A Liberian Red Cross health worker wearing a protective suit disinfects a courtyard under the eyes of citizens after the body of a victim of the Ebola virus was found on September 10, 2014 in a district of Monrovia. The World Health Organization (WHO) warned on September 8 that Liberia, already hardest-hit by the Ebola epidemic ravaging west Africa, should brace for thousands of new cases in the coming weeks. The country already accounts for half of the more than half of the 2,000 deaths across west Africa from the virus.

A Liberian Red Cross health worker wearing a protective suit disinfects a courtyard under the eyes of citizens after the body of a victim of the Ebola virus was found on September 10, 2014 in a district of Monrovia. The World Health Organization (WHO) warned on September 8 that Liberia, already hardest-hit by the Ebola epidemic ravaging west Africa, should brace for thousands of new cases in the coming weeks. The country already accounts for half of the more than half of the 2,000 deaths across west Africa from the virus.

The U.S. plans to send 3,000 troops to West Africa as part of its increased efforts to fight the spread of Ebola. President Barack Obama will be in Atlanta today for a briefing from the CDC on the crisis and will detail additional crisis management plans. Some 4,200 people are reported to have been infected with the disease and at least 2,200 deaths have been reported in five countries. Efforts to treat and contain the virus have to date fallen far short of what’s needed to treat those who are sick and monitor the many more who have been exposed. And epidemiologists warn that without urgent action the projections for how the disease will spread are ominous. Please join us to discuss the Ebola crisis and the world’s response.


  • Dr. Rajiv Shah Administrator, USAID.
  • Betsy McKay Atlanta bureau chief, Wall Street Journal
  • Dr. Jesse Goodman Director of the Center on Medical Product Access, Safety and Stewardship and professor of medicine at the Georgetown University Medical Center; attending physician, MedStar Georgetown University Hospital and Washington DC VA Medical Center. He was formerly chief scientist for the Food and Drug Administration.
  • Dr. Malonga Miatudila Former public health specialist, The World Bank
  • Dr. Michael Osterholm Director of the Center for Infectious Disease Research and Policy and director of the NIH-sponsored Minnesota Center of Excellence for Influenza Research and Surveillance; board member, National Science Advisory Board on Biosecurity.


  • 10:06:54

    MR. STEVE ROBERTSThanks so much for joining. I'm Steve Roberts of the George Washington University sitting in today for Diane Rehm. Diane's recovering from a voice treatment and will be back in this chair soon. West African countries, most especially Liberia, Guinea and Sierra Leone, have issued a clarion call to the rest of the world for help. The ebola virus has claimed the lives of at least 2400 people and threatens many thousands more without swift international intervention.

  • 10:07:19

    MR. STEVE ROBERTSJoining me in the studio, Dr. Jesse Goodman of Georgetown University, Dr. Miatudila Malonga, formerly with The World Bank, by phone from Atlanta, we have Betsy McKay ** of The Wall Street Journal and from Dallas, Dr. Michael Osterholm of the University of Minnesota. Welcome to you all. Good morning. And with me here as well in the studio, Dr. Rajiv Shah. He's the administrator of USAID and later this morning, right from this broadcast, he will be leaving to join the president to fly to Atlanta for this announcement on the latest U.S. initiative, which was reported this morning.

  • 10:08:01

    MR. STEVE ROBERTSDr. Shah, welcome and give us an update on what the president's going to say.

  • 10:08:07

    DR. RAJIV SHAHWell, thank you, Steve, and I'm so glad you're doing this piece today because the ebola crisis in West Africa is extraordinarily important. The president has noted that with more than 4,000 cases and more than 2,000 deaths, this is a national security priority. And the United States government has been focused on this since at least March, having committed and spend $175 million to support a broad range of activities in Liberia, Sierra Leone, Guinea and throughout the region.

  • 10:08:37

    DR. RAJIV SHAHThis has been the largest deployment to date of the Centers For Disease Control personnel for any international epidemic and we have 28 agencies represented on the ground in West Africa working together to support the response.

  • 10:08:50

    ROBERTSAnd what specifically will you be doing?

  • 10:08:52

    SHAHBut today, the president is going to specifically announce a historic expansion of this effort and it will focus on insuring that the entire international community has the resources, capabilities, logistic support in place to mount a response commensurate with the challenge and turn the tide on this epidemic, specifically we will be deploying significant military capabilities for command and control, for logistics and operations, for supply chain management and importantly, to help build out ebola treatment units in Liberia and throughout the region.

  • 10:09:32

    SHAHAnd that will be important. One of the most important things we'll be doing is establishing training capabilities so that we can greatly accelerate the number of local healthcare workers that get trained in the very important and very significant protocols required to provide services and support to likely patients without infecting oneself.

  • 10:09:56

    ROBERTSNow, I noticed in an interview you did with NPR over the weekend, you talked about the recruitment process you're going through to get healthcare workers to join this effort and that -- but also that there are inhibitions here. I mean, this is dangerous work. And other healthcare workers have been infected. Tell us about who these workers are going to be, who are going to be joining you, if folks are listening, can they volunteer and what precautions are you putting in place to protect them?

