Did Austerity Abet the Ebola Crisis?

(AP Photo/Brynn Anderson)

Licensed clinician Hala Fawal practices drawing blood from a patient using a dummy on Monday, October 6, 2014, in Anniston, Alabama. The Centers for Disease Control and Prevention (CDC) has developed an introductory training course for licensed clinicians. According to the CDC, the course is to ensure that clinicians intending to provide medical care to patients with Ebola have sufficient knowledge of the disease.

 

 

Terry O'Sullivan is a professor of political science at the University of Akron. His research focuses on "the risk and dynamics of catastrophic infectious diseases threats from naturally occurring infectious disease outbreaks such as influenza and SARS, and from biological terrorism."

In this special podcast (transcript below) from Politics and Reality Radio, O'Sullivan makes two important points in his conversation with host Joshua Holland:

First, Ebola poses a minimal threat to a country like the United States, with a functional health-care system. We may end up with a handful of cases, but because Ebola is difficult to transmit from person to person, it will be contained.

At the same time, there are pathogens lurking out there that can spread through a population like wildfire, and we are woefully unprepared to meet such threats. 

Joshua Holland: Two polls have come out this week showing that two out of three Americans are really worried about Ebola. Now, [officials at] the Centers for Disease Control and most public health experts agree that there is very little chance of an uncontrolled outbreak occurring in the United States. We’ll get into more of that in a moment.

About 24,000 people die each year from influenza, on average—in peak years, it could be twice that number. So, there’s a disconnect between the actual risk and the perceived risk. Let me ask you: What do you think about the media coverage you’ve seen so far?

Terry O’Sullivan: Well, it’s varied considerably. It really has ranged from reasonably informed and responsible to tremendously irresponsible and demagogic. So, I think basically it’s a mixed bag, but unfortunately, especially in the last few days, it’s leaning toward a little bit more hysteria than is good for us.

Joshua Holland: Now, I recall that panic itself, independent of the characteristics of a disease, can make an outbreak much worse. Can you give us a sense of how that works—how fear itself is a risk factor for making an outbreak into a catastrophic outbreak?

Terry O’Sullivan: Absolutely. This can happen in a lot of different ways. The most obvious, of course, is a situation where people are generally afraid of a disease in a particular area, and [consequently] panic and leave the area—some of them carrying the disease with them. This has occurred throughout history in a variety of situations. India, for instance, back in the ‘90s experienced a [pneumonic] plague outbreak—not a big one, but big enough that hundreds of thousands of people fled the city. Had this been a bigger event, they would have essentially been taking plague to the hinterlands and spread it tremendously fast. This is definitely the biggest challenge, especially in a scary disease like plague or Ebola or the like in many areas, historically.

But the other problem is that panic tends to make people, obviously, irrational. It tends to make them less likely to listen to the authorities, more likely to do things that just don’t make sense. A lot of times it will be something perfectly innocent, like spending money needlessly on public health-related gear and personal protective equipment and so forth. The stock has risen considerably on the companies that make that stuff over the last couple of weeks. But it also can make people do things that are essentially going to spread the disease. And, as I say, getting out of town, getting out of Dodge, is kind of the biggest one. But there’s a whole host of things.

Joshua Holland: A big one we’ve seen in the three West African countries that have been afflicted very, very hard by this disease is that people are afraid to go and seek medical attention. The are the people who need to be isolated, who need to be getting treatment, but because they’re so panicked—and rightfully so, I have to say, in West Africa—they will avoid health-care workers and other things like that.

Terry O’Sullivan: Yup.

Joshua Holland: One of the other things that the polling has shown is that [proposals for] travel bans are very popular; the American people want a travel ban [for people who live in the West African nations where Ebola is spreading]. This seems like common sense. What is your view on a travel ban [for people] from West Africa?

Terry O’Sullivan: It’s a terrible idea, unfortunately. And this, again, is part and parcel of the idea of panic and over-reaction. Essentially, quarantines—especially forced quarantines—and travel bans have, historically, not worked. And it’s very important to emphasize here that this is something that is going to be very counter-productive. This going to make the epidemic and, as the case may be, the pandemic worse. And the reason is that those countries are already in a fragile state. They are some of the poorest countries in the world, to begin with, and they are going to be in danger of having their economies and even their political systems collapse.

