Ebola Response & USAID Impact (with David Gura, Christina Ruffini)

Asks about the accuracy of the official case count for the Ebola outbreak.

David Gura

Jeremy Konyndyk

The official count is an undercount. Cases jumped from under 250 to nearly 800 in a week, reflecting previously undetected transmission. It's likely over 1,000 cases now, possibly multiples. This is already the third-largest outbreak in history and on track to become the second-largest.

Full contact tracing is not yet operational.

Asks about the challenge of misinformation and community distrust in the outbreak response.

Christina Ruffini

Jeremy Konyndyk

Trust is the foundation of outbreak response. Communities in eastern DRC are skeptical of the central government due to decades of war. Misinformation and burial customs (washing bodies) complicate containment. This was also seen in the 2018-19 outbreak.

Health clinics are useless if people don't trust them.

Asks how the U.S. response posture differs from 2014, given the weakened public health apparatus.

David Gura

Jeremy Konyndyk

The U.S. capacity is dramatically less. USAID is gone, CDC is a shell of its former self, and the U.S. is no longer in WHO. The partnership that led the 2014 and 2018-19 responses has been demolished. CDC staff are often barred from speaking to WHO.

In 2014, USAID, CDC, and WHO worked hand-in-glove.

Asks about the breakdown in communication between the U.S. and affected governments, citing the State Department's clinic pledge.

Christina Ruffini

Jeremy Konyndyk

The exchange between Secretary Rubio and Uganda's health ministry shows a lack of coordination. In 2014, we worked in close partnership with local ministries; catching them off guard with an announcement would have been unthinkable. USAID facilitated those deep relationships, which are now gone.

Setting up Ebola treatment units is hugely complex and expensive, costing hundreds of millions of dollars.

Asks how concerned he is about the outbreak's trajectory given the weakened response infrastructure.

David Gura

Jeremy Konyndyk

The response will be much harder, slower, and more expensive. The outbreak has four strikes against it: highest momentum upon discovery, conflict zone with 3.5 million displaced, no countermeasures or vaccine, and a weakened U.S. and international response apparatus.

The 2018-19 outbreak in the same area took two years to control.

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