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September 26, 2014

Lessons learned from the Ebola outbreak

This sign, photographed in West Africa earlier this year, was put up in an effort to curtail Ebola transmissions. Image credit: CDC Public Health Image Library

Recent CDC estimates of the extent of the spreading Ebola outbreak have shaken a rather complacent industrialized world. The current crisis will reveal new information about Ebola and how it spreads. It will also offer an important lesson about public health preparedness and response. Poor disease surveillance infrastructure and inadequate health care systems serve to accelerate the epidemic. The average citizen in the currently affected regions has virtually no access to trained medical practitioners or access to care that might be life-saving. The average village served by an inadequately staffed and prepared district health office has almost no ability to track and contain incident cases. 

If Americans want to know why Ebola quickly got out of control, they should look no further than the neglected public health system. Building and sustaining infectious disease surveillance capability requires funding of the kind that most resource-strapped countries cannot find. Unfortunately, those with the resources tend to ignore surveillance systems and the disease prevention they provide until a crisis hits. By then, the cost of intervening is exponentially higher—both in terms of dollars and lives. Indeed, some warn that the cost of this outbreak may be civil order itself. An ounce of prevention would have been worth a pound of cure, at least.

Doctors in Nigeria receiving Ebola treatment training from the World Health Organization. Image credit: CDC Public Health Image Library

Investing in core public health infrastructure, like infectious disease surveillance systems, pays exponential dividends over the years. If it comes to the U.S., Ebola will be detected and contained because our state and local public health agencies, working in tandem with their health care partners and the CDC, will rapidly detect cases, report them, follow them and treat them. In the affected West African countries, there was virtually no detection until hundreds of cases had occurred. Reporting was slow and ineffective. Treatment was problematic at best and non-existent at worst, and the latter was by far the most common. No one conducted contact tracing to follow up and check on those that had been near those sickened with Ebola, because there was no public health workforce trained for this specialized work. 

I hope the U.S. Congress takes heed of this unfolding crisis and sustains a robust public health workforce and disease surveillance infrastructure, both here and in developing nations. Without it, all of us will face more death and dismay from Ebola or other infectious diseases. The lesson for the U.S. is that we must continue to invest in our public health system. Over the past two years, the IOM released three reports under the banner title “For the Public’s Health.” The third report focused on recommendations aimed at building a stronger public health system. Today’s Ebola outbreak provides the example justifying further investment in the U.S. public health system’s foundational capabilities. 

Bill Brand and Jim Jellison contributed to this blog post.

David A. Ross, ScD

President/CEO of the Task Force for Global Health, former director of PHII