Which is the greater threat to the United States and the world: ISIS or Ebola?
ISIS and Ebola hit the news at more or less the same time. The Islamic extremist group ISIS, also known as ISIL or Islamic State, shocked American military and political leaders earlier this year by taking control of large parts of Iraq and Syria in a fast-moving military campaign. ISIS, which has killed more than 9,000 people in Iraq alone this year, provoked visceral anger among Americans when it disseminated cockily narrated videos of the beheading of two American hostages. Amid warnings that ISIS could supposedly strike within the United States, one military analyst estimates that Washington is currently spending the equivalent of about $20 billion a year on military action against the group, and looks set to increase that figure to the $30 to $40 billion range despite warnings from many experts that US action may just make things worse.
Ebola has meanwhile killed at least 4,500 people in the West African nations of Liberia, Guinea, and Sierra Leone, according to official statistics, though health care workers on the ground believe that thousands more have died unrecorded deaths. (Laurie Garrett, author of The Coming Plague, estimates that the real number of dead is more than 15,000.) As the initial trickle of news coverage grew, it focused sensationally on the gross eruptions of bodily fluids from the dying and spooky images of health care workers garbed in hazmat suits as if they were dealing with the aftermath of a nuclear accident. While American pundits and politicians spent the summer beating the drums of war against ISIS, Ebola was represented in the media as another of those calamities that sadly afflict black and brown people in faraway places—like the 2004 tsunami in the Indian Ocean or the 2010 earthquake in Haiti. For a while Oklahoma Republican Sen. James Inhofe, convinced that Africans’ problems are not American problems, prevented any US government funding from going to West Africa to help contain the Ebola epidemic. The United States is now planning to send up to 400 military personnel to West Africa and spend $750 million over six months—less than 10 percent of what it is spending on the ISIS campaign. Relative to its resources, tiny impoverished Cuba has shown more commitment to helping the Ebola-stricken countries of West Africa, having sent 165 specially-trained health care workers in recent days with more on the way.
Until Thomas Eric Duncan travelled from Liberia to Dallas, where he infected two nurses with Ebola before dying of the disease, ISIS and Ebola were framed in US public discourse in contrasting ways. Despite having killed only two Americans in a faraway desert, ISIS was seen as a clear and present danger to the United States that warranted a massive mobilization of financial and military resources. (Incidentally, as University of Arizona instructor Musa al-Gharbi points out, Mexican drug cartels also decapitate many victims, and have killed almost 300 Americans, but are not seen as a threat to the United States in the way ISIS is, presumably because they are not Muslim.) Ebola was, on the other hand, seen as a problem local to West Africa. Thomas Frieden, who astonishingly is still director of the Centers for Disease Control and Prevention (CDC) despite a string of public missteps, kept assuring the American people that Ebola would not come to the United States, and that if it did, it would be quickly confined and eradicated in the advanced modern hospitals of the wealthiest nation on earth. In other words, we were told to fear the third world extremists with guns (and to kill them before they kill us), but to rest confident that we in the affluent West are safe from third world diseases associated with poverty and disintegrating public health systems.
In fact, in the era of enhanced security and surveillance, it is quite hard for Middle Eastern extremists to get to the United States, develop an organizational infrastructure, and kill Americans. Thus there has been no Muslim terrorist attack on US soil since 2001. In order for Americans to be killed by ISIS and its ilk, they have to travel to Iraq, Syria, Afghanistan, or Pakistan. Ebola is a different story. Abundant but invisible in the bodies of the infected, it is easy to imagine ways it could travel through the infrastructural arteries of a globalized world. At least 17 people have been treated for the disease in Europe and the United States, mostly health and aid workers who contracted it in West Africa, and transmission of the disease has already taken place in the United States and Spain. In the words of the distinguished doctor and anthropologist Paul Farmer, “it’s clear enough that attempts to seal national borders won’t stop it. There are no checkpoints or barriers in the forests. The day when enclosure might have worked is long gone. A CNN interviewer asked me if Ebola might spread to Europe and North America. ‘Of course it will,’ I replied. ‘We live in a global economy.’”
I do not want to stoke hysterical fears of Ebola at a moment when a teacher has been sent home simply because he was at a conference in Dallas, parents have kept their children home from a school where the principal was recently in Zambia (which has had no Ebola cases), and one college has started rejecting all applicants from Africa—even from countries with no Ebola cases. As my Facebook friend and New York Times reporter Claudia Dreifus points out, more Americans have married Kim Kardashian than have been killed by Ebola. But the apparent assumption by the CDC and many political leaders that the United States is somehow immune to Ebola by dint of being a wealthy country may be equally irrational.
While the CDC’s Frieden believes the United States is safe from Ebola because of its advanced medical technology, the case could equally be made that it is acutely vulnerable to the disease because of its dysfunctional health care system. Its overcrowded emergency rooms where the sick are in close proximity to one another for hours increase the risk that an Ebola patient could transmit the virus to others. So does the American practice of fragmenting care for the sick between so many hospital employees. (Duncan was attended to by about 70 people, all of whom are now among the more than 2,000 people being tracked for possible exposure from this one case.)
Moreover, the decentralized American health care system, in which each hospital is an island, lacks the centralized regulatory oversight and data-gathering capabilities that characterize public health systems in other advanced economies. The American patchwork approach makes it harder to detect epidemics early and, as we saw in Dallas, make hospitals adopt best practices in the face of new challenges.
Finally, the uniquely profit-centered character of the US health care system increases the likelihood that, rather than being quarantined and cared for, Ebola patients without health insurance will be sent away to infect their families. Indeed Duncan’s nephew has claimed that his uncle was originally sent home by Texas Health Presbyterian Hospital in Dallas, despite having a high fever, stomach pain, and a history of recent travel to Liberia, because “he was a man of color with no health insurance and no means to pay for treatment.”
We read a lot in the media about Africans’ supposedly irrational beliefs about Ebola. But I am struck by a kind of magical thinking among Americans who cling to the belief that, in a globalized world, they will be immune to eruptions of infectious disease in countries with collapsed public health systems as if they had nothing to do with us. If there is a single lesson about security, it is that it is indivisible. We cannot be truly safe from an epidemic if thousands of others are dying from it, even if they are on a different continent. Viruses cross borders more easily than terrorists.
The number of Ebola cases in Africa is doubling every three weeks. The New York Times reports that unless the West gives massive aid, experts fear a new infection rate of 10,000 cases per month in West Africa, with the total number of dead rising to as many as 1.4 million by early 2015. Remember that, with only 4,500 dead by official counts, Ebola has already made it to Europe and the United States. Now we are anticipating more than three hundred times as many dead, unless strong preventive action is taken. This increases the likelihood that individual cases of Ebola will recurrently appear in the United States, requiring strenuous programs of biocontainment, waste incineration, and epidemiological tracking to stop them from spreading. But even if, unlike SARS and avian flu, Ebola can be kept out of the bloodstream of international tourism, commerce, and refugee movements, think of the human catastrophe that 1.4 million Africans dying painful, lonely deaths represents. When 800,000 Rwandans died in 1994, we called it genocide and wondered how the Clinton administration could have done nothing as the massacre unfolded. Will the Obama administration now stand idly by as twice as many Africans are massacred by a virus that can be stopped not at our borders, but only at the source?
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