TIME ebola

WHO Chief Says Ebola Response ‘Did Not Match’ Scale of the Outbreak

TIME sits down with WHO Director-General Margaret Chan

The Ebola outbreak in West Africa has morphed into one of our biggest health crises in years, with at least 4,900 known deaths among more than 13,000 cases and experts warning the worst could be yet to come.

Despite a growing international effort to combat the virus, outside health experts say the United Nations’ World Health Organization (WHO)—the only worldwide health institution—has been slow to react. They stress that there’s plenty of blame to go around, including with the U.S. and other regional governments, who were tragically sluggish in responding to Ebola. Still, critics complain that WHO has failed to lead the global fight—exactly the kind of crisis it has aimed to efficiently handle or prevent since its founding in 1948. In general, many say it’s “too politicized, too bureaucratic… too overstretched and too slow to adapt to change,” according to a report by the London think tank Chatham House, citing health experts and some former WHO staffers.

Armchair critics have it too easy, says WHO Director-General Margaret Chan, or “DG,” as she’s known in the graceful Geneva headquarters. WHO, she says, is only as good as the world’s 194 governments—their members, whose contributions pay their salaries and set direction—allow them to be. Governments haven’t raised their WHO dues in decades. The global financial crisis has pummeled the organization, stripping it of $1 billion in funds and about 1,000 bright minds. If the world wants a strong WHO, its staffers say, it needs to plow more money in and help it transform—and hopefully stop the next outbreak from whipping half way across the globe in just seven months.

On Oct. 28, WHO invited TIME to spend the day inside its Geneva headquarters, watching officials grapple with the Ebola epidemic and sitting in on a two-hour, top-level crisis meeting. In a wide-ranging interview with TIME’s Vivienne Walt, in her Geneva office, Chan, a 67-year-old Hong Konger, explains how she and her staff have struggled with the outbreak:

TIME: When was the moment when you thought to yourself, “Holy cow, this Ebola outbreak is big?”

Margaret Chan: I heard about it moving up at the end of June, when the analysis [inside WHO headquarters] was presented. I was very concerned. I asked my scientists to give me an assessment. After that we scaled up unprecedentedly. We have managed many outbreaks in the past but this has got to be the biggest. If you are going to war with Ebola, you need soldiers, weapons, and you need a war chest. WHO is well geared and has the capacity to do outbreaks on a smaller scale. We have been doing this for many, many years, protecting the world from pandemics. But this, the complexity and the scale of things, outstripped the capacity of WHO.

TIME: You say it was the end of June when you thought, oh my God. But people I’ve interviewed in the U.S. and elsewhere tell me that for months they were raising the alarm, from back in March, and that somehow the sense of urgency was not felt here at WHO in Geneva. Is that a fair criticism?

Chan: Well, with the benefit of hindsight, in retrospect…. We are doing a retrospective study on a regular basis, with all this information of colleagues around the world. And they realize, actually, cases of Ebola were spreading in a hidden manner. And now, looking back, all of us would say, yes, the scale of the response did not match the scale of the outbreak. And that is fair. And of course all of us underestimated the complexity.

When you look at this outbreak, thousands of people in Africa died and it didn’t get the attention it deserved until recently. People were saying, quite rightly, it takes a few cases outside of Africa to get attention. This was a perfect storm in the making. In the past, Ebola outbreaks happened in the bush in small villages. Twenty, 30, 40 years ago, there were less people in these countries, and less movement of people. It happened in three countries which came out of long-term conflict. Health systems were destroyed. And in terms of doctors and nurses, they have one or two per 100,000.

TIME: Yes, that’s certainly true. But others say you in Geneva did not get the information from the field when the outbreak occurred, that the details did not reach you. One person we’ve interviewed describe some WHO regional offices are “awful.”

Chan: I’ve promised to do a review and get all the documentation… and will identify what mistakes were made, and correct them. That’s my commitment. But now the most important thing for me is to bring the whole team together, to bring the total assets of the organization together to fight Ebola. There will be plenty of time for history, and we really need to do it in a transparent and accountable manner. But it is important that we move on and get the job done first and foremost.

