This Is What Functioning Government Looks Like

After an embarrassing start, public-private sector leaders get their acts together on Ebola.

When the first person diagnosed with Ebola on U.S. soil died in October, I suggested there was something scarier than the prospect of an outbreak. More alarming than a Texas hospital's misdiagnosis of Thomas Duncan. More threatening than a bureaucratic snafu at the state health department that delayed sanitization of Duncan's apartment. More worrisome than the sluggish pace of U.S. aid to West Africa, ground zero for the virus.

Of all the reasons to get hysterical about Ebola, what concerned me most was the social precedent. The initial response reminded Americans of the limits of critical U.S. institutions—in this case, various state, local, and federal agencies and private-sector health systems that responded to Duncan's illness slowly, inefficiently, and with a lack of candor that Americans, unfortunately, have come to expect.

In short, the United States faces crises of leadership and trust. Which, to me, is the scariest thing about the Ebola outbreak. I'm far less worried about the disease striking me or my loved ones than I am about what this incident says about the nation's ability to survive a true cataclysm. Whether the next existential event is Ebola or ISIS or any of the countless 21st-century horrors, we are only as strong as our institutions—and our trust in them.

Since I wrote that column on Oct. 4, the institutions rallied. Our leaders got their acts together. President Obama and congressional Republicans, along with the public and private health sectors, deserve credit for positive steps taken since the Ebola crisis's unacceptable start.

Two health care workers infected by Duncan recovered. Seven other Americans were infected with Ebola—all overseas, and all but one recovered. Most famously, Dr. Craig Spencer fell ill after returning from working for Doctors Without Borders in Guinea. While infected, he used the New York subway and a car service, and went bowling—all without transmitting the disease. He is fully recovered.

"Our best experts thought that high-quality health care could treat Ebola, but didn't really know because Ebola had never been here before," said Ron Klain who was appointed in the fall to be Obama's so-called Ebola czar. Sitting in his office overlooking the West Wing, Klain ticked off the accomplishments of a coordinated public-private sector attack.

  • "The number of U.S. hospitals certified to treat Ebola increased from three to 44.
  • "The number of labs that can test for Ebola increased from 14 to 42."
  • "The first-ever Ebola vaccine completed first-stage trials in December, and 20,000 doses will be administered in Africa in just weeks."
  • A voluntary self-monitoring system for travelers was replaced with an "active monitoring system" that routes anyone traveling from West Africa to one of five U.S. airports, where they are screened and given a preprogrammed cell phone with numbers to call if they get ill. Each person is tracked by a state public health department for 21 days. Travelers exposed to the virus get their temperature checked twice daily. Klain gets a daily update. On Monday, data were recorded on 98.9 percent of the people being tracked."
  • Congress took just five weeks to pass a $5.4 billion package aimed at preventing further outbreaks. While the White House had asked for $6.2 billion, Obama signed the bill, and Klain said the GOP made "reasonable changes.""
  • In Liberia, Ebola treatment units were built by the United States on time, and the number of news cases has dropped from about 100 per day to five or 10 per day. For all of West Africa, the epidemic is still rampant, although Klain said the number of cases is below forecast

"The point here isn't that the response has been perfect," Klain said. He noted that a lab error at the Centers for Disease Control and Prevention in Atlanta may have exposed a technician to Ebola. In West Africa, Sierra Leone, and Guinea steep challenges remain. "But I think it is the case that the Ebola response has been coordinated, effective, and shown real results."

Klain said Obama deserves credit for ignoring the clamor for a West African quarantine, a step that might have helped the White House politically but that scientists said would have made it harder to fight Ebola at its roots.

He also praised congressional Republicans, particularly outgoing Rep. Jack Kingston of Georgia, who chaired the Appropriations Subcommittee that oversees health care funding. After losing is Senate bid, Kingston helped steer the aid bill through the House while a lame duck. "He busted his butt," Klain said.

Finally, Klain said the public and private health care systems deserve huge praise for treating and containing Ebola. "They took up the challenge very aggressively," he said.

Policy ahead of politics? Bipartisanship? Competent bureaucracies? Klain attributed the Ebola rebound to "the classic American attitude of people holding up their hands and saying, 'I'm willing to do it.' "

The institution faring worst in all of this may be mine: The media, which seems to flit from crisis to crisis like a moth against a well-lit window, converting fear into ratings and page-views.

Numerous polls show the media leading an unhealthy trend: Steadily, over the past four decades, the nation has lost faith in virtually every institution that is key to a functional society: banks, school, colleges, charities, unions, police departments, organized religion, big and small business, and, of course, politics and government.

While no single event will reverse or even nudge the trend, on Ebola "“ of late, anyhow "“ U.S. leaders seem worthy of our trust.