Why an ‘America First’ approach won’t work in Ebola pandemic

The current Ebola epidemic has grown rapidly since April in the Democratic Republic of Congo, killing more than 1,700 people, with 2,438 confirmed cases. The outbreak was declared a level three emergency almost a year ago and was recently declared a public health emergency by the World Health Organization (WHO). The threat is compounded by the first confirmed case in Goma, a hub city with a population of two million people.  

This is the DRC’s 10th Ebola outbreak in 40 years and a reminder of the 2014-2016 outbreak in West Africa, which concluded with 15,261 confirmed cases and 11,325 deaths, spreading from Guinea to Liberia and Sierra Leone and eventually to Italy, Mali, Nigeria, Senegal, Spain, the United Kingdom and the United States. In addition to the massive human cost, the World Bank estimated Ebola costs of $2.8 billion in 2015 GDP for the initial three countries. Similar outbreaks of other diseases, including Zika, Swine Flu, Avian and Influenza, regularly occur and impose large costs locally.

For government officials in the U.S. focused on a policy of “America First,” the primary concern related to emerging infectious disease is the threat and potential cost to the U.S. Suggested policies often include travel and trade restrictions on countries experiencing outbreaks and a focus on domestic preparedness rather than foreign aid.

Travel and trade restrictions have limited effectiveness and may be counterproductive. In a globalized world, it is infeasible to perfectly screen travelers and commodities from individual regions. Additionally, restrictions disincentivize reporting of infections by local officials who fear economic and political consequences that can persist beyond an outbreak. Additionally, restrictions limit the ability of health organizations to fight outbreaks.

This is also the wrong approach from an “America First” perspective. Reducing the risk of an outbreak threatening the U.S. means rapidly responding to smaller outbreaks overseas and building healthcare capacity in hotspots for disease emergence. This can be done by working within existing health structures and developing new capacity. Examples of this approach include Doctors Without Borders (MSF) and the WHO, particularly through its Global Outbreak Alert and Response Network. These investments are a form of what economists call “self-protection.” By building capacity abroad, the U.S. reduces the probability of an outbreak reaching its own shores. 

Conversely an “America First” approach would focus entirely on what economists would refer to as “self-insurance,” where investments are made solely in the American health care system to build capacity domestically. These investments are justified—the U.S. would benefit from greater health care capacity, such as an increase in the number of nurses, hospital beds and trained staff. But they only reduce the consequences of an outbreak arriving in the U.S. Investment in both “self-protection” and self-insurance” would be ideal.

In both recent Ebola outbreaks, international organizations and donor countries attempted to respond rapidly. In 2014-2016 the U.S., the United Kingdom and Germany donated more than $3.6 billion (USD), and the U.S. government alone allocated $2.369 billion for response activities. The Center for Disease Control and Prevention (CDC) partnered with governments in West Africa to provide capacity and support services. The CDC trained health care workers both in West Africa and the U.S. during the outbreak and built laboratories in the original three countries to test for Ebola. Private organizations such as MSF have also made major contributions during both outbreaks, often taking a leading role.

But many of these investments are made as one-time contributions in response to a particular outbreak. They may be ill-placed for the next outbreak, and the funding may become more difficult to justify once the epidemic is over. Capacity may then be allowed to dwindle. If, for instance, new health care workers are not trained in infection control to replace those leaving the field, or labs and clinics lose their funding base.

The next outbreak then requires responders to rapidly build capacity, and outbreaks are occurring with increasing frequency due to climate change, urbanization and globalization. Additionally, investments may be hampered by a lack of trust-building with local communities, as people are understandably wary of sudden large foreign intervention that coincides with disease outbreaks.

Instead, donor nations should look to partner with international and private organizations to make more lasting, long-term investments in health capacity to prevent and quickly respond to outbreaks. The investment in a mobile “standing army” of capacity to respond to outbreaks in disease hotspots could have potential economic returns in response to diseases like Ebola, and, after large start-up costs, would only require investments to maintain existing capacity.

Kevin Berry is an assistant professor of economics at the University of Alaska Anchorage. He is an author on seven peer-reviewed academic papers on prevention and infectious disease. Follow him on Twitter @kberry6788.