TIME: You’re dealing with this unprecedented outbreak. Do you think it is going to change the way WHO works?

Chan: This has to be the turning point. It’s not only Ebola. You have to look at what other crises we are dealing with. We have crises in Central African Republic, Iraq, Syria, South Sudan. My staff are truly, truly at [a] breaking point. Members [governments] need to look at what kind of WHO is appropriate for the 21st century. With climate change, which is the defining issue for the 21st century, and a highly interconnected world, we should expect to see more crises of different sizes, magnitude and geographic location.

When a crisis gets to a certain level the D.G. [Director General] has [to have] the ability to deploy the entire assets of the organization. At this point, I need to consult, ask, urge. We don’t have the money. When I talk to member states, I tell them, the system does not provide the flexibility and the agility for the Director General to manage the organization. I said to them, if you want a credible, strong WHO, we need a WHO reform.

TIME: Do you think pre-recession WHO might have been able to handle the Ebola crisis better? Or with all the money in the world, are you up against something too complex, too difficult?

Chan: This is too big and it’s happening in countries with a lot of factors that amplify it. There are lessons the world’s countries need to learn, like the reliance on old experience to deal with Ebola in a new context. What worked 20, 30, 40 years ago will not work. Another lesson: I was not able and also MSF [Doctors Without Borders] we were not able to mobilize people. For the typhoon in the Philippines [in 2013] 150 medical teams came to help. For the Haiti earthquake, more than 125,000 aid workers came. With Ebola, the fear factor, the lack of formal medevac, lack of quality health care…. Outbreaks are human-resource intensive. To manage an Ebola treatment center of 80 beds you need 200 health workers. And I need foreign medical teams to manage them. The U.S. and U.K. governments are building state-of-the-art treatment centers to take care of health care workers in Liberia and Sierra Leone. So there are some good signs and things that are coming.

TIME: Any regrets about decisions made early on or not made early on?

Chan: If people think WHO alone can prevent this crisis I think people are trivializing the reality on the ground. In the initial phase, we sent experts right away. We sent commodities, we sent equipment, we supported governments.… But, as I said, the transmission of the disease was spreading hidden through the movement of people.

I’ve been asking myself: how much time can I spend on Ebola given that it is going to be a sustained, severe outbreak? I [spend] about 70% of my time on Ebola. Would my member states accept I’m a one-issue D.G. There are more people dying of non-communicable diseases: Cancers, heart diseases, lung diseases, diabetes. There are millions suffering from mental health conditions. There are many people dying too early in road crashes. Can I drop everything? I don’t think so. I work at least 18 hours a day, even on weekends. And I’ve also learned great humility is important—to make sure we are not taken by surprise by an unforgiving virus.

TIME: It seems to me that WHO and certainly you have been talking about reforming WHO for years, and you have been running up against walls. So, is Ebola a crisis of such magnitude that this will shake the world into rethinking all this, allowing reform to happen?

Chan: This Ebola outbreak should really make them [governments] look very hard, really hard, at if outbreak control is so important, why didn’t they [WHO] have resources to do the job? The problem is that with prevention when you do a good job people say, okay that’s alright, now we need to move the money some place else.

Ebola for 40 years was an African disease. The world this time has learned a lesson: The world is ill-prepared for severe, sustained public health emergencies. That’s why I hope this is a turning point, a watershed event for people to understand that. If you want global health security, you need to invest.

In the next 2.5 years [Chan retires in 2017], I’m going correct all the mistakes before I leave this organization. I have the responsibility to the governments, but governments also have to look at how they can support WHO to do what they want it to do.

With the reforms [streamlined staff, reworked programs] I would never have been able to pull it off without the financial crisis. I’m very good at this. You know why? There are two sides to the Chinese character for crisis: One side crisis, one side opportunity. Deeper reforms will come from the Ebola crisis. I’m not going to waste this crisis.

