1

Ebola in America

NEW YORK – Until Thomas Eric Duncan brought Ebola into the United States, the disease was largely dismissed as an exotic pestilence of concern mainly to impoverished West Africa, and those who dared to volunteer there. And its transmission to two nurses responsible for Duncan’s care – likely resulting from several breaches of medical protocol – has focused intense scrutiny on US preparedness for a possible outbreak. President Barack Obama even announced last week the appointment of an “Ebola Czar” to manage the detection, isolation, and control of the virus in the US.

Medical and public health experts had been assuring the public that there was little cause for fear. The Centers for Disease Control and Prevention (CDC) and other health agencies were working behind the scenes, painstakingly tracing anyone who may have come into contact with Duncan and quarantining those who might transmit the disease. Transmission in the US was nearly impossible, owing to the strength of the US health system, it was thought.

But, as recent events have illustrated, robust health agencies should not be taken for granted. In fact, over the past decade, the government has slashed budgets at several top health agencies, including the CDC, the National Institutes of Health (NIH), and state and local health departments. Between 2005 and 2012, for example, the CDC lost 17% of its funding, and officials recently reported that funding allocated for Ebola-type health emergencies is $1 billion less than it was in 2003.

The challenges faced at the state and local levels may be even greater. Some 23% of local health departments reported that public health preparedness programs were reduced or even eliminated in 2011, while a further 15% reported similar cuts in 2012. In 2014 alone, the Hospital Preparedness Program, which links regional hospitals with local health departments to prepare for potential public health emergencies, suffered $100 million in budget cuts.