Forbes | November 21, 2014
By Senator Bill Frist, M.D.
Thankfully—and appropriately—the panic surrounding Ebola in the United States has waned over the past weeks. But the calm doesn’t mean it’s time to move on, though the news cycle may have. All major crises can be teachable moments and now is the time to carefully consider our response to the Ebola outbreak and what we can learn to prevent these types of outbreaks in the future.
This morning I sat on a panel hosted by the Center for Strategic and International Studies (CSIS), the Vanderbilt Institute for Global Health, and Hope Through Healing Hands. I want to share some notes from the discussion. Joining me were:
- J. Stephen Morrison, Ph.D. (Senior Vice President and Director, Global Health Policy Center, CSIS);
- William Schaffner, MD, (Professor of Preventive Medicine, Vanderbilt University School of Medicine);
- Sten H. Vermund, MD, Ph.D., (Director, Vanderbilt Institute for Global Health);
- Muktar Aliyu, MD, (Associate Director for Research, Vanderbilt Institute for Global Health);
- James E. Crowe, Jr., MD, (Director, Vanderbilt Vaccine Center);
- Congressman Jim Cooper (D-TN)
America’s Role in the Crisis
All of these experts started with some good news. There has been a significant reduction in infection rates in Liberia. International resources have come from the United States, World Health Organization, World Bank, private groups such as the Gates Foundation, and NGOs, particularly Doctors Without Borders (MSF).
We have projected American power into the region with unparalleled and unprecedented commitment, Steve Morrison said. He believes US leadership here is important because it will guide how we respond to global health threats in the future. Dr. Vermund noted that global health opens the door for “soft diplomacy”, which often has a more profound impact than “hard diplomacy.”
I definitely agreed. I have spoken often about using healthcare as a type of global diplomacy and in using global health as a currency for peace. I think it is so important for the United States to take a leading role in addressing the problem. But we still have much to learn about handling an outbreak like Ebola, both abroad and at home.
The Disease in West Africa
This particular Ebola outbreak has been different, Dr. Vermund said. The hemorrhagic features of the disease have been less prominent while fever, fatigue, diarrhea, and headache are the most common, making the disease very similar to malaria or even cholera depending on the presenting symptoms.
Dr. Vermund pointed out how difficult it is to truly appreciate how unprepared these developing countries are to deal with diseases like Ebola—a truth I’ve seen firsthand. We are used to managing fluid, respiratory and electrolyte issues in an ICU. West Africa does not even have running water and electricity in every room, must less the fancy trappings of advanced medicine in the U.S.
During an infectious disease outbreak, the ideal strategy is surveillance and ring containment, a strategy of isolating all exposures and contacts and then vaccinating them. This is what has been done with small pox. However without a vaccine, we are left with just containment, which is much less effective.
The good news is that we will see the virus controlled over the next few months, said Dr. Aliyu, but we cannot become complacent. We must be thinking about strengthening the health systems in these countries moving forward. Dr. Aliyu also highlighted the importance of effective health communication and education that is culturally sensitive, infrastructure support for fragile health systems before they are in crisis, and personal protective equipment and services to keep health care workers safe. In other words, we need a truly circumspect strategy, not just a reactive one.
Dr. Schaffner joked that a transplant surgeon would be calling for “barefoot doctors,” but the most important and needed resource truly is health workers. Globally, 570 health workers have been infected and 320 have died making recruitment difficult. Priority must be given to protecting and supporting those workers.
The Disease in America
We all agreed that the likelihood of an Ebola outbreak in the United States is extremely small, and there is zero chance of the virus mutating to become airborne and spread through respiratory contact. This a message we cannot stress enough to assuage public fears. Dallas was poorly handled, Dr. Vermund conceded, referring to the process of treating Thomas E. Duncan, but there is no real risk in the U.S., he said.
That’s not to say we shouldn’t be prepared for the patients that do arrive here. It’s important to educate at-risk communities. Tennessee’s Health Commissioner, Dr. John Dreyzner mobilized local health workers that serve West Africans to make sure the community knew how to connect returning relatives and friends to health resources.
Dr. Vermund argued that when the number of cases are few, we should prepare specialty hospitals like Emory; we do not need to prepare all health facilities. We also all agreed the media, government and health community has dealt poorly with the public’s fear, letting media reports whip up a frenzy of hysteria short on facts. We’ve also not been sensitive to the returning aid workers. Dr. Vermund said, “stomping on civil liberties in the face of common sense.”
Where there are mistakes, we must continue to learn, and Ebola is no different. The panel and I truly believe this outbreak is one of many infectious disease outbreaks we will have to address in the future—outbreaks that won’t respect national borders and will demand international responses.
Bill Schaffner explained that Ebola is a virus that lives in the wild happily in fruit bats. It is when humans enter the wild that the virus “spills over” to humans. Habitat destruction, expansion of cities, and other growth will cause more humans to be introduced to these types of infections.
James Crowe concurred. In his lifetime there have been four major phases of vaccine targets. The first was against diseases like polio and pertussis. The next was for less conventional targets like HIV. The third targeted potential bio terrorism agent. For the most recent phase, Mother Nature is the terrorist. We are thinking less about bioterrorism and more about emerging infectious diseases, he said.
Quickly responding to these types of outbreaks means being prepared. Neglecting research areas that are not prominent in the developed settings leaves us vulnerable, Dr. Aliyu warned. Dr. Vermund wondered if a tax on some products might subsidize development of vaccines or treatments for diseases like Ebola. We cannot continue to ignore these issues just because they are rare and unprofitable.
The $6.2 billion in funding that Obama recently asked for includes supporting the UN strategy, but also fortifying domestic infrastructure and developing rapid diagnostic tests and vaccines. I believe the forward-looking part of this strategy is imperative. It is tempting to just deal with this outbreak, but we have to look towards the future implication of outbreaks in these vulnerable communities.
Congressman Jim Cooper believes the funding has a poor chance of being passed by Congress as a standalone bill, but could fare better if attached to an Omnibus bill. These are our issues, but people do not see it that way. “This is a place my constituents will never go, have never gone and wouldn’t let their children go,” Cooper said. But Cooper and the rest of us agreed, the best way to contain the disease and protect Americans is to contain it in West Africa.
I learned a lot from this convening of experts. The emerging theme is that Ebola may just be the beginning. We will continue to encounter new infectious diseases and vulnerable communities will continue to experience outbreaks. Diseases that are not profitable cannot be ignored. Preparedness is a hard sell in politics because it is so forward looking and answers the “what ifs.”
However, as we all sit down to renew our personal health insurance this year, we should also give some thought to our global health insurance plan.
It is not just enough to stem this tide of Ebola. We need to look to the future and consider the ramifications of not being prepared again.