By Jonathan Fielding Cofounder of The Big Cities Health Coalition
In 2014, we were lucky. There were only four diagnosed cases of Ebola virus in the United States. But in Africa, there were over 25,000 diagnosed cases of Ebola virus and more than 11,000 deaths, amounting to a public health tragedy.
The response to Ebola was helter-skelter. Doctors Without Borders was the first to warn about the rapidly expanding epidemic in Africa, but local governments and international organizations were slow to respond. The World Health Organization provided neither the leadership nor the operational coordination necessary to fight Ebola.
Fortunately, the director of the Centers for Disease Control and Prevention sounded the alarm that started to mobilize U.S. resources to help the affected West African countries. But U.S. public health officials were also challenged as they tried to address the threat from Ebola. At the beginning of our involvement, there were no well coordinated plans to identify Ebola treatment centers; implement quarantines; store and deploy the necessary level of protective equipment; manage and dispose of waste material; or monitor international travelers.
There are still active cases of Ebola in Africa, but you would not know it by scanning the news. Zika is the public health emergency du jour. And we are about to make many of the same mistakes we made not only with Ebola, but also with the SARS and West Nile viruses and H1N1 bird Flu. In all these instances, we were lucky. We rang the emergency sirens, marshaled resources, stretched medical and public health assets as thin as we could and made it through the crisis.
According to the CDC, as of August 4, there were over 510 pregnant women in the U.S. with laboratory evidence of Zika infection. The CDC has identified a neighborhood in Miami where mosquitoes are spreading the Zika virus and advised pregnant women not to travel to the area.
State and local public health officials are mobilizing to fight, often with insufficient resources. Meanwhile the mosquitoes are now in the continental U.S. and there is evidence that efforts to eradicate the pests may not be working as anticipated. We will need to be lucky, again, in the fight against Zika.
How long will our luck last? This question haunted the work of an independent panel established by the U.S. Department of Health and Human Services to review the response to Ebola, which I chaired. Our focus was on Ebola; What lessons did we learn, how can we do better next time? And our fear is that our luck is running out.
Zika is the next public health threat, but it is not the last. As our small planet's population grows it increases contact with animal reservoirs for serious infectious diseases, both those you heard of – HIV, Ebola, malaria, dengue fever – and those you probably haven't – Marburg, hantavirus and hendra virus. The CDC reports that more than 6 of every 10 infectious diseases in humans come from animals.
There is a lot we can do to ensure that we are prepared to detect and contain most infectious diseases. The independent panel made 48 specific recommendations to help strengthen public health capabilities, coordination and communication. These recommendations underscore the complexity of the public health community and the range of competencies that are needed to address a public health threat. In the U.S. alone, multiple agencies and stakeholders are part of the public health response team. These include the HHS Office of the Secretary; the CDC, the Food and Drug Administration; the Department of Homeland Security; the State Department; state, county and city health officials; the Federal Emergency Management Agency; U.S. Agency for International Development and more. The number is further compounded by international organizations and governments.
HHS must play a greater role in coordinating the global public health response through implementation of the Global Health Security Agenda, a cooperative arrangement launched in 2014 by over 50 nations, nongovernmental organizations and other stakeholders; better coordination with other government agencies, and state, local and private sector partners; and clear delineation of roles and responsibilities within and among HHS offices.
When novel infectious agents threaten us, HHS and its key public health agency, the CDC, have the daunting responsibility of communicating rapidly evolving and complicated messages to Congress, the public and other stakeholders. With Zika, the agencies are doing an admirable job, with clear though if necessarily evolving messages delivered by trained spokespeople. They have learned the lessons from lapses in communication about Ebola to clarify what is not known and the inherent uncertainty on where Zika could next be transmitted.
Additional resources – money and people – will be needed to implement the panel's recommendations. The WHO needs additional financial, technical and logistical support to support the Global Outbreak Alert and Response Network. NGOs, often the first line of detection and response, need additional resources to be more visible and effective in the corners of the world where public health threats emerge.
et as the need for additional resources has grown, funding for state and local health departments has dropped. Local governments report cuts in federal support of up to 50 percent. And state budget constraints have resulted in fewer resources to fight emerging threats. As a result, public health officials are using funds allocated to fight Ebola, which is still active in Africa, in the fight against Zika. They are rolling the dice, hoping that Ebola does not re-emerge as an imminent public health threat.
But the biggest crap shoot is happening now in Washington. Congress adjourned for its summer recess without approving additional funds to fight Zika. Politics as usual got in the way of addressing this major public health threat with fights on not only the level of funding but also abortion and other unrelated, contentious issues.
The most important recommendation from the independent panel is to create a flexible contingency fund to support preparedness and response activities. Public health should not be a partisan issue. Public health officials should have the resources they need to detect and protect us from Ebola, Zika, West Nile, Marburg, hantavirus or whatever comes next.
We will continue to need luck as we fight public health threats. But without the necessary resources, our luck will run out.