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If U.S. pulls global health support, prepare for another Ebola wildfire

Editor's note: Two years ago, RTI expert Pia MacDonald recommended steps at global, state, and local levels to empower communities to stop the spread of diseases, such as Ebola. Below is the piece that she wrote from her experiences combating Ebola in Congo.

Imagine your home is in a forest. The fire department protects your house but not the forest around it. As long as a fire starts in your home, you can count on firefighters for help. If it starts in the forest, you might be at terrible risk because no firefighters are present.

This is the scenario with Ebola, a virus that causes an illness so severe that it is often fatal to humans.

It took 17 days for the Democratic Republic of the Congo (DRC) to report the current Ebola outbreak in a far-flung region of the country. The epicenter is 800 miles and a 2 to 3 day journey from the capital of Kinshasa. These 17 days allowed a viral spark to smolder and opened the potential for a 5-alarm global fire.

In the United States, it has taken more than 10 years and billions of dollars to enhance our public health preparedness infrastructure to effectively prevent, detect, and respond to threats.

Most countries, however, have fewer and less sophisticated resources to adequately respond to health threats. For example, the DRC—having fought regular Ebola outbreaks since the virus was discovered in 1978—is considered the gold standard responder in Africa. Despite this experience, the fact remains that it still took them more than two weeks to alert international authorities and mount a response. In places like the DRC, surveillance officers often lack basic items like phones or transportation to follow up on suspected cases.

In 2014, the Global Health Security Agenda (GHSA) elevated global health security to a high-priority issue. It provides a framework for countries to prevent, detect, and respond to public health emergencies of international concern.

The GHSA is a vital effort to ensure the security of our country and requires investment by the United States and other global leaders for its continued funding and sustainability.

However, to date, only about one-third of participating countries report fully achieving these core capacities. The other two-thirds have not been able to meet these goals primarily because of weak public health infrastructure.

And now, after just four years of GHSA’s efforts, the United States is threatening to pull key financial and technical support.

In the DRC, the U.S. Centers for Disease Control and Prevention (CDC) may have to withdraw its country office and boots-on-the-ground technical support due to budget constraints. Imagine the difficulties of countries with weaker public health infrastructure and no support from wealthier, more equipped nations.

The GHSA is a vital effort to ensure the security of our country and requires investment by the United States and other global leaders for its continued funding and sustainability. Despite plans by other nations like the United Kingdom, Japan, and Finland to step up, U.S. funds are close to being depleted, and there are no plans to sustain this critical commitment.

While U.S. policy makers might see this move as diverting funds to more domestic concerns, we know that threats like Ebola can travel like wildfire. This means that if one country is at risk, we are all at risk. It is our public health and moral responsibility to vigorously support the GHSA to ensure the health of our people and our national security.  We need to increase funding for the National Institute of Health’s Fogarty International Center, enact a permanent public health preparedness fund, and mount a massive global effort to help all countries meet the International Health Regulations.

Pia MacDonald, PhD, MPH, is a senior director and epidemiologist at RTI International. She has two decades of domestic and international public health and epidemiology experience and serves as principal investigator and/or project director of large projects funded by the CDC in the areas of public health preparedness, infectious diseases, surveillance, global health, and global health security. She is an adjunct associate professor at the University of North Carolina and author of the book, Methods in Field Epidemiology.

Disclaimer: This piece was written by Pia MacDonald (Senior Director, Applied Public Health Research) to share perspectives on a topic of interest. Expression of opinions within are those of the author or authors.