On Thursday, Liberia will be declared "Ebola-free" by the World Health Organization, joining Sierra Leone and Guinea -- signaling an end to the Ebola epidemic. What did we learn?
First, it did not have to be this bad. It was not inevitable that the 2013 outbreak of Ebola in West Africa -- the world's 22nd known Ebola outbreak -- would become the world's first Ebola epidemic. While bad luck and the reality that previously remote areas in Africa are now more connected to population centers contributed to the outbreak becoming an epidemic , for the most part, the catastrophe was an avoidable failure of global health authorities, especially the WHO, to sound the appropriate alarms early enough, and not to let up on the initial efforts to combat the disease when it (falsely) appeared to be diminishing. If the right steps had been taken at the right time; if the world had acted more quickly and more decisively in the early phases of the outbreak, the death toll could have been limited to a small fraction of what it ultimately became. The ghastly tragedy that unfolded in the summer and fall of 2014 in West Africa did not have to happen.
On the other hand, it could have been much, much worse. While the Ebola epidemic itself was not inevitable, its subsequent reversal was also not preordained. In October 2014, scientists forecast that the epidemic would cause 1 million deaths, which in some ways understated the risk at that time: it covered only two of the three countries then suffering from the disease, and didn't factor in the potential for spread to other nations if the epidemic had not been checked. In the end, the death toll was less than 2% of that forecast. How were 980,000+ forecast deaths avoided? The bulk of the credit should be given to the people of West Africa themselves, for fighting this disease on the front lines, making hard cultural and behavioral changes to slow the spread, and sacrificing mightily to treat their friends, family, and neighbors. But this locally-powered effort was substantially aided by an unprecedented global response: medical volunteers, NGOs, philanthropists, and governments around the world made generous and courageous contributions.
At the top of that list was the United States, which sent over 10,000 civilian government workers, volunteers, and contractors (led primarily by the US Agency for International Development and the Centers for Disease Control), and over 3,000 US troops under Operation United Assistance. Thousands more Americans went to West Africa as volunteers through NGOs, religious groups, and medical associations. Our US Public Health Service built and staffed a critical hospital in Monrovia, Liberia. The talented team at NIH provided medical leadership and accelerated promising vaccines and treatments. America wasn't the only generous nation in the world: far from it. But it was the most generous nation, and that generosity saved thousands and thousands of lives.
Third, government can work. At a time of unmatched cynicism about our government, coming from nearly all sides of the political spectrum, the Ebola response is a powerful example of our government working effectively. Yes, there were some initial stumbles in Dallas when the first case emerged in the US. And yes, some political leaders stirred fears and put in place unnecessary quarantines on returning health care workers. But by and large, the Ebola response is a success story for our federal, state and local governments.
President Obama mustered a whole-of-government response that dispatched dramatic and successful assistance to West Africa; quickly ramped up Ebola treatment centers in the US; vastly expanded our testing lab capacities; imposed screening systems for arriving passengers at US airports; and deployed a medevac plan that saved the lives of all but one US health care worker who got the disease overseas. The President opposed a ban on travel from the region, and demanded that science -- not fear -- govern quarantine policies. Of the 50 Governors, 36 followed the President's lead on quarantines, and state public health departments successfully monitored arriving travelers who had been in West Africa and quickly got them to medical care if they showed symptoms of the disease. A bipartisan majority in Congress funded over $5 billion for the international and domestic response, without including travel ban legislation or other pernicious measures. All in all, it was a quick-moving and impressive demonstration of how government can work to keep us safe, respect civil liberties, and save lives.
Fourth, we still have a long way to go to be ready for the truly dangerous global pandemic to come. In some ways, Ebola was an "easy" test of the global response systems for a pandemic: it is a hard disease to transmit, it erupted in three countries with relatively small populations that do not send huge numbers of travelers out of the region, and these nations welcomed outside help. But a future epidemic could be transmitted by airborne means (not just by bodily fluids) and be far more contagious; it could break out in a nation with a megacity where a disease would spread rapidly; it could be an emerging commercial power that sends thousands of travelers around the world each day; and could be in a country that would resist outside volunteers (and US troops).
This is why Bill Gates has said if something is likely to kill 10 million people suddenly in the next 20 years, it's not terrorism or nuclear war or a natural disaster: it's a pandemic. The Ebola epidemic should increase -- not assuage -- our fears in this regard.
That is why -- while the epidemic is still fresh in our memories -- the world needs to tackle reform of the WHO to fix what went wrong with Ebola. It's why President Obama's global health security agenda needs continued funding from Congress, not just the one-time boost it got during the epidemic. It's why we need a global "white helmet" battalion that can go into places where US troops cannot go to contain a disease and stabilize an effected area: an idea being advanced by German Foreign Minister Frank-Walter Steinmeier. It's why work on promising vaccines and treatments needs to be accelerated, and global governance and liability issues around that work need to be addressed.
The Ebola epidemic is finished, but our work to make the world safe from a future pandemic is not. Now, before the former is forgotten, the latter must be made a priority for governments and concerned citizens around the world.
Mr. Klain served as the White House Ebola Response Coordinator from October 2014 through February 2015