What you heard:
From a head of state
In a nearly unprecedented gesture for a sitting head of state, Liberian President Ellen Johnson Sirleaf joined the Senate Foreign Relations African Affairs subcommittee hearing on “The Ebola Epidemic: The Keys to Success for the International Response” to provide a statement, as well as to answer questions. Heartfelt gratitude for US leadership and support; the havoc Ebola is inflicting on Liberia’s development gains; and the recent progress fighting the disease led her remarks.
But no (good) congressional testimony would be complete without an ask, and President Sirleaf’s remarks included two direct asks of the US government: (1) continued US support to achieve full eradication of the disease and (2) an MCC Compact. With Congress readying to vote on a $5.4 billion emergency Ebola supplemental (nearly funding President Obama’s $6.2 billion request) as part of the CRomnibus and the MCC just announcing Liberia’s re-selection for first compact development, both appeals seem on track.
Representatives of Partners in Health, World Vision, IntraHealth International, and Mercy Corps each provided testimony. The two most important takeaways:
don’t just focus on the emergency response, build sustainable health systems;
this is not just a public health crisis, it’s a systems crisis and should be addressed as one (this wasn’t a big focus of the hearing, but Mercy Corps was spot on in this characterization).
If not quite as rare as an appearance from a sitting head of state, a fairly full roster of members attended the subcommittee hearing. Senators Coons (D-DE), Flake (R-AZ), Durbin (D-IL), Shaheen (D-NH), Murphy (D-CT), and Markey (D-MA) each joined, rather than the usual lonely conversation dialogue between the witnesses and the chair and ranking. Smart questions from all, particularly around building sustainable health systems and ensuring new facilities have a use beyond the immediate crisis.
What I hope we’ll hear more of in future hearings:
How to Stop Making the Same Mistakes
There is much that is unprecedented about the Ebola epidemic. But the United States and the international community respond to major humanitarian disasters every year. Donor governments should know how to do emergency responses and disaster recoveries. And for the most part, we do. The US response, in particular, has been extraordinary. However, I fear that once we move beyond this initial phase, we could find the same problems on the donor side that were in painful evidence in the response to the Haiti earthquake and other recent disasters: a failure to “build back better,” little ability to identify where the money went but clear indications of a lack of effective donor coordination, and a failure to work with the local governments and communities that need to carry on the recovery once the donors leave.
The International Health System is Broken—How the US Can Help Fix It
Future health crises are coming and the international health system isn’t ready for them. Strengthening national health systems should be a priority, but it is one that is difficult, costly, and slow. We also need an improved WHO: one that can lead on public health preparedness and provide active disease surveillance capabilities. The United States can—and must—lead the drive for a newly effective WHO.
How to Help Drive an Economic Recovery
The economic costs of the Ebola outbreak are potentially catastrophic to Liberia, Guinea, and Sierra Leone. And it is critical to immediately address the second-order costs of the outbreak, which include critical challenges such as food security. But it’s also more than time to start planning for post-Ebola economic recovery. The US government and our private sector have a role to play as President Sirleaf told SFRC—I hope SFRC and HFAC will examine how the US should and does plan to help put West Africa on the road to economic recovery.