The United States mishandled the Ebola epidemic and exacerbated an international public health crisis by not developing long-term relationships with global health partners, not communicating well with the public about the real facts and dangers, and not presenting a coordinated emergency response, the Presidential Commission for the Study of Bioethical Issues said in its recently released report on the crisis.

The fact that US public officials were not unified in their reaction to the epidemic — "addressing political implications" rather than real public health concerns — only fed the public's fear, the commission said.

Further, the commission stated that it was both an "ethical and prudential" responsibility for the US to respond to global health crises because of our "national values," especially in a modern globalized world.

Part of that is preparing for the "next epidemic. A failure to prepare and a failure to follow good science — for example, by not developing vaccines and not supporting health care providers — will lead to needless deaths," Commission Chair Amy Gutmann, PhD, said in a news release.

Quarantines an Issue

Inconsistencies in quarantines were particularly a concern. For example, the US Department of Defense was more restrictive than US public health leaders recommended, implementing a 21-day quarantine for anyone in the department returning from Ebola-affected countries. Sylvia Burwell, secretary of the US Department of Health and Human Services, said that the policy of the Department of Defense "was not based on the science."

The commission offered seven recommendations for improved responses to future international health crises. It advised the US to strengthen its collaboration with and funding of the World Health Organization (WHO), which can quickly respond to public health emergencies but is underfunded and politicized. The report criticized WHO's "organizational structure and bureaucracy."

The commission also advised that any restrictions, such as quarantines, be based only on the best scientific evidence available and restrict only as much as absolutely necessary to protect public health. Public officials should only implement a restriction if it is the only way to effectively protect people from harm. And if a restriction is implemented, government officials should be able to communicate clearly to the public why the restriction is needed and how it would help, the commission said.

When several Ebola cases emerged in the US, the report stated, some state quarantine policies "were ineffective and overly restrictive."

"Many public health experts considered an imported case to be inevitable, given the size and scope of the epidemic and the ability for people to travel from western Africa to the United States in less than 24 hours," the commission wrote. "What appeared to be more of a surprise was the lack of national and local public health preparedness, the degree to which Ebola was politicized, and the public and media reactions."

The commission also strongly recommended "identifying and empowering" a single US health official to take charge of federal response to both domestic and international public health emergency response activities. And it advised streamlining the command structure of the US Public Health Service to hasten response to emergencies. More resources to train and maintain the skills of emergency responders are also needed, according to the report.

Although the crisis has abated in terms of new Ebola cases, the epidemic has had the long-term effect of taxing already fragile systems in West Africa. "Catastrophic health, social, and economic effects are emerging, including food insecurity, unemployment, orphaned children, disruptions to education, and diversion of resources from other pressing health needs, such as malaria," the report stated.