  • 10:10:30

    SHAHWell, first, I'll speak to the precautions. The Department of Defense, working with USAID and CDC will be building a 25-bed hospital in Monrovia, specifically to provide very high-quality, very controlled treatment to healthcare workers who get exposed. This, coupled with our emerging capability to expand access to medical evacuation and the partnership of other countries to take patients if necessary will allow us to say to healthcare workers that if you go and you're part of this response, we can vouch for your safety as much as is possible.

  • 10:11:07

    SHAHAs a result, we hope to see hundreds of critical care health workers, medical professionals flood into West Africa right now. And just in the last few weeks, we've asked workers to go to USAID.gov to register there and then we can assign you to a partner like International Medical Corp, Partners In Health or others, Medicines (unintelligible)

  • 10:11:31

    ROBERTSSo listeners who want to join can go to that website.

  • 10:11:33

    SHAHThey absolutely can. We've had a few hundred already.

  • 10:11:35

    ROBERTSI will post that on our own website here at WAMU so that folks who are listening will have a way to do that. Go ahead.

  • 10:11:41

    SHAHExcellent. And I think this makes the important point. Today's announcement of a very significant military deployment in order to enable the effectiveness of a global response is coordinated and conducted with our international partners. The Department of Defense capacity to build out training capability and support for healthcare workers will allow the African Union to be successful with its pledge of more than 100 healthcare workers that are going from all over Africa to West Africa, will allow other countries in Europe and Latin America and Asia that have made important commitments to sent healthcare worker to plug into a coordinated, well-run system to tackle this disease.

  • 10:12:20

    ROBERTSNow, you talk -- you said, Dr. Shah, that the U.S. government's been focusing on this problem since March and you mentioned the research that you've allocated. But Betsy McKay, who'll be on this program in just a minute from The Wall Street Journal just this morning wrote in the journal that a lot of health professionals think that the response has been too slow and that this epidemic has, to quote one, "has spiraled out of control."

  • 10:12:45

    ROBERTSHow do you answer the criticisms that the response has been too slow?

  • 10:12:48

    SHAHWell, I'll say that I'm a medical doctor by training and the reality is that we are fully committed to this effort and the disease has accelerated as it's gone from hundreds to thousands of cases. We have seen the needs and the requirements on the ground go up exponentially. And that's why, in just the last several weeks, we've delivered more than 130,000 personal protective equipment kits, more than 5,000 body bags, WHO certified body bags, so that people who, unfortunately, die from this disease can have safe and dignified and rapid burials or cremation without infecting others.

  • 10:13:28

    SHAHThis is an all-hands-on-deck effort and the very reason we're calling in these significant military resources is to try to match the scale of the crisis.

  • 10:13:38

    ROBERTSBut were you surprised at how rapidly this spread? Because previous ebola outbreaks have not been nearly as contagious, not nearly as widespread and it's entered urban areas, particularly in Liberia. So I'm not, you know, the international community caught unaware of how rapidly this would spread?

  • 10:13:59

    SHAHWell, certainly no one has seen this before. This is a epidemic of ebola that far outstrips anything that has been experienced previously, both in the transmission and in the mortality rate and, in particular, in the urban context and the risks and rapid transmission that that has lead to in Monrovia and other urban areas. I will say this is also the largest response that's been mounted in any infectious disease control effort.

  • 10:14:29

    SHAHAnd it will require the kind of massive logistics capability that the Department of Defense will bring not just to enable USAID or CDC or U.S. government partners to be more effective, although that will be critical, but to enable other countries to put more resources in and more capacity in. We've worked with the European Union. They've announced $180 million commitment.

  • 10:14:51

    SHAHWe're working with countries all over the world to get healthcare workers into run and provide services in these ebola treatment units and ultimately the success of this will rely on thousands of Liberians, of members of the West African community themselves getting trained and being part of the response.

  • 10:15:09

    ROBERTSNow, one of the things you stressed, Dr. Shah, was that this is a national security issue for the United States. And some listeners might say, why would an epidemic, even one of this power in West Africa, threaten American security? What's the connection you're making and the connection the president will be making later today?

  • 10:15:31

    SHAHWell, first and foremost, as part of our strategy, we have an explicit commitment to keep the disease contained and to allow other countries in the region to have the preparedness and the capacity to prevent a similar outbreak in those areas. As Dr. Tom Frieden of the Centers For Disease Control has highlighted, there is not an immediate risk of ebola coming to the United States, but certainly we're going to do everything we can to keep this contained and to prevent the risk of that happening.

  • 10:16:00

    SHAHAnd this is part of that picture. I also would note that these are low income countries that are relatively fragile and the capacity of any country to see a 10 or 20 percent reduction in its economic activity over night, to see companies, like mining companies, just stop employing people, people no longer going to stores, food becoming scarce, water becoming scarce, these are the kinds of consequences that can lead to rapid societal breakdown after which, by the way, the cost to Americans will be much, much more significant given the region and the intending threat.

  • 10:16:35

    SHAHSo this is an effort to get ahead of that. We are providing food. We're providing water. We're providing financial support. We're working with The World Bank and the IMF to unlock hundreds of millions of dollars so this is genuinely an international coordinated effort.

