The United States fumbled its response to the Ebola epidemic before it even began, neglecting experiments to make vaccines and drugs against the virus, and cutting funding to key public health agencies, a presidential commission said Thursday.
Americans focused on their own almost nonexistent risk of catching Ebola from travelers instead of pressing to help the truly affected nations, the scathing report from the Presidential Commission for the Study of Bioethical Issues says.
"Both justice and prudence demand that we do our part in combating such devastating outbreaks. Once we recognize our humanitarian obligations and the ability of infectious diseases to travel in our interconnected world, we cannot choose between the ethical and the prudential," it reads.
"Ethics and enlightened interest converge in calling for our country to address epidemics at their source."
Ebola started spreading in Guinea just about a year ago, but the response was slow. By summer, it was spreading quickly in Liberia and Sierra Leone, but the World Health Organization has admitted it was slow to raise the alarm and says it lacked the resources to move in and help as it should have.
Charities such as Doctors Without Borders (Medecins Sans Frontieres or MSF) struggled against the tide of sick and dying people but it was not until fall - and after a few patients had landed on U.S. soil -- that U.S. troops were mobilized. More than 23,000 people have been infected and more than 9,600 have died in West Africa. Eight patients landed in the U.S. and two of them died; two nurses who treated one patient were infected and recovered.
U.S. troops were not rallied until after that. Now officials say the epidemic has begun to turn - there was just one new case in Liberia last week. But there were 98 new cases in Guinea and Sierra Leone.
"The Ebola epidemic in western Africa overwhelmed fragile health systems, killed thousands of people, and highlighted major inadequacies in our ability to respond to global public health emergencies," commission chair Amy Gutmann said.
"It demonstrated the dire need to prepare before the next epidemic. A failure to prepare and a failure to follow good science — for example, by not developing vaccines and not supporting health care providers — will lead to needless deaths."
Vaccines and drugs had been in the works for years, many with government funding and in government labs. But scientists who worked on them said there was never quite enough funding or support to move them forward. As a consequence, officials have had to rush their development and testing.
And Americans, with the most resources of all to help stop the epidemic in West Africa, worried about themselves instead.
"Against a charged political backdrop and 24 -hour media attention, frustrated public health officials struggled to convey, even before the first imported case, the low risk of individual and community transmission in the United States," the report reads.
Returning doctors and nurses were quarantined even though the risk was almost zero.
"When we look back on this epidemic I hope we'll recognize that fear caused our initial hesitance to respond -- and caused us to respond poorly (when) we finally did," Dr. Craig Spencer, a new York doctor who got infected in Guinea and who recovered at Bellevue Hospital in new York, complained in a bitter essay in the New England Journal of Medicine.
"I know how real the fear of Ebola is, but we need to overcome it. We all lose when we allow irrational fear fueled in part by prime time ratings and political expedience, to supersede pragmatic public health preparedness," he added.
"Instead of being welcomed as respected humanitarians, my U.S. colleagues who have returned home from battling Ebola have been treated as pariahs," Spencer wrote.
"I was labeled a fraud, a hipster and a hero. The truth is, I am none of those things."
Part of the problem comes because the U.S. public - read voters - don't understand what it means to send public health aid to other countries, the report says. It points to a 2013 Kaiser Family Foundation survey that showed people think the U.S. spends far more on foreign aid than it actually does.
"When asked, 'Just your best guess, what percentage of the federal budget is spent on foreign aid?' on average, Americans answer that 26 percent of the budget is spent on foreign aid," the report reads. And 61 percent said that was too much.
"In 2012, the United States provided $8.9 billion in global health funding, which represents approximately 0.24 percent of the U.S. annual budget. Overall, less than 1 percent of the U.S. annual budget is spent on foreign aid."
U.S. officials need to do a better job of communicating during crises, the report recommends.
"Needlessly restricting the freedom of expert and caring health care workers is both morally wrong and counterproductive; it will do more to lose than to save lives," it says.
It also has a few specific recommendations:
- Strengthening the capacity of the World Health Organization to respond to global health emergencies
- Identifying and empowering a single U.S. health official accountable for all federal domestic and international public health emergency response activities
- Strengthening the deployment capabilities of the U.S. Public Health Service, including by streamlining command structure for deployment and providing appropriate resources to train and maintain skills needed for emergency response.