shareholders as well the public.

Author: Jeff Schlegelmilch, Managing Director for Strategic Planning and Operations 

October 9, 2014

Global Connections to a Local Response 

This week, the story of the first person diagnosed with Ebola in the United States ended tragically, when Thomas Eric Duncan passed away succumbing to his illness.  Our thoughts go out to his loved ones, and to all of those impacted by this disease around the globe.

ZAIRE EBOLA KINSHASAWith this tragic event, the West African Ebola outbreak became something much less distant and theoretical for Americans. It took only the time of an international flight to move this from the international pages of the newspaper, to the US section. More importantly, in a short period of time it shifted from an overseas response of high profile agencies (CDC, USAID, WHO, and even elements of the US Military), to being under the responsibility of local health departments and healthcare facilities. Initial missteps by state and local authorities, as well the healthcare facility Mr. Duncan was initially released from, have been extensively covered in the media.

One can read the story of how Mr. Duncan was sent home despite his symptoms and travel history and ask “how could this happen?”. We can also ask why the contaminated articles were left in his apartment for so long with his friends and family left wondering what to do. But one only needs to wait in a crowded emergency room, or work in an understaffed and over-taxed health department to understand that these are the wrong questions to ask. The question is how, as a nation, are we preparing our local institutions to meet these global challenges?

Belkys Fortune, Teressa CeliaAll response is local. Our national level institutions have served our local practitioners well by ensuring the best possible science is available on this disease, fighting outbreaks overseas to minimize their spread, researching new vaccines and treatments and striving to understand emerging pathogens long before we need to confront them in our home towns. Although there is still much to learn about Ebola, an actionable set of infection control recommendations, treatment guidelines and other critical tools are being made publically available and updated regularly. However, as a nation, we are also failing our local practitioners by operating as though knowledge and world class national institutions are sufficient to stop an outbreak. According to US government figures, hospital preparedness funding has decreased by 50% since 2003, and by 30% just in the last year. Public Health Preparedness funding for state and local health departments has also been reduced by nearly 30% since its post 9/11 peak. Additionally the local public health workforce has been decimated by budget cuts with a workforce reduction of nearly 44,000 jobs since 2008, with more cuts expected. Without local institutions, national knowledge has no vehicle to effect response.

Preparedness is an investment that matures over time. We will likely see additional cases of Ebola in the United States as part of this outbreak. We may even see some cases of secondary infection, but we will not likely see a widespread outbreak like we are seeing in West Africa. These are the dividends being paid by our investment in local health and medical preparedness over the past decade. If we continue the trend of divestment in preparedness, our readiness will be a slow decline, marked by very public failures blamed on institutions and individuals who “should have done things differently”. We will be rich with the knowledge of what we needed to do, but lacking in our ability to mount an effective response. Ebola has captured the attention of our nation, and reminded us of how connected we are globally. It should also serve as a reminder for how we must continue to invest in being prepared to respond locally.

Author: Jeff Schlegelmilch, Managing Director for Strategic Planning and Operations