America knows how to defeat Ebola
But will the U.S. resume its leadership role in time to save thousands of lives?
By Elizabeth Cameron and J. Stephen Morrison
The United States knows how to defeat Ebola. A dozen years of bipartisan investment — spanning three administrations and billions of dollars — have built a formidable infrastructure of expertise, countermeasures, and rapid-response capability.
That infrastructure is now being tested by a dangerous outbreak in the Democratic Republic of the Congo, where confirmed cases have surpassed 1,100 and deaths exceed 300, with no end in sight.
After costly early delays, the Trump administration has begun to mobilize at scale, committing more than $700 million and requesting $1.4 billion in supplemental funding from Congress. The muscle memory is flexing. Whether it flexes fast enough — and in the right directions — will determine whether the United States resumes the leadership role it built and whether thousands of lives are saved.
That role was in evidence during the West Africa outbreak in 2014-2016 and the outbreak in the Democratic Republic of the Congo in 2018-2020. Although protracted delays and controversy surrounded the U.S. response to both outbreaks, the overall trajectory of U.S. engagement remained positive, bridging Republican and Democratic administrations.
Over the past 12 years, with bipartisan congressional support, the United States has invested billions of dollars in programs and plans that can stop the disease from spreading globally while keeping Americans at home safe from Ebola and myriad related threats. These measures include assets that did not exist prior to 2014.
The U.S. Centers for Disease Control and Prevention (CDC) and, before the Trump administration dismantled it, the U.S. Agency for International Development (USAID), deployed and fostered a joint global health security fighting force in more than 50 countries around the world. The White House created and exercised rapid response playbooks to practice deploying task forces, supplies, and countermeasures. The U.S. Biomedical Advanced Research and Development Authority and the Department of Defense have invested in Ebola treatments and vaccines. Thirteen U.S. Regional Emerging Special Pathogen Treatment Centers now exist across the United States that provide world-class care and treatment for Ebola and other special pathogens.
In recent days, following a sluggish start to the ongoing Ebola response in the DRC, the United States has begun to emerge as a major donor with reported commitments of $727 million to established global health and humanitarian emergency partners with proven ability to deliver. That was possible because the State Department has assumed control over some pre-existing funding mechanisms, formerly housed at USAID, that can mobilize UN agencies, international organizations, and operational, international nongovernmental organizations (NGOs), in addition to CDC capabilities. The White House also requested that Congress commit $1.4 billion in supplemental funding for the Ebola response, a striking signal of the direction of thinking around the president. CDC is stepping up with international partners to lend substantial expertise to the fight, though the agency remains far below full strength. A few staff have been added to the National Security Council (NSC) Resilience Directorate to support the Ebola response, although that capability falls far short of a reliable NSC directorate dedicated to handling bio threats.
On the countermeasures front, the United States has committed $50 million to the Coalition for Epidemic Preparedness Innovations to develop candidate vaccines for the Bundibugyo species of Ebola and is working with Mapp Biopharmaceutical to provide doses of a cross-species Ebola treatment for clinical trials. Reportedly the United States is engaging on technical matters with the World Health Organization (WHO) and the Africa Centres for Disease Control and Prevention (AFCDC).
However, a glaring gap remains, which reveals the high price of the United States’ withdrawal from WHO: CDC’s globally renowned experts are not part of the WHO-AFCDC incident management team deliberations, remotely or in person. Nor is CDC’s exceptional lab capability, critical to advancing scientific knowledge during earlier Ebola outbreaks, part of the current WHO-AFCDC led response.
A long fight has commenced, which could last months or years. We have identified seven critical steps that we believe the administration and Congress can rally behind, on a bipartisan basis, that will strengthen the international response, help hasten the end of the outbreak, and better protect Americans.
Strengthen the White House team. First and foremost, the administration should re-establish a permanent NSC home for bio threats, and the White House, together with the State Department, should name a leader with a record of interagency management success and the gravitas to lead the Ebola response. The focus should be on designating local or national leaders with state, local, and/or national-level credibility. The White House appointed Ron Klain, a senior political and legal operative who had served as chief-of-staff to Vice Presidents Biden and Gore, to coordinate the U.S. response to Ebola in 2014-2016. During the widespread 2022 mpox outbreak, the White House drafted respected Federal Emergency Management Agency and CDC leaders Bob Fenton and Demetre Daskalakis to run the response, building on decades of credibility at the state, local, and global levels.
