The Ebola code of silence: Column
Even after the arrival of Ebola in Texas, the national dialogue in the United States remains naive, overly optimistic and full of misleading assurances from elected officials and public health experts. What the public needs to know and understand is this: Ebola is a deadly virus and like all viruses it can and will mutate and change.
Right now the disease only spreads from person to person by bodily fluids but there is a possibility that could change and the disease could become airborne. If it does, we could face a public health challenge like we haven't seen in this country since smallpox or polio. Worse yet: even if Ebola doesn't mutate, there is a good chance that some other novel infectious disease that we know about now (or will find out about in the future) will cause a pandemic and result in a significant loss of life.
The public needs to be cognizant of these real and present dangers to calibrate their expectations about the limited capabilities of our health care and public health systems and to increase our community resilience to deal with these threats.
We currently have an overconfident view about the capabilities of our health care and public health systems in this country. This overconfidence comes in part due to willful ignorance and in part due to leaders who want the public to believe they've got things more under control than they actually do. The reality is that we have significantly underinvested in public health for decades.
The lack of infectious disease outbreaks gave the public the idea that public health was no longer a concern and policymakers capitalized on this by taking away funding for public health. The annual budget for the Centers for Disease Control and Prevention is about $11 billion. To put that number into perspective, there is a chance that Americans could spend close to that amount on Halloween festivities this year.
The state of public health funding at the state and local level is even more dire. Many public health departments in the past few years have had to cut critical programs and initiatives due to dramatic funding cuts. There is no other way to slice it — our public health system is not ready to deal with a challenge like Ebola if the situation takes a turn for the worse.
Americans also have an overconfident view of our health care system as a whole. The reality is that the surge capacity of our existing health care system is limited and any large-scale disease outbreak could overwhelm that system. While we have plans to use portable pop-up hospital tents and beds to expand surge capacity, we haven't yet figured out how to create pop-up nurses and doctors to staff them. In addition, infection control in our hospitals is a concern. The SARS outbreak demonstrated just how hard it is to prevent the spread of some infectious diseases and how easy it can be for those diseases to spread in hospitals despite our best efforts to contain them.
The most significant panacea that gets waved before the public is a miracle vaccine. Given our success with vaccines in Western countries, the public assumes that vaccines can be developed and administered quickly. This is a naive belief that doesn't match with the facts. It could take a year or more to develop a vaccine for a novel infectious disease that could be ready for widespread use. In the interim, a disease would have free reign to spread through the population with a limited number of non-pharmacological interventions to stop it.
Our leaders seem to be so concerned about avoiding panic that they are willing to give the public any type of assurance to placate them. We were initially told that the current Ebola outbreak would be contained and wouldn't be that large. Now we are being told that estimates put the number that could get the disease at more than a million.
Sending 3,000 troops to West Africa is a Band-Aid solution to a much larger problem. In today's globalized world we can't pretend that diseases "over there in Africa" are no longer our concern. We also can no longer pretend that our country's greatest threats are from terrorists.
We need to change our world view (sooner rather than later) to appreciate that novel infectious disease outbreaks may be one of our greatest threats that require real resources and significant funding if we are to stand a chance.
David J. Dausey is the dean of the School of Health Professions and Public Health at Mercyhurst University and a former researcher at RAND Corp.
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