While the emergency Ebola money in the Congressional spending bill released Tuesday allots nearly a billion dollars less overall than the $6.18 billion President Obama requested in November for responses to the crisis in West Africa and its impacts at home, the $5.2 billion in the omnibus bill closely follows most aspects of the President’s outline for the use of the funds. The allocations, as emergency funding, also follow the spirit of the President’s request, that make the dollars additional to, and not at the cost of, ongoing global health programs.
While the President asked for a combined 2.89 billion for the State Department and USAID, the bill dedicates 2.53 billion for exclusively overseas efforts to contain the outbreak and build capacities, as well as to respond to security threats posed by the virus. The bill exceeds the President’s request for $2.43 billion for the Department of Health and Human Services (which includes funding for the Centers for Disease Control and Prevention, the National Institutes of Health and the Food and Drug Administration), with $2.72 billion for domestic as well as global responses. The bill matches the President’s request for $112 million for the Department of Defense, largely for research efforts to develop technologies to better respond to the epidemic. The bill, however, passes on the President’s request for a $1.4 billion contingency fund to respond to evolving needs in the course of the epidemic. The bill does include provisions allowing reimbursement to agencies that have already spent money from their budgets on Ebola responses.
The bill comes the week that CDC’s MMWR released three new early reports of Ebola’s impacts, in addition to the early release of one the week before. The reports released this week tabulate results of airport exit and entry screening for the virus, the findings from a review of Ebola infection prevention control needs in Sierra Leone, and the disproportionate impact of the epidemic in Sierra Leone on health care workers. The report released Dec. 5 describes the climb, and outcomes of clinical reports of “PUIs” — persons under investigation for possible Ebola.
Highlights of the reports include:
- Between July 9 and November 15, the CDC responded to 650 reports from public health departments and health care providers across 49 states and the District of Columbia of people thought to be at risk for the virus, with the weekly number of reports reaching their height — 227 reports in mid-October — following the diagnosis of Thomas Eric Duncan, the first Ebola patient diagnosed in the United States. Of those reports, 490 concerned people who had not traveled to a country where Ebola was present, and had also had no contact with an Ebola patient.
- Of nearly 2,000 travelers screened for Ebola at American airports, 86 were referred for additional evaluation by public health officers, and seven were referred for medical evaluation. None were diagnosed with Ebola.
- Of 3,854 Ebola patients confirmed in Sierra Leone by October 31, 199 — or 5.2 percent — of those patients were health care workers. Considering the low number of healthcare workers in Sierra Leone, the impact of the epidemic on that population is particularly disproportionate, the report notes.
- An assessment of Ebola infection control capacities in six of Sierra Leone’s 14 health districts found that none had dedicated infection control personnel, none had standardized procedures for screening, care, isolation, and transport of suspected or confirmed Ebola patients. Deficits in infection control supplies included lack of running water, incinerators for contaminated disposable waste, chlorine, blood collection supplies.
In addition to the needs detailed in the latter report, in briefings leading up to the spending bill representatives of organizations prominent in responses to the crisis in West Africa described the impact of illnesses and deaths, as well as incapacitation of health services to meet needs additional to, and including those posed by the epidemic. They emphasized that the devastation caused by the outbreak will continue long after the last illness is treated, with ravaged economies, families, educational systems, social services all in need of rebuilding.
At the same time, as those in even the hardest hit areas struggle to defeat the epidemic, among the facets of life that remain intact in West Africa, Ebola survivor and health responder in Sierra Leone Will Pooley says: They do know it’s Christmas. The British nurse, who was volunteering in a Sierra Leone hospital when he became ill with Ebola in August, has recovered and returned to Sierra Leone where he is once again caring for Ebola patients. Familiar now with both Ebola, and life in the country currently hardest hit by the epidemic, he recently referred to the latest Band Aid version of “Do they know it’s Christmas,” as “cringeworthy,” and “cultural ignorance,” pointing out “it’s Africa, not another planet.” He suggested that those wanting to alleviate suffering caused by the current Ebola outbreak make a direct contribution to one of the organizations working on the ground there.