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As epidemic escalates, can U.S. aid for Ebola be deployed quickly enough?

September 16, 2014 at 6:10 PM EDT
How effective will new U.S. aid and military support be in fighting Ebola? Laurie Garrett of the Council on Foreign Relations and Lawrence Gostin of Georgetown Law School join Judy Woodruff for a deep dive into the plan. Then special correspondent Fred de Sam Lazaro offers an update from Nigeria, a country that has been relatively successful in controlling the deadly virus.

JUDY WOODRUFF: Let’s dive deeper now into the president’s plan to ramp up the response to the Ebola outbreak and to try preventing a humanitarian catastrophe.

It comes amid prior criticism of the administration, along with the WHO and of other countries, for not doing more and for not getting it done faster.

We turn back to two who have been closely watching this and speaking with government officials in recent days.

Laurie Garrett of the Council on Foreign Relations, she has written widely about Ebola, including the books “Betrayal of Trust” and “The Coming Plague,”and Lawrence Gostin of Georgetown University.  He’s the director of the O’Neill Institute for National and Global Health Law.

And we welcome you — welcome both of you back to the program.

Laurie Garrett, to you first.  What is your assessment of the president’s plan that he outlined today?

LAURIE GARRETT, Council on Foreign Relations: Well, it’s a bold step forward.  I’m delighted it’s actually taking place.

But I think everything depends on the haste with which we can mobilize.  And I am afraid a lot of people don’t understand that committing troops and saying you’re going to build a hospital are all very good steeps, but it takes weeks to execute these things.  And, in the meantime, the epidemic is doubling every 10 to 20 days.  We don’t have a lot of time.  We’re racing against a clock.

JUDY WOODRUFF: Lawrence Gostin, do you have the same concerns?  What’s your assessment?

LAWRENCE GOSTIN, Georgetown Law: I think Laurie is right about timing.

First of all, I am very proud of my country.  I mean, we have stepped forward when no one else would or could.  But there are major unanswered questions.  It’s not just timing, but also command-and-control.  There’s chaos on the ground.  It’s uncoordinated.

I was very pleased to see the president say that we have a command post, but how are we going to command Chinese or Cuban workers?  I do think we need a U.N. Security Council resolution to actually have the kind of international legitimacy that we need.

JUDY WOODRUFF: So going beyond what the U.S…

LAWRENCE GOSTIN: Yes, the U.S. can’t do it alone.

JUDY WOODRUFF: Well, let me just go further here with what the U.S. is doing.  You said you’re proud of your country.  What specifically do you think is going to make the most difference here?

LAWRENCE GOSTIN: Well, I think the most difference will be training health workers, although — and building health facilities in the community, contact tracing.  All of those things are very important.

JUDY WOODRUFF: Meaning going back and finding out where…

LAWRENCE GOSTIN: Meaning going back, finding out who has been in contact with whom, and quickly isolating them in safe conditions.

One of the big problems, though, is, is that even once we have built these treatment facilities, it’s going to be handed over eventually to the Ministry of Health in Liberia.  And they just don’t have the health workers.  The doctors and the nurses have been decimated.  And so we really do have a huge infrastructure task.

JUDY WOODRUFF: Laurie Garrett, you laid out your concerns, but of what has been announced, how do you see this unfolding and making any difference?

LAURIE GARRETT: Well, first of all, we don’t have any commercial flights landing in the area now.  And so just getting doctors on the ground, getting medical supplies, keeping stocks in place of such simple things as latex gloves to protect you from infection have all proven daunting, in the absence of real solidarity from neighboring countries and the willingness to have planes land and commercial flights.

So one huge role for the U.S. military is going to be helping Ghana, which has very kindly and generously agreed to be the air bridge for all supplies and human movement into the area, to extend their runway, build their airport up, have logistic and supply operations in place, and then to have smaller flights go from Ghana into specific targeted areas carrying supplies with them as needed.

But Larry points out a crucial problem with all of this.  We don’t have a central command, which means we don’t even have a centralized list of what’s needed.  Who needs latex gloves where?  Is the situation more dire in this county in Sierra Leone or in this county in Liberia?  Where do we need to deploy people first?

We don’t have that kind of operation in place.  And our U.S. military is not going to play that role.  We will have a central command, but it will be commanding U.S. military personnel, not people from other countries and certainly not the Liberians themselves.

