The Ebola War

Things are just awful in Liberia, and getting worse elsewhere as well. The problem now clearly outpaces the response, resulting in shortages of everything from barrier protection to hospital beds. Worse, there is a breakdown in civil order and trust that makes it impossible to do the hard work of case identification, contact tracing and education--which is what ultimately brings epidemics under control. 

The latest, and somewhat controversial, call is for a large-scale military or quasi-military response to the outbreak. Although there are clearly downsides, experts from Peter Piot to MSF leaders to Mike Osterholm are calling for military involvement. 

The need for such involvement is based simply on the scale of this disaster—WHO, CDC, non-governmental groups like MSF, no group has anything close to the logistical capability of the military to quickly deploy personnel and supplies almost anywhere in the world. If, as MSF suggests, military assets are “not…used for quarantine, containment, or crowd control measures”, which have backfired (particularly in Liberia), such a response could help bring essential capacity where it is needed most. The chart below provides a comparison of the total budgets for the US military, CDC, WHO and MSF. I realize that the military is not designed for infectious diseases outbreak response, but we’ve invested in a massive military complex (to the exclusion of investment in many other areas, including infectious diseases prevention), so I’m not sure we have any choice: the United Nations to coordinate, UN member nations' military assets to move materials and people, and the CDC, WHO, MSF and others to provide expertise.

NDM-1 in a US Military Hospital



source: wikipedia

Maryn McKenna has an interesting take on the MMWR report of NDM-1 in a US military hospital in Afghanistan. The patient had NDM-1 containing Providencia stuartii in a blood isolate collected early in 2011. This is the first case of NDM-1 in P. stuartii and in a US military hospital.  The parallels she draws to previous Acinetobacter infections in military hospitals are interesting. However, I'm not sure you can compare a specific species (Acinetobacter) to a plasmid-borne metallo-ß-lactamase (NDM-1), which can hop from species to species.

Either way, we will eventually need to beef up surveillance, infection prevention research and antibacterial drug discovery.  GNRs are not going away. I suspect the worldwide response to the many MDR-bacterial threats is going to require a significant reorganization and renewed focus (e.g. 1940s and 1950s) on how we fund these efforts. The days of nickel and diming these efforts, are coming to a close...