US President Barack Obama says the world must act quickly to stem the Ebola outbreak.  Credit: Pablo Martinez Monsivais/AP

The world must act quickly to contain West Africa's Ebola outbreak, which is “spiralling out of control”, US President Barack Obama said on 16 September.

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To that end, the United States will send 3,000 military personnel and spend roughly US$750 million on fighting the epidemic, which is thought to have infected nearly 5,000 people and has killed more than 2,400, according to the World Health Organization (WHO) in Geneva, Switzerland. Experts say that a massive increase in personnel and other resources will be necessary to contain the virus.

“The world knows how to fight this disease,” Obama said during a visit to the US Centers for Disease Control and Prevention (CDC) in Atlanta, Georgia. “We know how to prevent it from spreading. We know how to care for those who contract it. But we have to act fast. We can't dawdle on this one.”

Biodefence experts see the deployment of military personnel as a turning point in the effort to halt Ebola’s spread. “When they take over an operation, you can be assured things are going to go according to a set plan,” says Amesh Adalja, an infectious-disease physician at the University of Pittsburgh Medical Center in Pennsylvania.

The US effort will be based in Monrovia: Liberia is the country that has been hardest hit by the epidemic. It will set up 17 new hospitals in affected areas, coordinate transportation of equipment and personnel and set up a centre to train 500 health-care workers per week, according to the White House.

Unusual response

The US military often responds to natural disasters, such as floods or earthquakes, in other countries, but this is the first massive deployment for an outbreak, says Lawrence Gostin, an expert in public-health law at Georgetown University in Washington DC. The response is long overdue, he says, and the military could “bring discipline to the very chaotic response that’s been occurring on the ground where nobody’s taken the lead”.

On 28 August, the WHO estimated that it would cost $490 million and require nearly 13,000 more health-care workers to end the epidemic — but it has not been clear who would provide these resources, in part because the WHO recently slashed its budget for rapid responses to outbreaks. Donations have been trickling in from governments and private charities such as the Bill & Melinda Gates Foundation in Seattle, Washington; on 8 September, for instance, the United Kingdom announced that it would deploy military forces and build a hospital with 62 beds in Sierra Leone. And on 12 September, Cuba said it would send 165 health-care workers to Africa.

The US effort was announced just as the World Bank approved the release of $105 million from the $230 million that it has committed to support both the immediate response to Ebola and the long-term rebuilding of affected countries’ ravaged health systems.

The United States has spent more than $100 million on the Ebola response so far, the White House says — including $10 million to send more than 100 health-care workers to the region. The defence department hopes to redirect $500 million allocated for other programmes to the Ebola fight. And Obama has requested another $88 million from Congress for the effort, including $30 million to send additional CDC personnel to Africa. Already, more than 100 agency staff are in outbreak areas, making this the CDC’s largest international deployment in response to a health crisis.

Looking ahead

It remains to be seen, however, whether this response will help prevent future outbreaks. “My greatest fear is this will be another Haiti,” Gostin says, referring to the 2010 earthquake and concurrent cholera outbreak there, to which the US military responded. “All of a sudden we throw a lot of resources at it and then leave. Then the next epidemic happens down the road.”

At least some resources are being used for this purpose during the current outbreak. The European Union’s €140-million (US$181-million) donation is aimed largely at long-term rebuilding of health-care systems in areas where Ebola has spread, for instance.

But not everyone agrees that efforts to improve basic health-care capacity should be a priority. Leaders from the international aid agency Médecins Sans Frontières say that such a focus could detract from efforts to aid the sick and the dying. “The prevailing trend to treat humanitarian assistance as a branch of development aid might contribute to the current hands-off approach, leading to a paralysis of effective and direct humanitarian aid on the ground,” they wrote in a 10 September correspondence to the Lancet1.

But workers and troops deployed to fight Ebola will have a difficult task because of a general distrust of governments and foreign workers, which has helped to contribute to the disease's spread. “Any military response is going to have to be very respectful and patient with that trust deficit,” Gostin says.