Are We Ready for the Next Ebola Outbreak?

May Chu arrived at the White House Office of Science and Technology Policy in mid-May 2014 to a burgeoning disaster. At that point, the world was only starting to take note of a growing outbreak of Ebola virus in West Africa. The World Health Organization reported 239 cases by the end of the previous month, which ticked up into the mid-300 range by the time June rolled around.

In a few months, there would be thousandshumans and animals alikeinfected by the deadly disease.

Chu was on loan from the Centers for Disease Control and Prevention, and served for about 18 months as OSTPs assistant director for public health. An expert in infectious diseases, she had previously worked at the World Health Organization, and had spent time in West Africa managing disease outbreaks like Lassa fever, a dangerous and contagious viral disease that can kill quickly and leaves a quarter of survivors deaf.

As spring turned to summer and reports of more cases of Ebola from Guinea, Liberia, and Sierra Leone flooded in, Chus role increasingly evolved into the Ebola point person.

By mid-June, the outbreak had reached Liberias capital, Monrovia, and OSTP Director and science adviser to the president John Holdren called Chu to his office. [He] says, OK, youre going to brief me every day on this now, Chu told The Daily Beast. The entire leadership at the White House, including the president, really asked for and considered the advice of the scientists and the doctors.

The 2014 response was handled by an administration that had a more pronounced appreciation for science. OSTP had a staff of around 135, with dozens of experts detailed from elsewhere in government.

For Ebola, they made a conscious decision to put the politics aside and dealt with the science.
May Chu, assistant director of public health, Obama administration Office of Science and Technology Policy

Todaythough a spokesperson who preferred to be anonymous at OSTP says it is functioning just finethe White Houses science office may have more tumbleweeds than people. There is no science adviser to direct the office, and no clear sources of scientific or medical expertise that can even approach President Trumps inner circle. If Ebola, or another fast-moving, dangerous disease were to break out today, what would the response look like?

I think [in 2014] it was dealt with extremely well, Lawrence Gostin, a Georgetown University professor and expert on global health issues, said. We left it far too long, he added, but the eventual response emanating from the White Housealong with other countries and organizations including Mdecins Sans Frontires, among otherslikely prevented a far bigger disaster.

At OSTP, Chu said she kept a sort of macabre scoreboard on a conference room whiteboard, keeping track of the reported cases and deaths. Once she had impressed upon senior officials the catastrophic potential of the outbreak, she told The Daily Beast she began to sit in on National Security Council meetings, offering input and guidance to Holdren that could then be moved up the chain of command. And importantly, she added, she had connections across the government.

If you have somebody inside the White House that knows very much the network of scientists across the agencies like DoD, State, HHS, other agencieswe all talk, Chu said. That meant the best information from all those agencies could be filtered up to Holdren, and then to the Oval Office.

Eventually, in September, the administration announced it would send 3,000 military personnel to Liberia to aid in the response and attempt to control the outbreak. They built treatment facilities and helped train local health care providers on how to reduce transmission, among other projects. And at home, OSTP partnered with USAID to launch an Ebola Grand Challenge, aimed at designing new personal protective equipment, health care IT solutions suitable for an outbreak response, and other ideas.

While all this went on, the Obama White House had to weather repeated calls for travel restrictions from affected countries, an issue that many Republicansand eventually some Democrats as wellhammered the president on over and over. Chu, along with other voices at OSTP and experts from other parts of government like the CDC, insisted that banning travel would only make matters worse. Having worked in the region before, she explained how trying to close borders wouldnt work for a variety of cultural and logistical reasons, and that allowing health care workers to come and go, with appropriate precautions, was a far better idea than attempting toshut the whole area off.

What made the difference in the White House was leadership, from the top, from the president, who took science seriously, who took Americas role as a global leader seriously, and took health seriously, not only the health of Americans but of people a long way off, Gostin said.

In October 2014, Chu said President Obama called an emergency meeting of PCAST, the Presidents Council of Advisors on Science and Technology, to discuss Ebola. Chu said PCAST put together a series of recommendations (the specific meeting has no transcript, she said), based heavily on OSTPs work, and at the end of the day we all marched into the Roosevelt Room and briefed the president. Less than a month later, the White House requested $6.2 billion in Ebola-related funding from Congress; Congress almost granted what amounted to $5.4 billion in early December. Gostin says it was that appropriation, along with the military response and leadership on a United Nations Security Council resolution on the outbreak, that were among the U.S. best moves in helping to slow and eventually stop the epidemic.

What was impressive was that rather than the politics, they listened to the science and let science drive the decisions, Chu, who is now a professor at the Colorado School of Public Healths Anschutz Medical Campus, said. Theymeaning Holdren and other senior officials at the White Housewere, in the first months especially, like sponges. For Ebola, they made a conscious decision to put the politics aside and dealt with the science.

In September 2014, the CDC estimated that without dramatic intervention, 1.4 million people in Liberia and Sierra Leone alone could be infected within only a few months; when the outbreak had officially ended in 2016, while still clearly catastrophic (the WHO in particular has been criticized for being slow to respond), the number of cases stood at under 29,000, with 11,310 deaths (PDF).

What the fight against Ebola might look like now

Today, many of the particulars that drove the 2014 response simply dont exist. Trump still has not nominated a science adviser, and has left other senior OSTP positions vacant as well. Previous reporting has described the office as a ghost town.

Without a director, the line of communication up to the Oval Office is certainly in question, though again, its very unclear. Expertise at CDC and elsewhere in government could still be deployed in the case of a crisis, but some decisionslike deploying troops or instituting travel restrictionswould have to come from the top. And the top doesnt seem to have any connection to scientists at all.

An anonymous White House official pushed back, telling The Daily Beast that the president has a deep and varied bench of expertise within the executive branch to drawn on for advicethe Cabinet, OSTP, NSC, and other policy councils, not to mention agency heads and their senior staff and science leads.

I would expect not only an ineffective response, but a response that was a barrier to action. I would expect a nativist response, a very perverse America First response.
Lawrence Gostin, Georgetown University

Deep bench aside, these problems dont start and end with OSTP.PCAST simply doesnt exist anymore, meaning the president has no source of outside expertise on a host of scientific issues. The CDC recently announced it will have to dramatically scale back its work on infectious disease outbreaks in dozens of countries, thanks to an impending lapse in funding.

And Trump provided a glimpse into how he might handle a humanitarian crisis in places like West Africa, referring to such countries as shitholes. The comments raise a legitimate question of whether the presidents alleged racism could define actual policy decisions that have dramatic public health consequences. His comments did not refer directly to disease outbreaks, but Trump was among the loudest voices to repeatedly excoriate President Obama over the lack of a travel ban in 2014. Its almost like hes saying F-you to U.S. public, he tweeted at one point. At another: STOP THE FLIGHTS! NO VISAS FROM EBOLA STRICKEN COUNTRIES!

The CDC reports only four total cases of the disease in the U.S. related to the entire 2014-2016 outbreak.

Given their track record, I would expect not only an ineffective response, but a response that was a barrier to action, Gostin said. I would expect a nativist response, a very perverse America First response. Travel bans and quarantines, and an isolationist policy and disdain for international organizations like the UN, would likely only increase the risks to American security, Gostin added, rather than decrease them.

Chu agreed, saying that in conversations with her former OSTP colleagues, there is a consistent feeling of being sidelined. Those of us in public health response our thoughts dont matter, our advice does not matter, she said. Science evidence does not matter.

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