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What Did the U.S. Learn From Ebola? How to Prepare for Bioterrorist Attacks

The United States prepared for an Ebola crisis that never came. What it learned in the process was that it's not yet ready to confront a bioterrorist attack.

Medecins Sans Frontieres (MSF) medical staff wearing protective clothing treat the body of an Ebola victim at their facility in Kailahun, on August 14, 2014. Kailahun along with the Kenema district is at the epicentre of the worst epidemic of Ebola since its discovery four decades ago. The death toll stands at more than 1,000. The Ebola epidemic in West Africa claimed a fourth victim in Nigeria on August 14 while the United States ordered the evacuation of diplomats' families from Sierra Leone and analysts warned of a heavy economic toll on the stricken region. AFP PHOTO/Carl de Souza (Photo credit should read CARL DE SOUZA/AFP/Getty Images)

When the Ebola virus spread from Guinea to Sierra Leone and Liberia last spring, the initial international response was labeled a failure. By the time President Barack Obama ordered troops to the affected countries in September, more than 2,400 people were dead.

But in the United States, where major hospitals prepared for an outbreak, there were only four in-country diagnoses, one of which resulted in a death. And some see the urgency of that response as a lesson in how the government can prepare for another public health hazard: a bioterrorist attack.

Arizona Rep. Martha McSally chairs a House subcommittee that will examine over the next few months the threat of bioterrorist attacks and U.S. preparedness to respond to them. She told Foreign Policy that even if a disease outbreak and the use of a biological agent in a coordinated attack are not completely analogous, the response strains similar systems.

“We can learn lessons from other outbreaks that are naturally occurring,” she said. “We can identify weaknesses in our response and even if it wasn’t terrorism, it presses the system at the same level.”

What McSally and her colleagues saw as the biggest failure in the response to Ebola within U.S. borders was lack of central command. Bureaucracy, she said, got in the way of providing an effective response for Americans nationwide.

And that Ebola czar Obama named?

“He was a messaging social operative more than anything,” McSally said.

Leonard Cole, an expert in bioterrorism who also teaches at Rutgers Medical School, reiterated McSally’s concerns about comprehensive national protocol.

In a conversation with FP, Cole noted that in New Jersey and California, for example, governors ignored Center for Disease Control guidelines and insisted those under observation for Ebola stay quarantined for a full 21 days. The CDC said monitoring was certainly necessary, but total quarantine wasn’t always required.

According to Cole, that contradiction was a major breach of protocol for confronting a public health threat. “Rule No. 1 is there has to be an orderly and consistent manner of informing the public,” he said.

In 2010, a commission set up to assess national security responses gave the United States a failing grade on its ability to a confront a bioterrorist threat.

Today, McSally said, the United States is still only prepared to confront a fraction of the 15 potential biological agents that could be released in an attack. What the Ebola response taught the government, she said, was that effective communication isn’t optional next time. And the White House needs to prioritize the naming of a single coordinator for agencies responsible for responding to such an attack.

A biological threat from the Islamic State or al Qaeda is not necessarily immediate, McSally said, but there are three phases of biological attacks to take into account: isolation, weaponization, and dispersion of the agent. She said many U.S. cities currently would be left scrambling to respond.

New York, for example, is better prepared for an attack or pandemic outbreak than other cities because its budget allows for trial runs of emergency response systems. But even New York would need a significant increase in federal funding to prepare its entire population for such a scenario. And then there are rural areas to take into account, which would face entirely different challenges.

“We can’t possibly expect every single hospital in every single rural area to have the ability to respond to this,” she said.

The solution, she thinks, might instead be setting up regional response stations and transportation systems that could evacuate those in need of medical help.

Cole told FP that responding to anthrax scares in 2001 also prepared the United States for future attacks. But “honestly, the average physician is not thinking of anthrax or Ebola today,” he said.

McSally, who served 26 years in the Air Force, said preparation for a bioterrorist attack can only begin when Obama is willing to give someone the job. And trying to learn from mistakes made during the Ebola response sadly reminds her of an old military joke: “We call them lessons learned,” she said. “But really they’re just lessons identified until we actually learn from them.”