For more, read TIME‘s feature on how the World Health Organization has come under fire for its failure to stop Ebola

TIME Innovation

Five Best Ideas of the Day: October 27

The Aspen Institute is an educational and policy studies organization based in Washington, D.C.

1. In journalism, the ideological middle is fast becoming a myth. Journalists need a point of view if they wish to stay relevant.

By Jay Rosen in the Conversation

2. Shrinking public health resources and the fragmented health delivery system in the U.S. are the real problems with our response to Ebola.

By J. Stephen Morrison in Health Affairs

3. African-American girls are suspended from school at six times the rate of white girls, and this disproportionate punishment has a lasting impact.

By Lucia Graves in National Journal

4. Our war on ISIS is strengthening Iran’s hand in the region — and nudging closed the door on an independent Iraq.

By Paul D. Shinkman in U.S. News and World Report

5. Discovery-focused learning — think of the maker movement and home hacking — can save American education.

By David Edwards in Wired

The Aspen Institute is an educational and policy studies organization based in Washington, D.C.

TIME Ideas hosts the world's leading voices, providing commentary and expertise on the most compelling events in news, society, and culture. We welcome outside contributions. To submit a piece, email ideas@time.com.

TIME Innovation

Five Best Ideas of the Day: October 22

The Aspen Institute is an educational and policy studies organization based in Washington, D.C.

1. Don’t conflate a cause with its celebrity.

By Kriss Dieglmeier at the Tides Foundation

2. Handwashing and Ebola: Understanding the power of a proven public health intervention.

By Hanna Woodburn in Ebola Deeply

3. President Obama has remade the federal courts by appointing more women and non-white judges than ever before. The impact will far outlast his administration.

By Jeffrey Toobin in the New Yorker

4. It’s vital that new pre-K initiatives are designed to build a high-quality foundation for learning.

By Beverly Falk in Hechinger Report

5. Trafficked workers — who often enter the country legally before being exploited — power many American cities.

By Tanvi Misra in Citylab

The Aspen Institute is an educational and policy studies organization based in Washington, D.C.

TIME Ideas hosts the world's leading voices, providing commentary and expertise on the most compelling events in news, society, and culture. We welcome outside contributions. To submit a piece, email ideas@time.com.

TIME ebola

#TheBrief: Watch How the CDC Is Changing Its Ebola Protocol

As two nurses who contracted Ebola begin to receive specialized care

As the Ebola virus continues to ravage parts of West Africa and two American health care workers begin to receive specialized care, we have to wonder: Are hospitals in the U.S. well-equipped to contain any further spread at home?

Thomas Frieden, director of the U.S. Centers for Disease Control and Prevention, assured Americans in September that the country’s hospitals could control and curb any threat. But after two nurses contracted the virus while helping to treat the first person diagnosed with Ebola in the U.S., who died in Dallas last week, criticism is piling on and answers to this question and more are in high demand.

TIME health

How Lessons From the AIDS Crisis Can Help Us Beat Ebola

Health officials counsel guests on the p
Health officials counsel guests on the prevention of HIV/AIDS transmission at the Argungu fishing festival in Kebbi State, northwestern Nigeria on March 13, 2008. Hundreds of fishermen from different parts of Nigeria and neighbouring West African countries have started arriving in Argungu fishing Town to participate in the fishing festival. AFP PHOTO / PIUS UTOMI EKPEI (Photo credit should read PIUS UTOMI EKPEI/AFP/Getty Images) PIUS UTOMI EKPEI—AFP/Getty Images

Ruth Katz is the director of the Health, Medicine and Society program at the Aspen Institute, a nonpartisan educational and policy studies institute based in Washington, D.C.

For too long, the history of infectious diseases has been that of ignoring a threat until it nears disaster

Without urgent action, Ebola could become “the world’s next AIDS,” said Thomas Frieden, director of the U.S. Centers for Disease Control and Prevention (CDC). HIV/AIDS has killed some 36 million people since the epidemic began, and another 35 million are living with the virus. Is history really about to repeat itself?

