- By Michael MillerMichael Miller is a Washington, D.C.-based consultant and an adjunct associate professor at the Duke Global Health Institute. Previously, he was Republican Policy Director at the Senate Foreign Relations Committee, and served as senior advisor in the office of the secretary of health and human services, deputy assistant administrator for global health at USAID, and director for Africa at the National Security Council.
We are pleased to welcome Michael Miller to the Shadow Government team — and just in time. With the headlines talking about pandemic scares and health screening of VIPs visiting the White House, it is obvious that health matters have profound implications for foreign policy and vice-versa. Michael has just the right background and perspective to make sense of these issues and to help our leaders manage them more wisely. Welcome aboard.
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The news coverage of the Ebola outbreak in West Africa has left Americans reasonably unsure whether the threat is real or hype. In fact, it is both. The outbreak’s startling spread and high mortality rate is indeed a real crisis, but it is unlikely to pose a serious threat to Americans at home. Stark differences in natural, cultural, and capacity factors between West Africa and the United States, and the way the virus is transmitted among humans make it extremely unlikely that the United States will face the kind of crisis that has swept through Guinea, Sierra Leone, and Liberia.
The low likelihood of a serious threat to us from Ebola, however, does not mean we should be unconcerned. Though the story is becoming part of a hype-and-fizzle news cycle that contributes to dangerous complacency and even cynicism about the very real threat of a global pandemic, such as from H5N1 influenza ("bird flu" or "avian flu") that could mutate and become readily transmissible among humans, it still carries important lessons.
Like bird flu, Ebola is an animal virus whose novelty among humans makes it highly pathogenic. But Ebola is spread only through direct contact with body fluids of an infected person, and a person directly exposed to Ebola is not contagious if he or she shows no symptoms, which makes travel possible and screening and response relatively straightforward, if admittedly challenging, for competent authorities.
By contrast, a traveler infected with a mutated bird flu could be asymptomatic yet contagious for days, giving no indication of the acute public-health threat they represent and rendering global point-of-entry-focused security measures dangerously ineffective. This scenario is the most common one discussed regarding a potential global pandemic — it’s not far-fetched and should be added to the growing list of things that keep a president up at night.
For its part, the Obama administration has responded to Ebola appropriately thus far, and has not treated the situation as a crisis it shouldn’t waste. That said, a bit of "good crisis" thinking is perhaps in order to improve our ability to prepare for and respond to a future pandemic threat. Instead of allowing the "lessons learned" process around Ebola to default to a recommendation to simply spend more money — a typical Washington impulse — this crisis should be an opportunity to also honestly examine potential systemic weaknesses and advance policies that could be the difference between life and death for millions of people.
First, the White House should provide clarity about roles and responsibilities among U.S. government departments and agencies involved in health-security, both at home and abroad. Earlier this year the administration unveiled a Global Health Security agenda that sets the right tone and goals, but at least publicly is unclear about authorities, responsibilities, and accountability. In this case, the National Security Council (NSC) process of interagency refereeing and policy development cannot suffice for clearly established authorities and responsibilities at the department and agency level. A lack of clarity in this case can be dangerous, and someone has to be in charge and accountable to the public. There is no room for considerations of fairness or equity among agencies, and parochial rivalries should be dealt with forcefully.
Second, if ever there’s an area in which the United Nations system should work, it is to address global public-health threats. The World Health Organization (WHO) is bloated, politicized, and inconsistent in fulfilling its essential role. It is impossible to see how the necessary reforms could ever happen in the absence of forceful U.S. leadership. The president and his new secretary of health and human services have a sometimes-willing reform partner in current WHO leadership, and they should exploit the opening as fully as possible.
Third, the president should use this opening to champion the International Health Regulations (IHRs) and explain importance of these un-sexy, "one world"-sounding commitments that spell out countries’ obligations to each other on health-security. Adoption and adherence is voluntary, and the entire system is only as strong as the weakest links. It should be no surprise that three of those weak links are now battling Ebola. Now that the agenda for this week’s U.S.-Africa Leaders Summit has been overshadowed by Ebola, the president should direct the discussion toward an honest assessment of the failures around the outbreak, why adherence to the IHRs could make a difference, and how and under what circumstance we can help.
In cases of "lessons learned," the default course for government tends to be one that leads only to a plea for more spending — doing something different will take a commitment of effort and discipline that seem in short supply in Washington these days. By using the Ebola crisis as an opening for honest evaluation and real reforms, the president has the chance to address some critical deficiencies in our government and the weak global health-security system upon which we all depend.
Michael Miller is a Washington, D.C.-based consultant and an adjunct associate professor at the Duke Global Health Institute. Previously, he was Republican Policy Director at the Senate Foreign Relations Committee, and served as senior advisor in the office of the secretary of health and human services, deputy assistant administrator for global health at USAID, and director for Africa at the National Security Council.