And we also see that the response is not a regional one.  We are, unfortunately, dividing our response according to kind of old colonial ties.  So the French are focusing on Guinea, which used to be a French colony.  The United Kingdom is focused on Sierra Leone, which is settled by the descendants of British slaves who came from the Caribbean, and we’re focused on Liberia, which is settled by former American slaves.

And so there’s this sort of distasteful neocolonial feel to things, and it means that the responses are not unified.  They are very divided by country.  So you have heard of 165 Cuban responders and 59 Chinese.  They’re all going to Sierra Leone, where they will be under we don’t know what kind of command, loosely coordinated by the Sierra Leone government.

JUDY WOODRUFF: And, Lawrence Gostin, this is sounding like a very complicated effort, which we already knew, but it sounds even more complicated listening to the two of you.

What about the timing of this?  How long is it going to take to begin to make a difference, to begin to get to the people who need treatment and are not receiving it?

LAWRENCE GOSTIN: Well, first of all, we are very late to the game.  The fire has nearly burned the house down, and we have arrived.  The cavalry has arrived.

It will take a long time, I think, to build the kind of facilities that we want.  I mean, the whole idea, for example, that we’re sending 500,000 home kits suggests that we can’t get people into hospitals quick enough to treat them and isolate them, and people who…

JUDY WOODRUFF: These are self-testing kits?

LAWRENCE GOSTIN: These are self-testing kits or self-protecting kits.  I’m not sure the community will know what to do with them when they get them.

And so this is a — this is a makeshift response to a huge humanitarian crisis.  I don’t think it had to come to this, but now that we’re there, I’m really glad the see the United States military involved.

JUDY WOODRUFF: So, Laurie Garrett, should we be pleased that this is happening or more worried because it’s not the holistic response that I heard you describing that’s necessary?

“…if we can’t get a response on the ground immediately, effectively, across the region … then we’re talking about something equivalent to the Black Death’s impact on Tuscany and Florence in 1346. “

LAURIE GARRETT: Look, I’m delighted, like Larry, to see my country step up to the plate and play a role.  And I’m hoping that we can save lots and lots and lots of lives and bring this epidemic under control.

But I agree completely we’re late to the game.  And if you just do the math, based on the statement made today by WHO, a doubling time every 10 to 21 days, and you take the number of actually identified and suspected cases existing now and do your math, you can see that if we can’t get a response on the ground immediately, effectively, across the region, we will be looking at a quarter of a million cases by Thanksgiving, and 400,000 by Christmas if this is not abated and brought under control.

And then we’re talking about something equivalent to the Black Death’s impact on Tuscany and Florence in 1346.

JUDY WOODRUFF: Sobering, sobering any which way you look at it.  We appreciate both of you joining us.

Laurie Garrett, Lawrence Gostin, thank you.


JUDY WOODRUFF: And one country in West Africa that has had relative success in controlling this virus so far is Nigeria.

While this nation has had 21 confirmed and suspected cases of the Ebola virus, including seven deaths, it has not had an explosive surge and spread since its first victim was reported in late July.

Our special correspondent, Fred de Sam Lazaro, is on assignment in Lagos, and he checked in with us earlier today.

FRED DE SAM LAZARO: Nigeria is Africa’s most populous country.  It has the largest economy on the continent and its commercial capital, Lagos, has 20 million inhabitants, all of which have raised concerns that an Ebola outbreak would be catastrophic.

But that hasn’t happened, in part due to an early break, and in large part due the a good public health response, experts say.  The virus was first brought to Nigeria by a Liberian traveler who fell ill at the airport, and, in a peculiar twist of fate, medical doctors were on strike when he was taken in for health care.

That exposed far fewer health workers to the virus, and health care workers have been especially hard-hit during this epidemic.  They have contracted the virus and they have passed it on to their patients.  Despite its reputation for chaos and dysfunction, Nigeria has launched a very sophisticated response to Ebola.

Everyone entering the country, including this reporter when we arrived yesterday at the airport, is screened for any symptoms.  Those with an elevated fever, for example, are taken in for secondary screening to make sure it’s not related to Ebola.

There’s a call center where people can report suspected cases, and a concerted public awareness campaign that has kept fear from turning into panic.  And a sophisticated surveillance system has enabled this country to trace and keep track of all cases and people with whom they came into contact.

All of these cases have been directly traced to that original index case, the Liberian traveler.  This is reassuring, but at a time when there’s so much travel and when the virus is running amuck in other parts of West Africa, Nigeria is nowhere near being able to declare victory.  A lot of fingers are still crossed tightly here.

JUDY WOODRUFF: And we will have more of Fred’s reporting from Nigeria in the coming days.