This Is What Functioning Government Looks Like

After an embarrassing start, public-private sector leaders get their acts together on Ebola.

Jan. 6, 2015, 6:09 a.m.

When the first per­son dia­gnosed with Ebola on U.S. soil died in Oc­to­ber, I sug­ges­ted there was something scar­i­er than the pro­spect of an out­break. More alarm­ing than a Texas hos­pit­al’s mis­dia­gnos­is of Thomas Duncan. More threat­en­ing than a bur­eau­crat­ic snafu at the state health de­part­ment that delayed san­it­iz­a­tion of Duncan’s apart­ment. More wor­ri­some than the slug­gish pace of U.S. aid to West Africa, ground zero for the vir­us.

Of all the reas­ons to get hys­ter­ic­al about Ebola, what con­cerned me most was the so­cial pre­ced­ent. The ini­tial re­sponse re­minded Amer­ic­ans of the lim­its of crit­ic­al U.S. in­sti­tu­tions—in this case, vari­ous state, loc­al, and fed­er­al agen­cies and private-sec­tor health sys­tems that re­spon­ded to Duncan’s ill­ness slowly, in­ef­fi­ciently, and with a lack of candor that Amer­ic­ans, un­for­tu­nately, have come to ex­pect.

In short, the United States faces crises of lead­er­ship and trust. Which, to me, is the scar­i­est thing about the Ebola out­break. I’m far less wor­ried about the dis­ease strik­ing me or my loved ones than I am about what this in­cid­ent says about the na­tion’s abil­ity to sur­vive a true cata­clysm. Wheth­er the next ex­ist­en­tial event is Ebola or IS­IS or any of the count­less 21st-cen­tury hor­rors, we are only as strong as our in­sti­tu­tions—and our trust in them.

Since I wrote that column on Oct. 4, the in­sti­tu­tions ral­lied. Our lead­ers got their acts to­geth­er. Pres­id­ent Obama and con­gres­sion­al Re­pub­lic­ans, along with the pub­lic and private health sec­tors, de­serve cred­it for pos­it­ive steps taken since the Ebola crisis’s un­ac­cept­able start.

Two health care work­ers in­fec­ted by Duncan re­covered. Sev­en oth­er Amer­ic­ans were in­fec­ted with Ebola—all over­seas, and all but one re­covered. Most fam­ously, Dr. Craig Spen­cer fell ill after re­turn­ing from work­ing for Doc­tors Without Bor­ders in Guinea. While in­fec­ted, he used the New York sub­way and a car ser­vice, and went bowl­ing—all without trans­mit­ting the dis­ease. He is fully re­covered.

“Our best ex­perts thought that high-qual­ity health care could treat Ebola, but didn’t really know be­cause Ebola had nev­er been here be­fore,” said Ron Klain who was ap­poin­ted in the fall to be Obama’s so-called Ebola czar. Sit­ting in his of­fice over­look­ing the West Wing, Klain ticked off the ac­com­plish­ments of a co­ordin­ated pub­lic-private sec­tor at­tack.

  • “The num­ber of U.S. hos­pit­als cer­ti­fied to treat Ebola in­creased from three to 44.
  • “The num­ber of labs that can test for Ebola in­creased from 14 to 42.”
  • “The first-ever Ebola vac­cine com­pleted first-stage tri­als in Decem­ber, and 20,000 doses will be ad­min­istered in Africa in just weeks.”
  • A vol­un­tary self-mon­it­or­ing sys­tem for trav­el­ers was re­placed with an “act­ive mon­it­or­ing sys­tem” that routes any­one trav­el­ing from West Africa to one of five U.S. air­ports, where they are screened and giv­en a pre­pro­grammed cell phone with num­bers to call if they get ill. Each per­son is tracked by a state pub­lic health de­part­ment for 21 days. Trav­el­ers ex­posed to the vir­us get their tem­per­at­ure checked twice daily. Klain gets a daily up­date. On Monday, data were re­cor­ded on 98.9 per­cent of the people be­ing tracked.”
  • Con­gress took just five weeks to pass a $5.4 bil­lion pack­age aimed at pre­vent­ing fur­ther out­breaks. While the White House had asked for $6.2 bil­lion, Obama signed the bill, and Klain said the GOP made “reas­on­able changes.”“
  • In Liber­ia, Ebola treat­ment units were built by the United States on time, and the num­ber of news cases has dropped from about 100 per day to five or 10 per day. For all of West Africa, the epi­dem­ic is still rampant, al­though Klain said the num­ber of cases is be­low fore­cast

“The point here isn’t that the re­sponse has been per­fect,” Klain said. He noted that a lab er­ror at the Cen­ters for Dis­ease Con­trol and Pre­ven­tion in At­lanta may have ex­posed a tech­ni­cian to Ebola. In West Africa, Si­erra Le­one, and Guinea steep chal­lenges re­main. “But I think it is the case that the Ebola re­sponse has been co­ordin­ated, ef­fect­ive, and shown real res­ults.”

Klain said Obama de­serves cred­it for ig­nor­ing the clam­or for a West Afric­an quar­ant­ine, a step that might have helped the White House polit­ic­ally but that sci­ent­ists said would have made it harder to fight Ebola at its roots.

He also praised con­gres­sion­al Re­pub­lic­ans, par­tic­u­larly out­go­ing Rep. Jack King­ston of Geor­gia, who chaired the Ap­pro­pri­ations Sub­com­mit­tee that over­sees health care fund­ing. After los­ing is Sen­ate bid, King­ston helped steer the aid bill through the House while a lame duck. “He bus­ted his butt,” Klain said.

Fi­nally, Klain said the pub­lic and private health care sys­tems de­serve huge praise for treat­ing and con­tain­ing Ebola. “They took up the chal­lenge very ag­gress­ively,” he said.

Policy ahead of polit­ics? Bi­par­tis­an­ship? Com­pet­ent bur­eau­cra­cies? Klain at­trib­uted the Ebola re­bound to “the clas­sic Amer­ic­an at­ti­tude of people hold­ing up their hands and say­ing, ‘I’m will­ing to do it.’ “

The in­sti­tu­tion faring worst in all of this may be mine: The me­dia, which seems to flit from crisis to crisis like a moth against a well-lit win­dow, con­vert­ing fear in­to rat­ings and page-views.

Nu­mer­ous polls show the me­dia lead­ing an un­healthy trend: Stead­ily, over the past four dec­ades, the na­tion has lost faith in vir­tu­ally every in­sti­tu­tion that is key to a func­tion­al so­ci­ety: banks, school, col­leges, char­it­ies, uni­ons, po­lice de­part­ments, or­gan­ized re­li­gion, big and small busi­ness, and, of course, polit­ics and gov­ern­ment.

While no single event will re­verse or even nudge the trend, on Ebola — of late, any­how — U.S. lead­ers seem worthy of our trust.

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