  • 10:16:48

    ROBERTSYou know, obviously, you're here to talk about the ebola, but as you talk, I hear echoes of the explanation and the argument for opposing ISIS in the Middle East, that the connection being that if states become unstable and descend into chaos, that even though it's far away, America's national interest gets engaged in trying to contain that chaos.

  • 10:17:18

    SHAHI think that's right. And what I would say here is that we know how to contain this disease, contrary to kind of public reporting. You know, the disease, it spreads often, but not as easily as some others and by taking relatively simple precautions but in a rigorous way, families can protect themselves, communities can protect themselves and countries can get over the hump. And so part of the announcement the president's making today is also a large scale messaging and communications campaigns so that every Liberian family, for example, has access to better hygiene and can take on the behaviors to protect themselves, even as they seek ebola treatment units for people who are suspect in probable cases.

  • 10:18:06

    ROBERTSBut a final question before you go to join the president. What's your sense that these countries will be receptive to this massive outside intervention of American military and from other countries?

  • 10:18:18

    SHAHWell, the United States' State Department and all of us have been deeply engaged with country leadership. I was on the phone three times in the last week with President Ellen Johnson Sirleaf who absolutely welcomes this effort.

  • 10:18:30

    ROBERTSOf Liberia.

  • 10:18:30

    SHAHOf Liberia, who welcomes this effort, called for it and actually is also saying that ultimately this will enable Liberians themselves to stand up and get over this crisis.

  • 10:18:41

    ROBERTSDr. Rajiv Shah, he's the administrative USAID. He's joining the president today for a major announcement on ebola in Atlanta. I'm Steve Roberts. We'll be right back with more guests and comments.

  • 10:20:00

    ROBERTSThank you for joining us. I'm Steve Roberts sitting in today for Diane Rehm. Our subject this hour, the American response will be announced by the president shortly of a major new response to the Ebola outbreak in West Africa. And we were joined by Dr. Rajiv Shah, the USAID administrator. He's now left to join the president. And I have four other experts with me.

  • 10:20:22

    ROBERTSDr. Miatudila Malonga who is formerly with the World Bank. And also with me here in the studio, Dr. Jesse Goodman of Georgetown University on the phone. Betsy McKay of the Wall Street Journal and from Dallas Dr. Michael Osterholm of the University of Minnesota. Welcome to you all. Thank you for joining us here on "The Diane Rehm Show."

  • 10:20:43

    ROBERTSYou, of course, can join us as well, 1-800-433-8850, email is drshow@wamu.org. Michael Osterholm, I want to start with you and pick up on something that Dr. Shah said, that this outbreak seems to be different. We've had Ebola outbreaks since 1976. But he seemed to indicate that not only was this one different, but that the world community of health experts were surprised at its ferocity. Give us your take on that.

  • 10:21:16

    DR. MICHAEL OSTERHOLMWell, thank you. First of all, it's always easy to be an armchair quarterback and so should we have, could we have identified that this was going to happen months ago, I think we should've and could've relative to understanding the developing world and the population changes there. But we didn't. This is very different. And in fact, I wrote a piece in the Washington Post on August 1 talking about why the virus hadn't changed, Africa had changed. And that's what made this different.

  • 10:21:41

    DR. MICHAEL OSTERHOLMThis is really the first urban outbreak of Ebola we've had where you have very large population centers with lack of access to adequate health care, poor sanitation, crowding. And that's very different than trying to work on an Ebola outbreak in largely rural Africa where it's a much more limited population, limited contacts and the ability to do follow-up is much greater. So this one clearly is different in that regard and that could be said for any developing world city around the world. Something like this could happen if it were to emerge.

  • 10:22:12

    ROBERTSNow you also have been quoted as saying while you mention that the Ebola virus has not changed that there are concerns that it might change and might mutate. And, as you point out, now at this stage it's transmitted, as Dr. Shah said, through bodily fluids which is relatively easy to contain. But if it mutates into a gene that's airborne that becomes far more contagious and far more dangerous. What's the science now? How big a threat is that?

  • 10:22:38

    OSTERHOLMYeah well, first of all, let's just back up and make it clear that, you know, when you look at modes of transmission of any agent, they can change occasionally. Influenza's a good example. It's a virus that goes from being that of an enteric virus or in the stool of ducks to one that is a respiratory transmitted agent in humans. So sometimes these mutations can change.

  • 10:22:57

    OSTERHOLMThe concern around this one is you might say theoretical but also real, we've actually had respiratory transmission of Ebola virus from some human prime mates or monkeys to each other from pigs to monkeys. And even in one outbreak investigation back in the mid '90s, the summary report actually from the CDC said it couldn't conclude that some of the cases could've been from full contact to respiratory.

  • 10:23:21

    OSTERHOLMSo I don't want us to focus on that. I think it's one that is surely an important issue. If this virus continues to pass through many, many humans, remember up until this outbreak, we only had documented about 2,000 cases of Ebola virus infection in the past 40 years. Clearly, there have been more we missed, but not a lot. We've more than probably doubled, quadrupled the amount of transmission that occurs in humans with this virus in the last four months than we did in the previous hundred and some years.