It doesn’t have to, if we have the wisdom to learn from past experiences. The tools we need immediately are swift international action, strong leadership, respect for science and broad-based compassion. But once we contain Ebola – and we will – we need new resource commitments and global health strategies to bring the next deadly epidemic under control much more quickly.

We’ve already done some things right. President Obama traveled to CDC headquarters in Atlanta, a rare presidential action, to detail an aggressive offensive against Ebola that includes sending troops and supplies to build health care facilities in Africa. Contrast that with the response to AIDS under President Reagan, who did not mention the epidemic publicly until 1987, six years after people started dying from it. This time around, we’re seeing leadership at the top.

Health officials have also put out a unified message about how Ebola can be transmitted – only through direct contact with bodily fluids. That, too, stands in welcome contrast with HIV, where irresponsible rumors quickly took hold and people worried about sharing toilets seats and touching doorknobs. The importance of educating health care workers and keeping them safe represents a commonality between Ebola and HIV, and must be among our highest priorities. Following the science is the only way we’re going to stop this thing.

Another lesson from HIV is that adequate resources can transform disease outcomes. The President’s Emergency Plan for AIDS Relief (PEPFAR), a $15 billion, five-year commitment under President George W. Bush saved millions of lives around the world. But by contrast, even though the CDC is attacking Ebola with the largest global response in its history, the effort doesn’t come close to having the budget necessary to do all the field work needed to really beat back Ebola. Bipartisan funding support is crucial to enable public health officials to act aggressively.

One lesson that has not been well learned is that we stigmatize people at our own peril. During the AIDS epidemic, we saw an American teenager, Ryan White, expelled from school after he contracted HIV through a blood transfusion. In Dallas, where the first known Ebola victim in the U.S. has died, we hear reports that people of African origin have been turned away from restaurants and parents are pulling their children out of school. Cries to ban flights from Ebola-affected countries — an ineffective strategy reminiscent of the 22-year ban on the entry of HIV-positive people into the U.S. — are growing louder.

Experience tells us that when we are driven by fear, we tend to push infected people underground, further from the reach of the health-care system and perhaps closer to harming others. There was a time when many people assumed every gay man could spread AIDS; now some are suspicious that anyone from West Africa could harbor a deadly virus. Acting on ignorance is the best way to disrupt an optimal public health response.

We should look to other infectious diseases for lessons as well. After severe acute respiratory syndrome (SARS) surfaced in China in 2002 and spread to more than 30 countries in just a few months, an aggressive, well-coordinated global response averted a potential catastrophe. We saw how much could be done when political and cultural differences were set aside in favor of cooperation. SARS also spurred the World Health Organization (WHO) to update its International Health Regulations for the first time in 35 years, and prompted many countries to strengthen their surveillance and response infrastructure, including establishing new national public health agencies.

But glaring gaps remain in the health care and public health systems of many nations, despite years of warnings from almost anyone who has taken a careful look at them. With a population of 4 million, Liberia has only 250 doctors left in the country. That’s more than just Liberia’s problem, because if we can’t contain the Ebola epidemic there, we’re at much higher risk here. And within our own borders, we have a public health system that the Institute of Medicine termed “neglected” back in 2002. That assessment was largely unchanged a decade later when the IOM said that “public health is not funded commensurate with its mission” in the U.S.

The international community dragged its feet far too long on Ebola, and as a result, the virus still has the upper hand, outpacing the steps finally being taken to defeat it. Sierra Leone has just 304 beds for Ebola patients and needs almost 1,500 right now; by next week, it will need more. When it comes to control and prevention, speed is paramount. With the epidemic doubling every three weeks, the actions we take today will have a much greater impact than if we take those actions a month from now.

