- 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.
In light of his discomfort or even resentment of situations where he is compelled to assert American power by virtue of our unique capabilities or the failures of others, President Obama’s decision to deploy up to 3,000 U.S. military personnel to West Africa to lead and coordinate an international Ebola response was a real surprise. But as a response to an unfolding human catastrophe and threat to global health security, it’s hard to fault the President. As the potential extent of the outbreak and its humanitarian and public health implications became clear, he was surely faced with the reality of what it might mean in human and historical terms if he did not act.
As a military intervention and a priority among many threats, the picture is less clear. The decision drew immediate criticism as both a double-standard when compared to a resistance to committing "boots on the ground" to address more direct threats to American security, and one that belies assurances that Ebola is highly unlikely to threaten us. Unfortunately, even among those who support his decision, the president has only deepened the lack of understanding of his doctrine (or lack thereof) around the assertion of U.S. military power.
Although Operation United Assistance, as the Ebola mission is called, lingers in the shadows of the strikes against the Islamic State (IS) and of Ebola cases in the United States, and in spite of its "non-kinetic" nature, the mission is not without real risks that could thrust it to the forefront of the news and politics. U.S. personnel are entering the fray even before the true extent of the crisis is known, and the prospect of our military engagement coinciding with exponential growth of the crisis is now a real possibility.
CDC predicts that, absent successful intervention, we could expect anywhere from 550,000 to 1.4 million cases in the region by January. At an estimated 70 percent mortality rate, the upper end of the projections would thus be as many as 980,000 deaths in just a few months. Even a significant fraction of that number of deaths could precipitate a breakdown of the tattered social order, where institutions are distrusted and years of violence and fear have contributed to a disturbing level of denial and even hostility about the disease, expanding the crisis into areas unknown and exercising a strong pull on our military presence. It’s not clear how long our military expects to be on the ground, but standing by or even withdrawing as horror unfolds could put them – and the president – in a very difficult spot.
While relieved or grateful, nobody is happy that it has come to this, a situation where the U.S. government is the only institution that can answer the mail and our military now constitutes a thin green line between control of the outbreak and a true cataclysm. The full implications of that fact will not be clear until some time after the crisis reaches its zenith or its horrible end. But perhaps the most important lesson can already be drawn: it is necessitated by the failure of a global framework that is supposed to be an essential part of our own health security.
As I described in an earlier post on the topic, Ebola should be a wake-up call for American leadership to address disturbing weaknesses against the threat of other, potentially more deadly pandemics. This job cannot be tasked to "the international community," virtually ensuring no one views it as their responsibility. It must be led by the United States, and seek real changes to the framework whose dysfunction and impotence are a large part of what necessitated our military’s involvement.
Structural and resource deficiencies for which there’s no easy fix hobble the WHO-based system that would be at the center of a working global health security framework. But some of the biggest obstacles are political, with the question of money being especially perilous for a reform process that must be honest and specific about abilities, weaknesses, responsibilities, and accountability among all parties. The WHO, like Washington, confuses money with solutions and confuses budget increases with reforms. More troubling, though, is that it equates wealth with responsibility, creating and feeding dangerous notions that only donors are on the hook to fix problems and be accountable for failures. Absent real changes and reforms, money alone will do very little to fix the flawed framework, leaving us just as vulnerable and further in debt.
The president has shown leadership and taken real risks with the United States’ response to Ebola thus far. But his job will not be complete with the conclusion of Operation United Assistance. We should all hope that he shows similar resolve and leadership against the weaknesses in a global health security framework that represent a potentially much greater threat against which our military is as vulnerable as the rest of us.