  • 10:23:50

    OSTERHOLMSo I think that that's where we're concerned because with those transmissions occur more mutations that could happen. I think the focus should be, we've got to respond but the last thing we want to happen is give this virus an opportunity to actually curate a particular strain that could more readily be transferred by the respiratory route.

  • 10:24:05

    ROBERTSNow Dr. Goodman, you study this problem from the medical point of view as well. One of the articles I read said that the virus has the high ground now. Is that true? Has the medical knowledge, the medical response fallen behind?

  • 10:24:23

    DR. JESSE GOODMANWell, I think it is true that the medical and public health response has fallen behind but I don't think the virus has the high ground. At least it shouldn't have it for long. And, you know, I really welcome the president's announcement and a massive influx of resources. And I hope other countries, some of which have stepped up and others of which need to do that, follow.

  • 10:24:43

    DR. JESSE GOODMANYou know, as Michael said, we -- with the -- before -- unless this virus were to change, we know how to control it. Other countries have controlled smaller outbreaks. This is different. It's larger and involves urban areas. It involves countries that have infrastructure that is not set up to contain this. So in that sense we've allowed the virus to get the high ground, but that's ground that should be able to be reclaimed. We know the public health measures of isolation.

  • 10:25:11

    DR. JESSE GOODMANI believe that medical care can be improved and save many individuals with Ebola virus even without experimental therapy. So that also will help the...

  • 10:25:24

    ROBERTSIf the intervention is prompt enough and efficient enough.

  • 10:25:25

    GOODMANIf people believe that medical care can help them so they seek it and if those facilities are set up to provide it. Another reason why DOD helping set up health care facilities I think will be really, really helpful.

  • 10:25:39

    ROBERTSAnd I want to bring in Dr. Malonga because you have long experience here. I know that you were in Africa in the first outbreaks of Ebola back in the '70s. this question of the willingness of these African countries to accept the outside help, the suspiciousness of doctors and treatments, the burial rituals which can help spread the disease, how ready are the countries in Africa for this initiative the president is announcing today?

  • 10:26:09

    DR. MALONGA MIATUDILAThank you. Let me refer to my experience because I was indeed in the first -- I was part of the team that dealt with the disease, the first outbreak in the Yambuku and DRC. I was part of the team that named the virus, so I can talk.

  • 10:26:34

    DR. MALONGA MIATUDILAAll the fears that we have about the response from the African communities are actually false because I think most of the problems are created by we, by the experts that we are. What has worked so far is when you go there with open mind and you equip local communities with knowledge without creating hysteria or panic, just knowledge, give them adequate facts, and then you engage in a dialogue, in a two-way communication with communities, you'll be surprised.

  • 10:27:19

    DR. MALONGA MIATUDILAAfrican communities will be willing to accept you. And they're going to even come with their own strategies, how to deal with the disease. Because I've seen in just one month in northern Zaire DRC, it changed in the practices that we thought were impossible to change like the burial. In just one month, people completely changed the way they were cleaning dead bodies.

  • 10:27:56

    ROBERTSAnd what's the key to doing that. Is it a question of trust?

  • 10:27:58

    MIATUDILAThe key is one, information and two, communication. And communication is only possible when you trust the community. When you trust communities, communities are going to trust you back. So the mistake we have -- I think we are doing now in West Africa is coming there as outsider. When I say outsider, I don't only mean Americans or Europeans coming, but even the national authorities, they are seen as outsider.

  • 10:28:38

    MIATUDILASo the communities -- local communities, they don't trust them so they're going to hide the patients. And then when they come -- and then when they come to the hospital they come there to die. That also increases the suspicion because they're health centers.

  • 10:28:54

    ROBERTSAnd of course epidemiology requires information. It requires the ability for people to be frank about their contacts so that you can -- so the epidemiologists can do their work and track down the potential spread of the virus, right? I mean, it's absolutely -- epidemiology requires that kind of information.

  • 10:29:10

    MIATUDILAExactly, but we are not following the -- I mean, the reality, we are behaving like people don't know, people are stupid. And they need us to come there to take care of their problems. I think if we create trust then we be able to contain this.

  • 10:29:29

    ROBERTSI want to bring in Betsy McKay of the Wall Street Journal. Betsy, I must say, as a reader you've done some marvelous stories in the Wall Street Journal on this subject. And I've been following you for a while now. And one of the things you mentioned in the Wall Street Journal this morning, I asked the question of Dr. Shah, that for all of the -- his defense of how vigorous the U.S. has responded, there are a lot of people who think that this outbreak did not generate the kind of international response in the beginning that we're now seeing today. What's your best take on this? How and why was the response slow?

  • 10:30:11

    MS. BETSY MCKAYWell, there are a few things. I mean, it was -- Dr. Shah was right that this was -- you know, that it was unlike -- even from the start it was unlike previous Ebola epidemics. Previous ones have been contained, you know, to a certain -- a local area. They haven't spread far beyond that. They've usually been in rural areas. But this one was different from the start. And that's the reason that everybody should've paid attention to it.

