June 17, 2015 - U.S. health officials, policymakers, and others made significant mistakes during last year’s Ebola crisis which led to a sense of public distrust in the health care system’s ability to deal with the disease and helped foment panic, according to a leading health law expert and former University of Houston Law Center professor.
Mark A. Rothstein, the Herbert F. Boehl Chair of Law and Medicine and the founding director of the Institute for Bioethics, Health Policy and Law at the University of Louisville School of Medicine, served as director of UHLC’s Health Law & Policy Institute from 1986 to 2000. He spoke April 28 in the Hendricks Heritage Room.
Rothstein noted that since the colonial period, local jurisdictions such as counties and their subdivisions have held primary responsibility for public health, a situation that carried over when the U.S. Constitution was ratified in 1787. Although the federal Centers for Disease Control and Prevention has responsibility in international and interstate health emergencies, primary responsibility is still held by the states, he explained.
When Ebola outbreaks became rampant in several West African nations in early 2014, Rothstein said U.S. officials should have kept two important facts in mind: People who are infected are not contagious until they become symptomatic, “almost certainly” within 14 days of exposure; and, in the U.S., “the risk of transmission is to health care workers, period.”
The CDC’s original response to the threat that Ebola might be introduced into the U.S. was to implement a screening policy for health care workers returning from countries where the disease was present, including 21 days of self-monitoring.
But just days after public statements and actions by officials such as New York Gov. Andrew Cuomo and New Jersey Gov. Chris Christie concerning “how these people are dealt with” (including isolating a New Jersey doctor in a “medical tent” with no amenities), the CDC revoked its earlier guidance and created a policy dividing people into three new risk categories.
“It was a mistake because people hearing this are thinking CDC must have screwed up before, why are we trusting them now?” Rothstein said. Surveys showed that the public’s confidence in the agency plummeted to as low as 37 percent.
“We cannot have a public health system in the country when only a third of the people think the lead public health authority in the U.S. is trustworthy,” he said.
Rothstein said there were six major mistakes made in the U.S. in response to the crisis. The first was assuming that every hospital in the country, including understaffed ones in rural areas, was well-prepared and equipped to deal with Ebola cases, which Rothstein said clearly wasn’t the case.
Secondly, health care workers and the media failed to anticipate public reaction to the disease’s appearance on American shores. Returning health care workers should have gone about their usual lives, but kept “a low profile,” Rothstein said.
The third major mistake, he said, was officials (including at the CDC) imposing “severe and unnecessary” precautions “out of an abundance of caution” – which he defined as taking actions unsupported by scientific evidence “just to look good and calm the least-informed people in the community.”
“Abundance-of-caution actions are not cost-free,” Rothstein said. They involve costs to individual lives, financial costs to the public, societal costs such as spreading fear, and public health costs such as dissuading health care workers from traveling to West Africa to treat victims because of fear of the public’s response.
The fourth mistake, Rothstein said, was the “politicization and lack of courage” shown by elected officials in overreacting to public fear of the disease.
“We seem to have gone through a race to the bottom among public health and governmental leadership about who could be tougher on Ebola and more protective” he said.
The fifth mistake, he said, was “discrimination against anyone even remotely connected to the continent of Africa,” including people from nations thousands of miles away from the outbreaks.
The sixth and most egregious mistake, Rothstein said, was the failure by the U.S. and world health systems to recognize “the big picture in causation and response.”
“We’re never going to be over Ebola until nobody in Africa has Ebola. We’re never going to be safe from the next terrible illness unless and until there’s a public health system in place where this can be identified and responded to in the appropriate manner,” he said.
Although the immediate crisis in the U.S. has abated, Rothstein advised American officials to engage in some introspection.
“The fact that the tumult surrounding Ebola has died down does not meant it’s time for complacency. We still need to address the public health needs of the least-well-prepared and equipped countries of the world. And we have to rethink what we did, how we made some mistakes with Ebola,” he said. “It’s not a question of if this happens again; it’s a question of when. And we have to do a much better job.”
Read about a November workshop on the Ebola response held at UHLC here.