When we finally subdue this epidemic, we also need to shed our complacency towards the infectious diseases that plague us still, and the new ones likely to arrive with little warning. In a globalized world, they remain an immense threat. Almost 50,000 new HIV infections occur in the United States every year, as do 2 million worldwide. Influenza kills thousands of people annually, and more virulent strains can be much more dire. Yet we shrug most of this off, rarely paying attention until blaring headlines announce an impending cataclysm.

To get ahead of the curve, we need a renewed commitment to research and action, and enough resources to put more public health boots on the ground, both at home and abroad. Greater support for the Global Health Security Agenda, designed to close gaps in the world’s ability to quell infectious disease, should be a priority. The agenda, launched earlier this year, is a partnership involving the U.S. government, WHO, other international agencies and some 30 partner countries.

For too long, the history of infectious diseases has been that of ignoring a threat until it nears disaster, and then stepping in to prevent it from getting even worse. We can’t afford to keep repeating that pattern, and squandering blood and treasure in the process.

Ebola is a humanitarian crisis, but it does not belong to West Africa alone. We are all in this together.

 

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Ruth Katz is the director of the Health, Medicine and Society program at the Aspen Institute, a nonpartisan educational and policy studies institute based in Washington, DC. She served from 2009 to 2013 as Chief Public Health Counsel with the Committee on Energy and Commerce in the U.S. House of Representatives. Ms. Katz was the lead Democratic committee staff on the public health components of the health reform initiative passed by the House of Representatives in November 2009. Prior to her work with the Committee, Ms. Katz was the Walter G. Ross Professor of Health Policy of the School of Public Health and Health Services at The George Washington University. She served as the dean of the school from 2003 to 2008. This article also appears in the Aspen Journal of ideas.

TIME Ideas hosts the world's leading voices, providing commentary and expertise on the most compelling events in news, society, and culture. We welcome outside contributions. To submit a piece, email ideas@time.com.

TIME health

There’s a Solution to Ebola—It’s Called ‘Money’

Peter C. Doherty shared the 1996 Nobel Prize for Physiology or Medicine. He has worked on aspects of infection and immunity for almost 50 years.

We could have been better prepared for this outbreak, but we can’t expect industry to invest in vaccines for a sporadic, developing-world disease

The first initial diagnosis of Ebola has landed on U.S. soil. A man who had flown recently from Liberia presented on September 26 at Texas Health Presbyterian Hospital with fever and malaise. He was treated with antibiotics and sent home. By September 28, Duncan was back in the hospital and placed in quarantine.

Texas public health officials say that up to 100 people may have been exposed. Ebola has a long incubation period and patients become highly contagious only late in the course of the disease. Both from my own perceptions of watching the disease since it was first diagnosed back in 1976, and from talking to professionals who were working with it and trying to develop a vaccine, I don’t believe that Ebola, along with a whole list of horrible hemorrhagic fevers caused by a spectrum of different viruses (Junin, Korean Hemorrhagic Fever, Sin Nombre), constitutes a substantial pandemic risk. With all the federal and state resources available, along with the fact that the Liberian community in Dallas will be both readily contacted and sophisticated in how they handle information, the worst case scenario is a very limited, and likely local, outbreak.

But there are still no vaccines nor drugs nor cure for Ebola.

Gary Nabel’s group at the NIH Vaccine Research Center has been publishing on experimental Ebola vaccines for years, with 2010 seeing an account of what looks to be a reasonable candidate. Why isn’t that, or something similar, available now? The answer is one word: money. Developing and testing any product for human use runs in the range of hundreds of thousands to a billion dollars. We can’t expect industry to go down this road for vaccines with a minimal market. In addition, the Ebola outbreak is happening in West Africa, where substantial numbers of people die each year from yellow fever. We’ve had a yellow fever vaccine for more than half a century, but the problem is affordability.

Currently, two candidate Ebola vaccines (including the NIH product) are being fast-tracked through human limited human trials, providing, perhaps, a model for the future. No doubt this will be used at the earliest possible date to protect health professionals but, once the current outbreak is over, it will be interesting to see who gets the vaccine for the future.