  • 10:30:44

    MS. BETSY MCKAYAnd, you know, when we looked back we found that people on the ground like Doctors Without Borders, you know, which sent a team in -- or started putting teams in place in March, were already saying back then, this is an unprecedented outbreak. So, you know, Mike Osterholm is right. We can -- you know, hindsight is 20/20 or whatever but it was -- you know, it's been many months. So even not recognizing it in the first few weeks there should probably have been a recognition earlier on.

  • 10:31:16

    MS. BETSY MCKAYYou know, at one point -- someone else on the panel can correct me -- but I think it was in May, at one point, you know, there was a feeling that the epidemic -- the outbreak, I'm sorry, was wrapping up. You know, the number of cases was declining and it looked like things were slowing down. And that, you know, we now know tragically was an enormous mistake because by June cases were growing. By the end of June Doctors Without Borders was saying, you know, this is really out of control. And then we know what happened from there.

  • 10:31:49

    ROBERTSAnd what's your take about how and why the American government, after modest responses, is now going all in today? This question that Dr. Shah stressed of affecting America's own interests and security, is that really what happened, that people realized that this was not just an outbreak in a distance region but one with much larger implications?

  • 10:32:17

    MCKAYWell, I think that's what always motivates us. On the other hand, the U.S. plays a very significant humanitarian role in the world. And, you know, I think he is right in saying that beyond the disease itself, which is reason enough to go in, you do have a very powerful argument for the possibility that there will be social breakdown and economic collapse, or certainly economic issues. And so that is a national security problem for us. So, yes, I do think that's a major motivating factor.

  • 10:32:55

    MCKAYI will say that for several weeks, you know, public health experts, humanitarian aid experts have been calling for more involvement from the U.S. because there was really no coordinated effort on the part of the actors involved to date. And there -- you know, more and more -- particularly as aids started coming in, you know, then there was really a need to coordinate it.

  • 10:33:19

    MCKAYAnd the U.S. is traditionally the leader in these sort of things and we're highly valued for our military which, you know, as you know has this ability to command operations and conduct logistic -- you know, bring their logistics expertise, which is what's really needed right now.

  • 10:33:37

    ROBERTSI'm Steve Roberts and you're listening to "The Diane Rehm Show." I want to give the panel a chance to answer this question, and first Dr. Osterholm. Is this going to work? Is this intervention enough? Is it robust enough, aggressive enough to check this outbreak which, as a number of you have said, is really different from any other previous outbreak? What do you think?

  • 10:34:04

    OSTERHOLMWell, first of all, let me congratulate the U.S. government for stepping up in what is truly a major change in its position on how to deal with this. But, you know, let's face reality. This virus is in three countries primarily in West Africa. The U.S. effort right now is focused primarily on Liberia. It's kind of like fixing one of your three screen doors in your submarine. Unless we actually can bring a region-wide response to Sierra Leon and Guinea too, we're going to have a problem in terms of it continuing back into Liberia.

  • 10:34:35

    OSTERHOLMNow this is a good start and it should be a wake-up call that we need all the other countries of the world to help us make this a regional response. The second part of it is, is that there -- the U.S. is going to be building a number of Ebola treatment centers and then turning them over to the administrative health which then may turn them over to NGOs, Nongovernment Organizations, etcetera. It's unclear how that's going to work yet.

  • 10:34:58

    OSTERHOLMAnd so we need to understand that when you look at the model, for example, of Doctors Without Borders, they have done it very well where they handle everything from start to finish and have a very tight command of control over all that goes on. So we need effective Ebola treatment centers to be set up. It's not just setting them up. And that is still yet to be worked out.

  • 10:35:16

    OSTERHOLMThe third thing, if I can just say, is in fact we still have a matter of time. You know, we've been talking about all this help that we're going to do, and Betsy's paper did a story recently on looking at what was actually promised and what's actually been delivered And this is like a major burning fire. We need to have all the trucks on the scene right this hour, not next week or next month or next quarter. And so how fast this response occurs is also going to be important.

  • 10:35:41

    ROBERTSSure. Dr. Malonga, let me ask you that same question. Is this going to be sufficient given your experience, or is it not enough or too late?

  • 10:35:52

    MIATUDILAActually, what works is a five-component strategy. I think the U.S. is going to help with one of the component, which is logistics. What we need, as I said first, information and communication, a second very central part of the game. And early diagnosis -- we need to give Africa the possibility to make early diagnosis of the disease because the virus is going to stay in the area.

  • 10:36:27

    MIATUDILAAnd then the provision of care to patients I think is important. But most important component is the prevention of transmission. And that can only be done at the community level.

  • 10:36:44

    ROBERTSDr. Goodman, what's your take on this question?

  • 10:36:47

    GOODMANWell, I really resonate on those last points. I think that the logistics, the health care capacity, the training capacity, the gear that the U.S. military can bring in can be decisive. But only if it is connected to the country and the communities in its -- in a culturally appropriate and sensitive way and the communications are very robust...

  • 10:37:11

    ROBERTSThis question of trusting the information, trusting the advice is central to efficiency.

  • 10:37:15

    GOODMANYes. And I think this is one thing about the response that hasn't been said. It really -- for this to work like the president of Liberia has to request the U.S. to come in there. We couldn't just go in a month ago without that kind of request.