Reinstitute U.S. exercises. The administration should rigorously and transparently practice and plan for how it faces biological threats—both for those that are recurrent like Ebola and those that could be even more catastrophic, such as a deliberate biological attack. The White House should reinstate regular use of the Biological Incident Notification and Assessment Protocol and run exercises with its rapid response playbooks.
Stabilize CDC overseas and build its surge capacity at home. CDC experts are a crucial component of America’s biodefense capability. Traditionally, along with USAID global health leaders, they have been the essential eyes and ears overseas for early warning. Globally deployed staff previously operated in sync with a headquarters surge capacity. The costs of maintaining these assets are a fraction of the cost of a late response to a dangerous outbreak, delayed because surveillance and response were weak.
The administration should commit both to stabilize and sustain deployment of CDC overseas global health security officials, as essential members of U.S. embassy teams, at the same time that it commits to guarantee CDC’s surge capacity, based out of CDC headquarters in Atlanta.
The State Department reportedly is instituting, under the America First Global Health Strategy, plans for CDC country offices to transition to a fee-for-service model with partner countries. This approach has not yet begun to be implemented and much discussion lies ahead of how it is to work in practice. That approach will need to be managed carefully and integrated with other critical priorities. Success going forward in guaranteeing a durable CDC overseas presence and reliable and adequate surge capacity will require working closely with Congress to create flexible and enduring budgetary mechanisms.
Increase international markets and stockpiles for critical products. The United States has a rare opportunity to build and contribute to global capacity that can curtail and rapidly end large-scale Ebola outbreaks in the future. This crisis has created an opening to develop strategies for regional and global stockpiling and sustainment of Ebola vaccines, rapid tests, therapeutics, and personal protective equipment. To succeed requires making this goal a diplomatic priority.
Gavi, the Vaccine Alliance, in coordination with several partners, supports a 500,000-dose stockpile of the vaccine designed to protect against the more common Ebola Zaire strain. That stockpile has been successfully deployed in recent Zaire outbreaks and could manage a wider suite of Ebola vaccines, with renewed U.S. support for Gavi. The United States is well-positioned to rally development finance institutions across G7 and other nations, alongside AFCDC, the WHO, the World Bank, and other partners, to catalyze the advance market commitments needed to support a stockpile of cross-species Ebola and Marburg products on the African continent—deployable at the first sign of a major outbreak.
Be more transparent. To build its credibility and external support, the United States should transparently share its bilateral global health security agreements. Currently, countries, civil society organizations, and advocates are wary of U.S. motives with respect to the Ebola response and global health. Making the agreements public and conducting listening sessions to answer questions and gather input would go a long way toward clearing the air, building trust and understanding, and lowering conspiratorial thinking.
Integrate U.S. capabilities with the WHO-AFCDC incident management team. The United States can bring substantial capacity to stopping the Ebola epidemic. Effectively doing so, and accelerating the response, will rely on close integration with the WHO-AFCDC-led regional response, funding needs and priorities, and incident management team. The CDC’s special pathogens unit, in particular, brings significant expertise and lab capacity to the fight and would be even more effective if able to put its full weight behind the response as an integral partner.
Guarantee that endangered Americans can come home. The United States should clarify that Americans exposed to or infected with Ebola will be assisted to come home and access the exceptional care that has been created across the United States, including through the network of the National Emerging Special Pathogens Training & Education Center and 13 RESPCTs. The administration should publish protocols for working with states and cities to support monitoring and treatment for exposed Americans, including how they will access these world-class, taxpayer-funded, congressionally-appropriated facilities.
The Ebola outbreak unfolding in eastern DRC is dangerous, harrowing, urgent, and highly uncertain. Security concerns will dominate and require a U.S. diplomatic push for ceasefires and other measures to ensure safe passage of providers. But this moment could also trigger a renewal of U.S. leadership. The administration should take full advantage of this opportunity to fortify U.S. capabilities at home and abroad. Americans, members of Congress, international partners, and the imperiled and vulnerable populations in the DRC and beyond will applaud U.S. ingenuity, commitment, and compassion.
Elizabeth Cameron is professor of the practice of health services and senior advisor at the Brown University Pandemic Center, a nonresident senior advisor to the Global Health Policy Center (GHPC) at the Center for Strategic and International Studies, and a Miller Center senior fellow. J. Stephen Morrison is senior vice president and director of the Global Health Policy Center and a Miller Center senior fellow. Michaela Simoneau, a GHPC fellow, contributed to this article.