Financial constraints also apply when it comes to developing specific antiviral drugs (small molecules) to treat Ebola. Unlike antibiotics, antivirals need to be specific for the particular pathogen. There are good “designer drug” protocols for finding a virus’s “point of vulnerability” and making an appropriate chemical to block the infection. Think of the spectrum of such pills that keep HIV-infected people alive and well. Then there is the recent drug for treating Hepatitis C virus carriers, which retails for about $80,000 per treatment.

Again, where will the money come from to bring such a product to market for a sporadic, developing-world disease like Ebola? Mimicking our own antibody response to infection, there was some evidence of clinical success with an Ebola-specific monoclonal antibody (mAb) made in genetically engineered tobacco. While many cancer patients, in particular, have been treated successfully and safely with mAbs, such “biologicals” are enormously expensive to make in sufficient volume for widespread use.

So what’s the bottom line? We could have been better prepared for his horrible Ebola epidemic, but who pays? The Bill and Melinda Gates Foundation has done a terrific job when it comes to countering developing world diseases, but they can’t do everything. One thing that would be inexpensive is to develop and distribute much better educational material using, for example, the cell phones that are as ubiquitous in developing countries as they are here.

And are we in for a U.S. Ebola epidemic, or even a pandemic? I don’t think so, though we should take this as a warning and exercise “duty of care” when it comes to sustaining our public health services.

Peter C. Doherty shared the 1996 Nobel Prize for Physiology or Medicine. He has worked on aspects of infection and immunity for almost 50 years. His recent books include Pandemics: What Everyone Needs to Know and Their Fate is Our Fate: How Birds Foretell Threats to Our Health and Our World. He spends his professional time between St. Jude Children’s Research Hospital, Memphis, and the University of Melbourne, Australia.

TIME Ideas hosts the world's leading voices, providing commentary and expertise on the most compelling events in news, society, and culture. We welcome outside contributions. To submit a piece, email ideas@time.com.

TIME health

Ebola in America: Government Can Lock Us Up for Weeks at a Time

A nurse puts on protective gear during a demonstration at a quarantine unit set up at Wilkins Infectious Diseases Hospital in Harare on Sept. 26, 2014 to deal with ebola virus cases in the event of any outbreak.
A nurse puts on protective gear during a demonstration at a quarantine unit set up at Wilkins Infectious Diseases Hospital in Harare on Sept. 26, 2014 to deal with ebola virus cases in the event of any outbreak. Jekesai Nijkizana—AFP/Getty Images

Arthur Caplan, PhD, is the Director of the Division of Medical Ethics at NYU Langone Medical Center. Alison Bateman-House, PhD, MPH, MA, is a Rudin postdoctoral fellow in the Division of Medical Ethics at New York University Langone Medical Center.

Individual states, like the Federal government, have broad authority to protect the health of the public in the case of dangerous diseases

Thomas Duncan, a 42-year-old Liberian citizen, is in serious condition with Ebola in a Dallas hospital. His partner Louise is confined to the Dallas apartment where Duncan became very sick from the virus. Texas health officials have placed her, one of her children, and two nephews in their 20s, under quarantine. This means they have been ordered, under threat of prosecution, by the county not to leave their home or have any contact with outsiders for 21 days. Any exception requires the approval of the local or Texas state health department.

Have government officials done what they need to do to prepare us for the reality of quarantine in a time of Ebola? No. But if there is a deadly communicable disease, they can lock us up for weeks at a time. Personal freedom and liberty are foundational American values. But in the face of a threat of death, liberty can and should be, as we are watching in Dallas, limited so that you can’t move around freely and infect others.

The federal government derives its authority for isolation and quarantine from the Commerce Clause of the Constitution. Under the Public Health Service Act, the Secretary of Health and Human Services and the CDC are authorized to take measures to prevent the entry and spread of deadly communicable diseases from foreign countries into the United States and between states. Ebola surely meets that description. So quarantine at an airport or the harbor is legal, and we should be ready to see it used.