  • 10:37:30

    ROBERTSThat's Dr. Jesse Goodman of Georgetown University. I'm Steve Roberts sitting in today for Diane. We'll be back with your phone calls so stay with us.

  • 10:39:59

    ROBERTSWelcome back. I'm Steve Roberts, sitting in today for Diane. Our subject this hour, the president's announcement coming any time now of a major new U.S. effort to help combat the Ebola outbreak in West Africa. Dr. Malonga Miatudila is with me. He's formally with the World Bank. As well as Dr. Jesse Goodman of Georgetown University. On the phone, Betsy McKay, has been covering this subject for the Wall Street Journal.

  • 10:40:19

    ROBERTSAnd from Dallas, Dr. Michael Osterholm of the University of Minnesota. And I have some emails I want to read. This first one comes from Gretchen. "Why is it always the U.S. that is called upon to fix world problems? And the U.S. is faulted for not doing enough or not doing it fast enough. Why not hand the burden to France or China or Argentina or Russia or Spain?" Jesse Goodman?

  • 10:40:41

    GOODMANWell, I think many people ask that question. I think one reason is the capability of the U.S. Another reason is the generosity and humanitarian nature of our people, who often will support these kind of activities. But it's a good question. And I think this is a teachable moment in global public health. And I think there needs to be almost an after-action about this, once we've got this hopefully under control. It is a ludicrous situation, in my mind, that the health of nations in the world depends on non-governmental volunteer organizations, depends on a WHO, which is chronically underfunded and has very little…

  • 10:41:21

    ROBERTSThat's the World Health Organization.

  • 10:41:23

    GOODMANWorld Health -- has very little authority. So I think we need to look -- if we want to have a world where the U.S. isn't constantly in this role -- which isn't good for these countries either -- we need to have a world that builds global health security and infrastructure.

  • 10:41:37

    ROBERTSAnd is it -- isn't this also an example of how not only do viruses know no borders…

  • 10:41:43


  • 10:41:43

    ROBERTS…but travelers know no borders. And that one of the things that's happening that threatens to increase the spread of this is it's reached Nigeria, which is a critical transportation hub in West Africa.

  • 10:41:57

    GOODMANWell, you know, I think as Dr. Shah said, there are very legitimate national and regional security issues for dealing with this. But underlying this, you know, we shouldn't have horrendous levels of preventable disease and death. You know, and we shouldn't have a global governance system which can't respond to that. So I think we need to support other countries to -- it's like the teach a person to fish.

  • 10:42:22

    GOODMANWe can't always do the fishing and we have to teach them. There's the -- U.S. advanced what's called the Global Health Security Agenda, which offers, with its partners, to build capacity throughout the world. I think we need to support that so people can solve their own issues.

  • 10:42:37

    ROBERTSWe have a number of callers and questioners who raise this issue, similar to John, who writes to us from Dallas, Texas. "China has recently been a big investor in Africa. And has a significant stake in Africa's flourishing. Why wouldn't the Chinese be a major partner and contributor to the renewed American efforts to stop the current outbreak?" Betsy McKay, what is the Chinese role here?

  • 10:42:59

    MCKAYWell, I'm glad somebody asked about that because I think one of the big issues here, you know, with the U.S. plan -- which is great -- is, you know, there are two issues. One, how fast is it put in place? Because, you know, this -- even if it's put in place tomorrow it's going to take a while to start getting this under control. The second is what is everybody else going to do and where have they been in the first place anyway?

  • 10:43:25

    MCKAYSo it's interesting that today WHO, World Health Organization, said that the government of China has dispatched a mobile lab and is sending teams of experts to help with the, you know, teams of epidemiologists and clinicians and nurses. So they're stepping up. Cuba is sending a large team of doctors. I mean, countries are starting -- we're hearing of other countries doing more. The European Union has made a big commitment. But it is a good question, you know. And it'll be interesting to see now what other countries do now that we are taking this leadership role.

  • 10:44:07

    ROBERTSAnd here's a question from Tamarin. Dr. Osterholm, perhaps you could take this one because she also asked a question that we've gotten from several listeners. "At the risk of sounding stupid," she writes, "how exactly do U.S. health care workers get the free time they need to fly off to Africa for a few months? Last time I checked my local doctors, especially primary care physicians, were quite busy and already seemingly short-staffed.

  • 10:44:32

    ROBERTS"Is there some sort of sabbatical program that U.S. physicians," and of course this is not just physicians. It's other kinds of health care workers, nurses and others -- "have access to that the rest of us don't know about?" How would this work? You have a sense?

  • 10:44:46

    OSTERHOLMSure. Well, just following up with what Dr. Goodman just said, in fact this is an amazing response of volunteers and NGOs, non-governmental organizations. A lot of these people are not getting paid. They literally are taking time off to go do this just because of the humanitarian concerns that they have. So it varies by individual going, but a lot of people are volunteering time. And I think that's the important message.

  • 10:45:09

    OSTERHOLMI do think that -- following up on the previous question, though. However, one of the concerns that I have is as more of the other donor countries enter into this area, who is going to be in charge. What is the command and control? Are the Russians and the Cubans and the Ugandans and the Chinese and the Japanese and the Canadians and the European Union people all going to work with us in a way that we all agree who's in charge? Because when everyone's in charge, no one's in charge.