I think people can find resonance in this idea by looking to examples like Somalia, historically, and other failed states. When you get a failed state, you essentially get lawlessness, and not just political violence, but also people who are unchecked and not within systems that would be required to bring an epidemic like this into bay. We really don’t want those countries to collapse and have refugee populations streaming across their borders because keeping them quarantined physically is just going to be impossible. People will find a way to get out. To go back to the idea of panic, if we do this and the world is seeming to isolate them, people are going to be much more inclined to flee those countries, and to flee to other places in the world, stay below the radar, lie on questionnaires, etcetera, etcetera. And it is simply going to make this far, far worse. So this is far more than a political set-up or, as the case may be, an attack on the Obama administration; this is tremendously counter-productive.

Joshua Holland: We’ve learned in recent days that—I think you argue that there shouldn’t have been those transmissions in the hospital in Dallas, Texas. We learned, it was just reported... by the Dallas Morning News that hospital workers working with Thomas Eric Duncan, Patient Zero, they worked with him for two days without wearing any protective gear while they awaited confirmation of his diagnosis.

Terry O’Sullivan: Yeah.

Joshua Holland: And then we find out that they allowed the second nurse to get on an airplane and fly across the country, despite the fact that she was running a fever, which is a symptom, a potential symptom, of Ebola. Should we be reassured by this, that there would not have been any transmissions were it not for what seems like some really boneheaded moves? Or should we be alarmed that authorities seemed ill-prepared to do the most basic things to prevent the disease’s spread?

Terry O’Sullivan: I think the word is “concerned.” Honestly, the bad news is that we’ve kind of seen amateur hour at the Dallas hospital, and the Centers for Disease Control has clearly made some mistakes here, and they really need to get their act together. So, I certainly am concerned about that. But the learning curve, I believe, is going to be steep. The United States has really had no experience with this kind of thing, aside from the swine flu back in 2008, 2009, but in general we haven’t had things like the SARS outbreak like Toronto had, and Hong Kong, to be a shot across our bow. So we’re going to need to get our act together, and I think that the CDC is up for it.

But the bottom line is that most American hospitals and much of the system has not had to deal with something quite like this before, and so they’re going to have to make adjustments. So, I’m concerned that they didn’t make them sooner, but I think that they will happen. And, again, I don’t think this is any reason for panic. I think that we will be able to get this together. But, among other things, these cases are clearly going to need to be sent to the people who know what they’re doing at the four federally-overseen Bio-Safety Level 4 hospitals around the country—clinical environments. So, we’ve got to make sure that we don’t put any of these public or private hospitals that are really not prepared for it in the line of fire now.

Joshua Holland: And a Bio-Containment Safety Level 4 is the elaborate systems we have with negative air pressure to keep bugs from seeping out. Here’s the broader question, and this is totally in your wheelhouse and field of study: How prepared are we to deal with a potentially deadly outbreak of Ebola? Laurie Garrett wrote a seminal book on public health systems called Betrayal of Trust; you assigned it in your class. She wrote in the Washington Post last week it’s a myth that we have significantly improved our capacity to respond to infectious disease outbreaks following the attacks of 9/11. Is that your view—is it a myth?

Terry O’Sullivan: To some extent it is. I would disagree with a hard-line statement like that; in some ways, we’re better prepared, clearly. You know, we’ve got the Strategic National Stockpile [of medicines and equipment], which has its own issues, but there are some areas where we’re better prepared. But I think it’s very important to emphasize here that we have been starving public health in the last 10 years—since 9/11—despite the 9/11 attacks and the anthrax attacks. The World Health Organization has had its income significantly reduced, including by the U.S. Congress, and the CDC and the National Institutes of Health have also had their real-dollar income reduced significantly.

This is a classic situation where the lack of a fire has led people to short-change the fire department. And we’re finding out the peril of that at the moment. So, one of the biggest things that needs to come out of this is a recognition that public goods are critical for the functioning of any nation—including the United States. The private sector cannot step in to fill all the gaps here, and we have to have a good, robust public-health sector, as well as a medical-response capability—domestically and internationally—to be able to deal with these things, because the world is a very small place. Globalization has been tremendously enriching for the world—at least for some people—but the bottom line is that people could be anywhere in the world fairly quickly, and diseases spread too quickly, so we have to have a fire department ready to roll.

Joshua Holland: Yeah, we say austerity kills... The head of the National Institutes for Health said last week that we would probably have an Ebola vaccine by now, had it not been for cuts to that agency’s budgets. I want to stay on this topic a little bit more.

We’re unique among wealthy countries, among first-world countries, in terms of how much we rely on the private sector for the delivery of health care in general, in the OECD—the so-called rich countries’ club—about 40 percent of health-care spending is private. In the U.S., those numbers are reversed; about 60 percent is private and 40 percent is public—these are rough numbers. How specifically does this affect our ability to respond to catastrophic disease outbreaks?

