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 Medicine Sans Frontières (MSF) leaders to Mike Osterholm are calling for military involvement.
The need for such involvement is based simply on the scale of this disaster. The World Health Organization, the Centers for Disease Control and Prevention, 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. This chart provides a comparison of the total budgets for the U.S. 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.
Daniel J. Diekema, MD, FACP, practices infectious diseases, clinical microbiology, and hospital epidemiology in Iowa City, Iowa, splitting time between seeing patients with infectious diseases, diagnosing infections in the microbiology laboratory, and trying to prevent infections in the hospital. This post originally appeared at the blog Controversies in Hospital Infection Prevention.