  • 10:45:35

    OSTERHOLMSo one of the areas I think that is still very critical is the United Nations really does need to actually put together a structure for command and control. They don't have the resources. They don't the expertise to do this. But they surely can empower a command and control structure with all these other different countries that are going to be sending support to the scene.

  • 10:45:54

    ROBERTSDr. Malonga, you're nodding when you -- at Dr. Osterholm's comment. You agree that this question of coordination with so many different national groups is critical?

  • 10:46:05

    MIATUDILAOh, yeah, yeah. That is what I got from my first experience because in 1976, yes, we had the CDC, yet not -- the Americans came, South Africans came, the French came, the Belgians came and (unintelligible). And one of the questions that the minister asked, "Who is going to coordinate?" So unless you have a coordinator, you are going to create chaos. And chaos is going to help the spread of Ebola.

  • 10:46:45

    ROBERTSLet me go to some callers here and…

  • 10:46:47

    GOODMANCould I just add one…

  • 10:46:48

    ROBERTSWell, just a minute. I want -- I -- we really need to get some -- to some of our callers. And Samuel, you're on the line. Welcome.

  • 10:46:56

    SAMUELHi. How you doing?

  • 10:46:57

    ROBERTSHappy to have you on "The Diane Rehm Show."

  • 10:47:00

    SAMUELHi. Well, it's not a question. This is a statement more so to -- not to the panel, but to people that have families back home. Because I am from Sierra Leone, but I came here as a little boy, but, you know, the first time I called my mom and told her, you know, make sure people back home are okay. They really believe that it's either -- it's a plague from God or something like that. Or some -- even in the communities here, believe it or not, believe that this disease was cooked up in America, came to Africa just to experiment on us.

  • 10:47:28

    SAMUELAnd it makes people there -- if the information is getting to them, they believe in those conspiracy theories, it makes them not even believe the disease even exists. They really think it's just somebody trying to lie to them or something. And that will help a lot if they just believe in the science and follow what doctors are telling them. Because that's a major part of this disease, if the information that they believe in is not the science that they are told, then they're really not going to take it seriously.

  • 10:47:52

    SAMUELAnd family members are getting sick because they just think it's some type of make-up disease or they're just trying to get rid of us or something. We have to educate people there, let them know they follow the science, follow whatever you are told and it will help stop the spread of the disease.

  • 10:48:05

    ROBERTSSamuel, thank you very much for that call. Very helpful contribution. Dr. Malonga, we were talking about this question of trust and here the caller reflects it directly. How do you deal with the misinformation, the distrust, the mythology that Samuel was talking about?

  • 10:48:23

    MIATUDILAThe only way you deal with that is by talking with people. My mentor was from -- a physician from California told me that, "Miat, if you want to succeed in Africa you have to go into villages, sit down with the elders, talk." You have to build trust. So unless you build trust this misinformation are going to stay. So we are going back again to this problem of communication. Meaning it's not educating people, it's communicating. It's exchanging ideas.

  • 10:49:08

    MIATUDILAYou can start with the information they have that, okay, this virus was cooked somewhere or it came from God. But when you talk, after a while, if you know how to communicate people are going to change.

  • 10:49:25

    ROBERTSYou're nodding, Dr. Goodman.

  • 10:49:27

    GOODMANYeah, I totally agree. And I think also those people can have some of the best ideas for how to then control this disease. They know what people are really doing. They know the behaviors. They know how to influence people. One thing some of us have talked about and colleagues from Liberia, is enlisting Ebola survivors in the effort to control the disease. You know, people who are being shunned by their communities, but can help their communities.

  • 10:49:51

    ROBERTSThey also can contribute blood.

  • 10:49:53

    GOODMANWell, we don't really know if that works, I have to say. But that's right. One comment I was going to say about the coordination that Mike Osterholm made and we all agree on, is I think that coordination is also needed to assure that everybody who goes in is practicing sound, culturally competent communication. Because if people go in there without communication, they can undo what others are doing.

  • 10:50:20

    ROBERTSI want to turn to Anselm, in Carmel, Ind., who is originally -- if I understand -- from Nigeria. And wants to get in on this very subject. So welcome. You're on "The Diane Rehm Show." Anselm?

  • 10:50:36

    ANSELMExactly what the previous caller had said is what I was trying to imply. That we need to empower the people in West African region through education and proper information, so that they will be able to manage and control the spreading of this disease. It's a very complex but simple way to control it. But we have such a belief in West Africa that only people down there can really explain it to them how we can break the spreading of the disease across the whole place.

  • 10:51:16

    ANSELMAnd for America or anybody to think that it's an isolated -- it is no longer an isolated thing. I came from Nigeria, I traveled to Nigeria, I came back here. The person who brought it to Nigeria came from Liberia. It's an American. He send it to Nigeria. He could have brought it back to U.S. here. The same thing happens all over the continent. So that is my contribution to it.

  • 10:51:42

    ROBERTSWe -- and we're grateful for the contribution. Thanks for calling us here on "The Diane Rehm Show." I'm Steve Roberts and you're listening to "The Diane Rehm Show." Dr. Osterholm, your reaction to Anselm's call?

