Attachments
Tiaji Salaam-Blyther Specialist in Global Health August 26, 2014
Summary
Ebola virus disease (Ebola or EVD) is a severe, often fatal disease that was first detected near the Ebola River in the Democratic Republic of the Congo (DRC) in 1976. Originating in animals,
EVD is spread to and among humans through contact with the blood, secretions, organs, or other bodily fluids of those infected. It is not transmitted through the air. On March 22, 2014, the World Health Organization (WHO) announced that 49 people had contracted EVD in Guinea, West Africa, and 29 of them had died. As of mid-August, the virus had quickly spread to Liberia, Sierra Leone, and Nigeria.
The Ebola virus that is circulating in West Africa is not new, but the current Ebola outbreak has infected and killed more people than all previous Ebola outbreaks combined. As of August 20, 2014, the WHO reported that 2,615 people had contracted the disease, of whom over 1,427 have died, slightly less than the combined cases (2,387) and deaths (1,590) from previous outbreaks.
Although there are no drugs proven to prevent or treat EBV, health experts know how to contain it. The disease is spreading, however, because the health systems in the affected countries are ill-equipped to undertake requisite containment and disease surveillance measures. Years of neglect and armed conflict have weakened infrastructures, including health systems, in the affected countries, most prominently in Sierra Leone and Liberia. WHO estimated that the outbreak had likely begun in December 2013, but was belatedly reported in March 2014 due to poor disease detection and surveillance capacity.
In July 2014, two U.S. citizen health workers contracted Ebola in Liberia and were first provided medication that had shown promise in animal studies but that had not yet been tested in humans.
They were evacuated to the United States to receive additional care. Debate in the United States has ensued regarding entry and exit rights of people infected with communicable diseases; whether the international community (including the United States) had responded early and effectively enough to contain the virus; the appropriate use of experimental drugs that had not yet been tested for human safety and effectiveness, including how to choose recipients of scarce and sometimes costly drug supplies and how to arrange dispensing to allow analysis of safety and effectiveness; and feasible approaches to accelerating drug and vaccine development and the scale-up of manufacturing capacity for investigational products.
The apportionment of most U.S. global health aid is determined by language in appropriations legislation and their accompanying conference reports, which direct the majority of health aid at particular diseases, leaving proportionately fewer resources for broader health system strengthening activities. While deliberating the appropriate response to ongoing Ebola outbreak, as well as FY2015 appropriations, Congress is likely to discuss how to balance support for bolstering weak health systems while directly addressing the health effects of Ebola. The FY2015 budget includes a $45 million request from the Centers for Disease Control and Prevention (CDC) for the newly announced Global Health Security agenda and a $50 million funding proposal for pandemic preparedness efforts implemented by the U.S. Agency for International Development (USAID). The USAID FY2015 budget request is roughly 30% lower than the FY2014 appropriation. This report discusses these funding issues and examines other related concerns, including the impact Ebola is having on other health problems, such as maternal and child mortality, and the capacity of U.S. agencies to respond rapidly to unforeseen events, like the Ebola outbreak, in light of budgetary constraints and spending directives.