Terry O’Sullivan: I think there’s little question that it has negatively affected it. Part of the problem these days is that just-in-time health care in general—public- and private-sector—has led to reductions in staff and capabilities and equipment, and things like that, which has essentially reduced the surge capacity of the nation as a whole. So, in other words, it’s essentially a business model that has become more profitable, and [created] a lot of very profitable, for-profit medical systems, but the bottom line is that we’re not capable of dealing with surges in demand that might occur from something like this. So the system is more efficient, in a sense, but it is far less able than it was before to accommodate a big increase [in patients] or a crisis that might arise. Again, we’ve got to build some more fat into this system. Wherever it comes in, it’s got to be more capable of dealing with these unexpected surges, or we are going to get caught flat-footed. And another thing that I think is very important to emphasize here, Joshua, is that this is the shot across the bow. This is not the big one. Ebola will be able to be contained. We might get a handful of cases—maybe a dozen or a few dozen, at most, by next year. But this is not the H5N1 influenza. This is not something that’s going to race through the population. But we’ve got to be prepared for those eventualities because they’re sitting out there as potential major threats, both to the United States in general, but also to world trade and so forth.

Joshua Holland: And they say another global influenza pandemic, such as we saw in the early part of the 20th century, when our troops were coming home from World War I, is not a question of “if” but “when.” I think it’s important to point out what you’re saying: We have an efficient health-care system, and this is an area where efficiency isn’t really good for our health. Surge capacity, which you mentioned, is excess capacity that you don’t normally need.

Terry O’Sullivan: That’s right.

Joshua Holland: And if you look at what the private sector’s incentives are, it is not to have stuff there sitting around for an eventuality that you may or may not need.

Terry O’Sullivan: Precisely.

Joshua Holland: Before I let you go: How is it that a disease that is not that easily transmitted has spread like wildfire across these three West African countries? And why has the same disease been so well-contained in Senegal and Nigeria? The World Health Organization says those countries are about to go 42 days without a new infection, at which point their outbreaks will be declared over.

Terry O’Sullivan: I think the most important variable here is, without a doubt, the competency of the health-care systems, and just the governmental responses in general in a broad sense. The three countries that are most affected—Liberia, Guinea, and Sierra Leone—are three of the poorest countries in the world, and they just started out well behind the curve in the very beginning. Their health systems were terrible just for day-to-day diseases like malaria and gastro-intestinal diseases and so forth. And they were not able to deal with anything that posed a major surge, and this has just devastated them. But Nigeria has a better system [although] Nigeria has a lot of issues that could make it a very dangerous place if Ebola ever got a foothold. But the Nigerian government jumped on this quickly, realizing the threat—and the same with the Senegalese government. They’re screening people at the border, they’re making sure that people’s contacts are traced, and doing good basic public-health work to stamp it out—because that’s essentially what any country has to do, ours included. Just to make sure that anybody who’s suspected of having it, or who actually has Ebola, is isolated and kept under surveillance for however long it’s required, and that’s how you break the chain of transmission. Senegal and Nigeria did that. But the sad fact is that we could have nipped this in the bud back in the spring of this year, if we had had a robust international response. But with the sequester and the budget cutbacks to the WHO and the CDC and the NIH and so forth, we did not—and the world community did not—muster a full-scale response to this, and we’re paying the price.

Joshua Holland: Folks, in Sierra Leone, there are 304 hospital beds for Ebola patients.

Terry O’Sullivan: Yup.

Joshua Holland: The New York Times reported this week that, basically, “patients are slowly dying at home, untreated and with no place to go.” They’re being treated, of course, by family members who are not well-trained. They’re not wearing personal protective equipment. It’s a disaster.

And the thing is, what people need to understand is, in order to guarantee our own safety, we’ve got to address the very, very serious crisis going on in these three West African countries. Because of globalization, this is not one of these things where we can say, “This is their problem.” It is our problem. And as we see a handful of cases cropping up here in the United States, I think that’s becoming clearer and clearer.

Terry O’Sullivan: Yes. The thing to know, obviously, is that the United States has been the biggest beneficiary of globalization in the world and, because of that, we have a responsibility, both from an ethical standpoint and from a self-interested standpoint, to make sure that that system is not disrupted by this. You’re absolutely right; we have to stamp it out at the source—or otherwise it’s going to get worse and worse, and it’s going to come back and make it worse here, as well. 

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