“Officials are importing Ebola into the U.S.,” warned the popular far-right website InfoWars. Donald Trump, less than a year from becoming a candidate for President, tweeted:
The U.S. cannot allow EBOLA infected people back. People that go to far away places to help are great—but must suffer the consequences!
And:
The U.S. must immediately stop all flights from EBOLA infected countries or the plague will start and spread inside our “borders.” Act fast!
Trump would play a significant role in hyping the possibility of a mass Ebola outbreak in the US, firing off more than fifty tweets on the topic and raising it during his TV appearances.38 Thanks to the care provided by Emory’s experts, Brantly and Writebol were declared Ebola-free and released soon after receiving treatment—a development that generated far fewer headlines.
I had first heard about the outbreak of Ebola in West Africa several months before Brantly and Writebol were infected. At the time, I had instinctively viewed it as a horrible medical calamity that would be conquered with the help of public health professionals. This is what had occurred in every previous Ebola outbreak.
Only when I spoke with the UN’s top humanitarian official, Valerie Amos, did I realize that this time was different. Amos told me people were so scared of the disease that the UN was having trouble getting even its fearless humanitarian emergency staff to deploy to Guinea, Liberia, and Sierra Leone.
“Ebola is winning,” Amos said, with unusual panic in her voice. “We are not close to stopping it.”
I asked my mother, who at seventy was still a practicing physician, if she would consider doing a medical mission to West Africa. She answered with an emphatic—and unexpected—“no.” As she explained to me, “I want to be around to see Declan and Rían grow up.”
Only then did I appreciate the reflexive conclusion that even seasoned medical professionals were drawing: go near Ebola, and you could die.
SEEING THAT THE EPIDEMIC WAS SPIRALING out of control, in August of 2014, National Security Advisor Susan Rice assembled the President’s top advisers in the Situation Room to discuss how our government should respond. Gayle Smith had ably managed the US response from the White House up to that point, but she made clear that rapid action was needed, requiring decisions that could only be made by the individuals who ran the major government agencies. Tom Frieden, the director of the Centers for Disease Control and Prevention (CDC), briefed us that more people had already died from Ebola in Liberia alone than in the twenty previous Ebola outbreaks combined.
Frieden then passed around a single-page CDC handout we would soon begin referring to as “The Slide.” It showed a simple graph: the x-axis listed dates through January 2015, and the y-axis had the cumulative number of Ebola cases. The CDC was predicting an eye-popping spike in infections. Unless the doctors and aid workers attempting to prevent and treat the disease ramped up their response, The Slide indicated that the number of Ebola infections would continue to double every three weeks. This exponential spread would result in up to 1.4 million infections within five months.39
A full thirty seconds passed before anyone spoke. Perhaps sensing that the entire national security cabinet was in a state of shock, Frieden pivoted. “Ebola has always been beaten. Ebola will be beaten,” he told us. Frieden explained that Ebola patients needed to be temporarily quarantined from their communities so they would not infect their relatives and neighbors. If 70 percent of those with the virus could be isolated, we could bend—and ultimately end—the devastating curve of the epidemic.
Looking around the room, I noticed that almost everyone was still staring at The Slide.
In the flurry of meetings that followed, Susan surprised many of us by reporting that President Obama wanted to explore involving the US military in the response. He saw that those attempting to fight the epidemic in Guinea, Liberia, and Sierra Leone were overwhelmed. These countries had endured horrific conflict and made significant strides toward lasting peace, but they remained fragile, lacking the resources and expertise to contain the epidemic on their own. Obama recognized that unless their governments received help, Ebola would spread to additional countries in the region, causing a humanitarian catastrophe that would kill hundreds of thousands, including Americans who lived and worked in Africa. And, ultimately, Obama was concerned that without significantly more aggressive action, unsuspecting travelers with Ebola would end up making their way to the United States.
The Ebola mission being contemplated was like none undertaken before. But with talk of sending troops, Defense Secretary Hagel and Chairman of the Joint Chiefs Dempsey did what the military sensibly does when any new troop deployment is being discussed: they questioned whether soldiers would be given clear tasks that they had the mandate and means to accomplish.
“I keep hearing you all saying, our soldiers will ‘suit up’ and do this and that,” Hagel said in one meeting. “Suit up? What does that even mean? My guys have never even seen these HAZMAT suits, apart from in horror movies.”
Frieden and his staff at the CDC were big proponents of involving the US military because of its singular logistics and rapid deployment capabilities, but Dempsey pressed the public health experts to define precisely what the soldiers would do day to day once deployed to West Africa. Frieden responded that they would rapidly assemble what were called Ebola Treatment Units, the specially designed, tented field hospitals where patients could be treated.
“Hire the circus if you want to put up tents,” Dempsey said, demanding that the health officials offer more specifics.
Ultimately, Dempsey and the Pentagon planners devised a brilliant operation that the Chairman presented to the President—“a logistics mission with a medical component,” he stressed, “not the other way around.” President Obama then announced that he was sending some 3,000 troops to Liberia and ramping up each component of the US response. Drawing on the expertise of hundreds of USAID and CDC staff deployed to West Africa, the United States would facilitate the training of tens of thousands of local health workers to care for Ebola patients. We would create an air bridge to fly doctors, nurses, and supplies to the region quickly. And we would build the Ebola Treatment Units, which would allow up to 1,700 patients at a time to receive treatment.