The authority for controlling disease within a state falls to state and local health departments. Individual states, like the Federal government, have broad authority to protect the health of the public in the case of dangerous, communicable diseases such as Ebola.

Quarantine is among the oldest public health activities. It has been used to control diseases for thousands of years. It can be very effective in halting the transmission of disease, if it is scrupulously observed. But, Americans are so committed to freedom that government is only supposed to use quarantine if no other, less-restrictive, option exists.

If Duncan’s family, who may have been exposed to Ebola show no signs of illness after 21 days, they will be declared uninfected. At that point, the quarantine will be lifted – maintaining it would be an unscientifically grounded restriction of liberty.

Twenty-one days is a long time for a family to be stuck inside. During that time, Texas health authorities, who have exerted their authority over this family in the name of the public’s welfare, need to provide the family with food, drink, medical care, and – one hopes – less urgent but still important items like entertainment, educational services (they may need a computer), and financial assistance (rent, electric and water bills will still need to be paid, and anyone who works outside of the home will be unable to get there).

There’s more. Should others also wind up being quarantined, if they have pets, they will need pet food or boarding. If they have babies, diapers. If they use a Laundromat, they will need laundry services. All the things that one normally would obtain in day-to-day interactions for 21 days will need to be provided.

Public health departments these days are underfunded, so if these expenditures are a hardship for Dallas County Health and Human services, emergency funds need to be provided from somewhere to try to keep this family as comfortable and functional as possible as they endure quarantine.

Quarantine poses more hardships on the poor than the rich. Public health authorities can implore an employer to save a quarantined employee’s position for 21 days, but there may be no job awaiting upon release. If being quarantined causes an individual to become unemployed, government has a responsibility to help that person. If you are poor you are going to need more resources to get you through then if you are rich. Before you say, hey, I don’t want to pay, remember they are locked up for our sake more than theirs.

Quarantine isn’t as simple as padlocking the door and putting a police car outside on the street. If it’s going to be used, there’s a lot that needs to be in place. And the public, to support it, needs to understand why it’s being done, under whose authority and what is being done to make it both effective, fair and bearable.

Arthur Caplan, PhD, is the Director of the Division of Medical Ethics at NYU Langone Medical Center. Alison Bateman-House, PhD, MPH, MA, is a Rudin postdoctoral fellow in the Division of Medical Ethics at New York University Langone Medical Center.

TIME Ideas hosts the world's leading voices, providing commentary and expertise on the most compelling events in news, society, and culture. We welcome outside contributions. To submit a piece, email ideas@time.com.

TIME ebola

There Could Be 20,000 Ebola Cases by November if More Isn’t Done Now

Ebola Lessons
Nurses train to use Ebola protective gear with World Health Organization, WHO, workers, in Freetown, Sierra Leone on Sept. 18, 2014. Michael Duff—AP

Public-health experts warn that the epidemic could turn from “a disaster into a catastrophe”

A new study by the World Health Organization released on Tuesday warned of 20,000 Ebola cases worldwide in just over a month’s time if authorities failed to ramp up efforts to combat the growing epidemic.

“We estimate that, at the current rate of increase, assuming no changes in control efforts, the cumulative number of confirmed and probable cases by November 2 will be 5,740 in Guinea, 9,890 in Liberia, and 5,000 in Sierra Leone, exceeding 20,000 cases in total,” read the report published in the New England Journal of Medicine this week.

The Ebola virus is spread primarily through exposure to body fluids of symptomatic patients. Transmission of the virus is prevented through early diagnosis, contact tracing, patient isolation and infection control along with the safe burial of those killed by Ebola.

However, the virus has primarily hit impoverished West African communities, where many of these protocols are difficult or impossible to enforce.

“If we don’t stop the epidemic very soon, this is going to turn from a disaster into a catastrophe,” Christopher Dye, a co-author of the study and director of strategy at the WHO, told reporters in Geneva. “The fear is that Ebola will become more or less a permanent feature of the human population.”