  • 10:51:56

    OSTERHOLMYou know, as much as I talk about command and control, in terms of the logistics and the medical treatment and I think what Dr. Goodman said was right on the mark also, about the need to assure their messaging is right. But also just to assure that the quality of medical care is good. Think about this, Doctors Without Borders has not had one health care worker become infected while there. Meanwhile, we have over 320 health care workers from all the other NGOs or government programs that have become infected.

  • 10:52:22

    OSTERHOLMThat often is a marker for the quality of what they're doing. Meaning that people are getting infected from breaks in good infection control. What else is happening? We need to insure the best quality of medical care, of infection control, etcetera. We can help do all of that, but in the end it's West Africans saving themselves from this situation. We need to listen to them. We need to understand from their leaders how best to do it. We just need to provide the tool so that they can do it. And that's what's going to bring this one to an end.

  • 10:52:50

    ROBERTSLet's turn to Nancy, in St. Louis, Mo. Nancy, welcome. You're on "The Diane Rehm Show."

  • 10:52:58

    NANCYThank you. And good morning. Along with what you're saying about command and in control in country, my concern and my questions are about -- here in the United States we're part of the World Health Organization Treaty. And the things that got -- I responded to Haiti. And one of the things…

  • 10:53:13

    ROBERTSYou're a registered nurse, if I understand correctly. Right, Nancy?

  • 10:53:16

    NANCYYes. Yes, I am.

  • 10:53:17


  • 10:53:18

    NANCYAnd I did logistics in Haiti. And one of the problems we ran into was people who thought they were doing good in the United States sending stuff to a disaster area. And they sent things that were -- we had one person who sent eye implants, retinal implants that expired in the '80s. And then one person -- another health care group sent an antiquated PT scanner. And these things were burned on site or they were dumped into the ocean by the Haitians.

  • 10:53:49

    NANCYAnd so my concern is do we have anything here in the United States to control this stuff being sent to countries and preventing it from going -- what can we do on shore to stop this -- all this stuff being sent to these countries that needs to be controlled? What can we do?

  • 10:54:05

    ROBERTSThat's an excellent question. Betsy McKay, do you have an answer here? I mean this -- there are so many different countries wanting to help. But the potential for chaos is obviously very real.

  • 10:54:17

    MCKAYYeah, well, I think one of the problems so far has been that there hasn't been this outpouring of desire to help because people are scared. That will obviously change now or it may change with the U.S. going in and with more of this, you know, kind of official level help going in. You know, I think health care workers will be more interested in going if they feel like they really are going to be protected. And not just taken care of if they get sick, but that they're not going to get sick at all.

  • 10:54:46

    MCKAYSo that's one thing. The other thing is I think this is a very -- so you could see -- start to see more, you know, NGOs and people wanting to help. This one, you know, this outbreak, this event, humanitarian event is a little bit different. I mean, you can't have just anybody go, bringing anything. You have to go through specialized training to go and help in an outbreak like this. I mean taking care of Ebola patients, as you all know, is a very specialized type of work. You have to learn to wear protective gear. You have to learn how to…

  • 10:55:20


  • 10:55:21

    MCKAY…you know, operate in it and so forth. So I think things will be different. But I'd be interested to know what others think.

  • 10:55:26

    ROBERTSWell, we have just a minute or two. I want each of you to sum up here, starting with you, Dr. Goodman. What's the outlook here? What can we expect in the weeks and months ahead?

  • 10:55:38

    GOODMANWell, I think we can hope to expect a very quickly mobilized, ramped-up U.S. response that connects well with the people of Liberia and their ability to communicate with each other, and begins to bring that disease under control. I hope that will be part of an inspiration for a much broader international response and that will be well coordinated and well managed. And -- but I fear that many, many thousands of lives are going to be lost.

  • 10:56:06

    GOODMANAnd I do not want to lose the opportunities, as we bring this epidemic under control, to better be able to prevent and respond to future ones, whether it's figuring out what treatments work, evaluating new vaccines -- we have some exciting candidates, it's possible, or just finally getting the message through that we need to invest in global public health infrastructure for our national security and for humanity.

  • 10:56:32

    ROBERTSDr. Malonga, a quick final word?

  • 10:56:34

    MIATUDILAAnd I hope that these opportunities are going to give us the chance to go against one of the factors that make these outbreaks. We have -- today we have Ebola. Tomorrow we're going to have another outbreak. It is the weakness of the health system. If this can really help our countries to have a robust health systems, we are going to prevent this type of accidents in the future.

  • 10:57:06

    ROBERTSI'm afraid that's going to have to be the last word. Dr. Malonga Miatudila from the World Bank. Also with me Dr. Jesse Goodman from Georgetown, Betsy McKay, a correspondent ** with the Wall Street Journal. And on the phone from Dallas, Dr. Michael Osterholm of the University of Minnesota. I also want to thank Dr. Rajiv Shah, head of USAID, who joined us earlier in the broadcast. I'm Steve Roberts, sitting in today for Diane Rehm. And we're delighted to have you spend an hour of your morning with us. ** correction: Betsy McKay is the Atlanta Bureau Chief of the Wall Street Journal.

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