Obama was providing an awesome demonstration of US leadership and capability—and a vivid example of how a country advances its values and interests at once.
In his remarks announcing the operation, the President made clear that the burden of responding could not just fall to the United States; other countries needed to do much more. His decisiveness gave those of us who worked for him what we needed to mobilize this international support. I invited the other UN ambassadors to the US Mission to hear from Frieden, who once again explained the stakes in his mild-mannered yet terrifying way. He described how Ebola had jumped across national borders, penetrated urban areas, overwhelmed clinics, and caused businesses and schools to close. He detailed how local burial customs had helped it spread. And most unnervingly, he walked the ambassadors through The Slide depicting the path to 1.4 million infections by January of 2015.
“I have never seen an infectious disease of this lethality spreading so fast,” Frieden said plainly, as diplomats from around the world transcribed his most quotable lines for the cables they would send back to their capitals. In his presentation, Frieden let nobody off the hook. His message, which I reinforced with the foreign ambassadors, was that each of us had a responsibility—no matter how big or small our country, no matter how substantial or minimal our financial means.
In January of 2000, during Richard Holbrooke’s tenure as ambassador to the UN, he had helped shift the public debate on AIDS in Africa by placing it on the regular agenda of the UN Security Council. Inspired by Holbrooke’s initiative, I gathered my team and floated the idea of convening an emergency session of the Security Council on Ebola. Many of my staff were skeptical that other countries would support the idea: the Security Council
grappled with matters of war and peace—it did not generally address public health emergencies. Because Russia and China typically objected to expanding the Council’s writ, I turned to the individuals who represented the imperiled West African countries.
After the ambassadors from Guinea, Liberia, and Sierra Leone filed into a small conference room at the US Mission, I expressed my sympathies and asked them how they were holding up. Some 23 million people lived in their three countries, and the epidemic did not discriminate; the ambassadors’ immediate families were in grave danger. I told them I was considering convening the Security Council on the epidemic, and that the US was prepared to introduce a resolution declaring Ebola a “threat to international peace and security.” We would use this resolution, the first of its kind, to call on countries to provide more money and health workers to combat the outbreak.
The three ambassadors swiftly embraced the proposal. “This can only help,” said Vandi Minah, the ambassador from Sierra Leone. “Anybody who says otherwise isn’t seeing their country—and their people—disappear before their eyes.” No UN member state would dare defy these ambassadors and protest the emergency meeting.
The diplomats and staff at the US Mission dropped whatever other work they were doing to get other countries to join Guinea, Liberia, and Sierra Leone as cosponsors of the US resolution. After securing one country’s agreement to sign on, I would try to create a friendly competition by immediately relaying the news to ambassadors from that country’s geographic rivals. “Chile and Brazil are cosponsoring,” I told my Argentine counterpart, whose foreign minister was generally suspicious of US-led initiatives. The ambassador soon called to tell me that her minister had instructed Argentina to become a sponsor too.
When I entered the UN Security Council chamber on September 18th, just two days after President Obama’s dramatic announcement that he was sending troops to the region, every red seat in the diplomats’ gallery was filled with ambassadors and high-ranking officials. Senior diplomats even sat scrunched together on the steps in the aisles.
I had reserved seats on the floor for Mum and Eddie. My mother’s love of medicine was so fervent that she had always hoped that Stephen or I would feel the same pull. Back when Eddie was still a practicing physician, he had championed the medical contributions made by the African diaspora. Since Ebola struck, he had been taking advantage of the fact that he had retired to lend his support to my African UN colleagues by helping them fundraise. In convening the meeting to appeal to the doctors and nurses of the world to help, I felt closely connected to my parents and their passions, and I hoped they felt their hand in our efforts.
After I sat down and prepared to gavel the meeting to a start, I scrolled through a stream of text messages that were pouring in to my phone: “We want to cosponsor.” “We are in.” “Count on us.” “Thank you for US leadership.” I showed the texts to Rabia Qureshi, the foreign service officer at the mission who covered West Africa. She shook her head in disbelief and told me that, at last count, we had a breathtaking 100 country cosponsors. Ten minutes later, we had 20 more. By the time the sponsors’ list closed, we had 134, the largest number of cosponsors for any Security Council resolution in the sixty-nine-year history of the UN.
I HAD WORRIED before the session that nothing we said or did in the meeting would succeed in conveying the gravity of the moment. “We have to find somebody to speak who can drive this home,” I had told my deputy chief of staff Sarah Holewinski. “We need somebody who is from there, who feels this.” Sarah had delivered, tracking down a thirty-nine-year-old Liberian health worker named Jackson Niamah who was working with Médecins Sans Frontières (MSF, or Doctors Without Borders) in Monrovia, the Liberian capital.