The publication of the new report comes as Sierra Leone concluded an ambitious lockdown of the country for three days by effectively asking its 6 million residents to stay at home while approximately 30,000 volunteers and health officials canvassed the country to distribute soap and instructions on how to prevent contraction of the virus.

There are currently 5,833 recorded cases of Ebola across six African nations. The disease has killed at least 2,833 people.

TIME White House

U.S. to Commit $500 Million, Deploy 3,000 Troops in Ebola Fight

On Tuesday, President Obama will announce more efforts by the U.S. to lead a global battle against the spread of the deadly virus

Updated at 4:34 p.m. ET

The United States is dramatically escalating its efforts to combat the spread of Ebola in West Africa, President Barack Obama announced Tuesday, during a visit to the Centers for Disease Control and Prevention in Atlanta.

The unprecedented response will include the deployment of 3,000 U.S. military forces and more than $500 million in defense spending drawn from funding normally used for efforts like the war in Afghanistan, senior administration officials outlined Monday. Obama has called America’s response to the disease a “national-security priority,” with top foreign policy and defense officials leading the government’s efforts.

The officials said Obama believes that in order to best contain the disease, the U.S. must “lead” the global response effort. In the CDC’s largest deployment in response to an epidemic, more than 100 officials from the agency are currently on the ground and $175 million has been allocated to West Africa to help combat the spread of Ebola. Those efforts will be expanded with the assistance of U.S. Africa Command, which will deploy logistics, command and control, medical, and engineering resources to affected countries.

Officials said that the Department of Defense is seeking to “reprogram” $500 million in funding from the department’s “overseas contingency operations” fund to assist in the response. Obama has also requested another $88 million from Congress for the U.S. response, including $58 million to expedite the development of experimental treatments for Ebola.

The Pentagon will deliver 130,000 sets of personal protective equipment, thousands of kits used to test for the disease, two additional mobile lab units (one is already on the ground), and a 25-bed mobile hospital to the region. In addition, Africa Command engineers will construct additional treatment units, while the others set up a training center for to educate up to 500 health workers per week. The United States Agency for International Development will also airlift tens of thousands of home health kits and protection kits, including disinfectants and protective equipment, to be delivered to communities affected by the outbreak.

The U.S. effort, named Operation United Assistance, will be based out of Monrovia, Liberia, the country hardest hit by the Ebola epidemic and where the disease is currently spreading fastest, and will be commanded by an Army general. Obama’s announcement follows weeks of calls from global health organizations that global assistance, in particular American help, is needed to address the disease.

The World Health Organization announced last week that as of Sept. 7, there have been 4,366 confirmed, suspected, or probable cases of the disease, with 2,218 deaths. More troubling is the pace of infections, which has steadily risen despite local, regional, and international containment efforts. The WHO has predicted “thousands” of new infections in the coming weeks, calling on the global community to make an “exponential increase” in its response efforts.

U.S. officials have maintained that there is a minimal threat to the United States from the disease, but Obama warned in an interview earlier this month with NBC’s Meet The Press that failing to act could elevate the risk to the nation. “If we don’t make that effort now, and this spreads not just through Africa but other parts of the world, there’s the prospect then that the virus mutates,” Obama said. “It becomes more easily transmittable. And then it could be a serious danger to the United States.”

While the affected countries have imposed screenings at their airports to stop infected individuals from boarding aircraft, U.S. officials outlined efforts to build up detection and prevention capabilities at home, including new training efforts for airline employees and flight attendants to spot ill passengers. Customs and Border Protection officers manning ports of entry to the U.S. have also received additional training to spot potentially infected travelers. Currently the disease can only be spread by direct contact with the bodily fluids of infected patients.

U.S. officials said that in addition to the potential for the disease to spread to the U.S., they are concerned by economic, security, and political instability in countries heavily affected by the outbreak.

Earlier this month, Obama released a video to the people of West Africa, raising awareness about the disease.

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