Panel: Reform needed after failed HHS Ebola response

Ebola PPE
Ebola PPE

Army Medicine / Flickr cc

The US government was not prepared to rapidly respond to the domestic or international threat of Ebola, but increasing efforts to treat disease outbreaks abroad can protect the health of Americans, according to a report today that revisited the Department of Health and Human Services' (HHS's) response to the 2014-2016 Ebola outbreak.

An independent panel made up of public health, medicine, and government experts reviewed HHS efforts in July of 2015, critiquing the department's response and making recommendations for future emergency outbreaks. Jonathan Feldman, MD, MPH, distinguished professor of health policy and management, and pediatrics at University of California, Los Angeles, chaired the panel.

The committee made several recommendations that could apply as America faces the threat of Zika virus and other mosquito-borne illnesses. In addition to working with other nations on vaccines and medicine development, the panel recommended the HHS strengthen low-resource country's public health efforts through "pursuing the activities of—and committing funding for—implementation of the Global Health Security Agenda, thereby strengthening international detection and response to urgent public health threats."

Additionally, the panel recommended that HHS coordinate with the National Security Council to clearly establish roles for HHS when a crisis or emergency has both international and domestic components.

On the domestic front, the panel recommended that HHS maintain a national network of identified Ebola treatment centers, with standardized procedures for triaging potential patients.

Failure to use Framework

The Ebola outbreak, which claimed more than 11,000 lives, began in West Africa in 2014, and quickly circumnavigated the globe. The panel said the HHS failed to see that, "protecting the health and wellbeing of Americans at home may require the US government to provide healthcare, public health, social, and technical services in other countries."

Four thousand HHS personnel were unable to travel to West Africa, the panel said, because of untested regulations outlined in the Affordable Care Act (ACA). Additionally, US government workers who wanted to work more than 30 days overseas had to complete a training course before traveling to an outbreak country. The course had only limited availability, making it difficult to deploy staff quickly, the panel said.

Another criticism was HHS's failure to use the National Response Frameworkwhen addressing Ebola. The Frameworkwas developed by the National Strategy for Homeland Security and is meant to be deployed in response to disasters and emergencies.

"Although the National Response Framework applies to urgent public health threats, the U.S. government has never fully implemented the framework to respond to a public health event resulting from an infectious disease," the report said.

These roadblocks were compounded by poor public relations and other communication failures, the experts said. Americans were given conflicting messages about Ebola's ability to come to the United States. And when the disease first appeared in a Dallas hospital, there was an increased need for clear communication that often got lost in frightening and rapidly changing news reports, the panel said.

Ebola remains a threat

The panel offered several recommendations for HHS. In addition to strengthening communication strategies at the state and federal level, the panel recommended focusing on international response as a way to protect Americans from future disease outbreaks.

"HHS should consider establishing multidisciplinary assessment teams to make early and rapid recommendations for appropriate HHS response to urgent international public health threats," the report stated. "HHS should determine whether and how to maintain readily deployable medical personnel to treat patients in response to requests from other nations during these threats."

In a timely and political comment, Fielding said the US government's current focus on Zika could make the country more vulnerable to serious problems if Ebola re-emerges as a public health threat.

"There are important lessons learned from Ebola that can improve our current response to Zika and preparedness for the next global communicable disease threats," said Fielding. "I share other panel members' concern that Congress is requiring money be taken from continuing efforts needed to strengthen public health preparedness and the fight against Ebola—to be used instead for fighting Zika. … We can't rob Peter to pay Paul and protect our nation's health."

See also:

Jul 1 Ebola panel report

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