Niamah’s face appeared on a large video screen that descended from the ceiling of the Security Council chamber. The picture was blurry, the audio scratchy. One had the sense that the connection could go out at any time. But when this man on the other side of the world spoke, my fellow ambassadors—who usually multitasked during briefings—stared up at the screen, rapt.
Niamah said that when Ebola came to Monrovia “people began dying,” including his niece and cousin, both nurses, who passed away in July of 2014. “So many of my friends, university classmates and colleagues have died in recent months,” he said. “They die alone, terrified, and without their loved ones at their side.”
Niamah had signed up to work for MSF out of a sense of patriotism. His job was to assess patients and then help care for those diagnosed with Ebola. He described what it meant to have more infected people than the MSF clinic had beds. “We have to turn people away, and many are dying at our front gate,” Niamah said. “Right now, as I speak, there are patients sitting at our front gates, literally begging for life.”
He then went on:
One day this week, I sat outside the treatment center eating my lunch. I met a boy who approached the gate. His father had died from Ebola a week ago. I saw him with blood at his mouth. We had no space, so we could not to take him in . . . When he turned away to walk into town, I thought to myself that that boy is going to take a taxi, and he is going to go home . . . and infect his family.
Because Ebola was transmitted through fluids exchanged during physical contact, anyone the boy touched would likely become a casualty of his return.
Niamah pleaded for help. “There are still homes in Monrovia that do not have soap, water, and buckets,” he said. “Even those simple things could help curb the spread of the virus.”
Finally, he closed with an ominous warning: “We do not have the capacity to respond to this crisis on our own. If the international community does not stand up, we will be wiped out.”
The phrase echoed across the chamber, where diplomats sat without making a sound. “We will be wiped out.”
Niamah had made an abstract threat strikingly human and real. Still, each government was doing a cost-benefit calculus about the specifics of what they would contribute. For all the high drama of the moment, and all the support our Security Council resolution had earned, political leaders had experienced few costs for running away from Ebola. Even The Slide, by far the most powerful weapon I had in attempting to convince other countries to do more, was liable to cause despair and fatalism.
Speaking after Niamah, I addressed this head on:
These models show what could happen if we continue to let fear, inaction, or indifference drive our response . . . Models are forecasts of the future. But . . . it is we who actually determine our future. Individuals make history, not models. The United Nations was built for global challenges like this. That is why we are here.
As a young reporter, I had despaired over the inaction of UN peacekeepers in Bosnia. But I had come to understand that the UN was not a single entity, choosing to act or not act—it was a building where countries gathered. When confronting a crisis, individuals who helped lead those countries had to decide what they were prepared to do. If enough individuals could summon the will to chip in and work together, we could save millions of lives.
With this in mind, I urged the governments that had closed their borders to people coming from the infected countries to reconsider the implications of what they were doing. I said their reactions were understandable—driven by a desire to protect their own citizens from the spread of the virus. Rather than emphasizing the coldness of the restrictions, I focused on the fact that border closures put every country at greater risk. If medical personnel believed they would not be able to travel home after working in an Ebola-affected country, they would be less likely to volunteer to help. This would reduce the likelihood that Ebola would be controlled, in turn increasing the chances that the disease would spread to the very countries whose leaders were trying to keep their people safe. Like so many twenty-first-century challenges, Ebola was not a zero-sum fight in which some countries could “win” by pursuing their interests in a vacuum.
I had told the ambassadors from other countries not to take the floor if they
planned only to lament the seriousness of the epidemic. “Please don’t admire the problem,” I urged, repeating the expression I used with my staff and heard President Obama employ often. We needed to hear from those undertaking concrete actions.
As the session went on, there was no sweeter sound than to hear a colleague say, “I am pleased to announce today . . .” China, which was increasingly looking for ways to show off its superpower status, declared fighting Ebola “a common responsibility of all countries in the world” and pledged to send more money, supplies, biosecurity labs, and public health professionals. The UK promised an additional five hundred treatment beds in Sierra Leone (a contribution that might seem small, but that would prove important). Japan sent some 20,000 infection prevention suits for health care workers. The Swiss provided 14 tons of protective medical gear like specialized eye goggles and masks. Malaysia kicked in more than 20 million medical rubber gloves. Cuba sent its highly experienced team of 250 doctors and nurses trained in foreign disaster response. Uruguay promised not to pull its peacekeepers out of the UN mission in Liberia, as some countries had begun doing.
Our landmark session on Ebola was the most unified of my time in New York. Merely convening the meeting generated striking headlines like EBOLA DECLARED THREAT TO PEACE AND SECURITY BY UN. As US diplomats fanned out around the world and President Obama personally threw himself into lobbying world leaders, we suddenly seemed to be on a solid track. All told, the US and other countries would end up pledging some $4 billion toward supplies, facilities, medical treatments, and other components of the initial response.
However, just as we began making real progress, a person who became known as “Patient Zero” was diagnosed with Ebola in Dallas, Texas. At precisely the time when we needed to keep calm at home, act pragmatically, follow the science, and lead the world, all hell broke loose.
THE URGENT CNN BULLETIN appeared in my inbox on September 30th: BREAKING NEWS: FIRST EBOLA CASE DIAGNOSED IN U.S. My stomach sank.
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