NCDP Perspectives

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.

With 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?

All 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.