As epidemic escalates, can U.S. aid for Ebola be deployed quickly enough?

(or a better title would be: 'How to handle Ebola by experts from the CFR and Georgetown University')*

September 16, 2014 at 6:10 PM EDT

How effective will new U.S. aid and military support be in fighting Ebola? Laurie Garrett of the Council on Foreign Relations and Lawrence Gostin of Georgetown Law School join Judy Woodruff for a deep dive into the plan. Then special correspondent Fred de Sam Lazaro offers an update from Nigeria, a country that has been relatively successful in controlling the deadly virus.

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TRANSCRIPT

JUDY WOODRUFF: Let’s dive deeper now into the president’s plan to ramp up the response to the Ebola outbreak and to try preventing a humanitarian catastrophe.

It comes amid prior criticism of the administration, along with the WHO and of other countries, for not doing more and for not getting it done faster.

We turn back to two who have been closely watching this and speaking with government officials in recent days.

Laurie Garrett of the Council on Foreign Relations, she has written widely about Ebola, including the books “Betrayal of Trust” and “The Coming Plague,”and Lawrence Gostin of Georgetown University. He’s the director of the O’Neill Institute for National and Global Health Law.

And we welcome you — welcome both of you back to the program.

Laurie Garrett, to you first. What is your assessment of the president’s plan that he outlined today?

LAURIE GARRETT, Council on Foreign Relations: Well, it’s a bold step forward. I’m delighted it’s actually taking place.

But I think everything depends on the haste with which we can mobilize. And I am afraid a lot of people don’t understand that committing troops and saying you’re going to build a hospital are all very good steeps, but it takes weeks to execute these things. And, in the meantime, the epidemic is doubling every 10 to 20 days. We don’t have a lot of time. We’re racing against a clock.

JUDY WOODRUFF: Lawrence Gostin, do you have the same concerns? What’s your assessment?

LAWRENCE GOSTIN, Georgetown Law: I think Laurie is right about timing.

First of all, I am very proud of my country. I mean, we have stepped forward when no one else would or could. But there are major unanswered questions. It’s not just timing, but also command-and-control. There’s chaos on the ground. It’s uncoordinated.

I was very pleased to see the president say that we have a command post, but how are we going to command Chinese or Cuban workers? I do think we need a U.N. Security Council resolution to actually have the kind of international legitimacy that we need.

JUDY WOODRUFF: So going beyond what the U.S…

LAWRENCE GOSTIN: Yes, the U.S. can’t do it alone.

JUDY WOODRUFF: Well, let me just go further here with what the U.S. is doing. You said you’re proud of your country. What specifically do you think is going to make the most difference here?

LAWRENCE GOSTIN: Well, I think the most difference will be training health workers, although — and building health facilities in the community, contact tracing. All of those things are very important.

JUDY WOODRUFF: Meaning going back and finding out where…

LAWRENCE GOSTIN: Meaning going back, finding out who has been in contact with whom, and quickly isolating them in safe conditions.

One of the big problems, though, is, is that even once we have built these treatment facilities, it’s going to be handed over eventually to the Ministry of Health in Liberia. And they just don’t have the health workers. The doctors and the nurses have been decimated. And so we really do have a huge infrastructure task.

JUDY WOODRUFF: Laurie Garrett, you laid out your concerns, but of what has been announced, how do you see this unfolding and making any difference?

LAURIE GARRETT: Well, first of all, we don’t have any commercial flights landing in the area now. And so just getting doctors on the ground, getting medical supplies, keeping stocks in place of such simple things as latex gloves to protect you from infection have all proven daunting, in the absence of real solidarity from neighboring countries and the willingness to have planes land and commercial flights.

So one huge role for the U.S. military is going to be helping Ghana, which has very kindly and generously agreed to be the air bridge for all supplies and human movement into the area, to extend their runway, build their airport up, have logistic and supply operations in place, and then to have smaller flights go from Ghana into specific targeted areas carrying supplies with them as needed.

But Larry points out a crucial problem with all of this. We don’t have a central command, which means we don’t even have a centralized list of what’s needed. Who needs latex gloves where? Is the situation more dire in this county in Sierra Leone or in this county in Liberia? Where do we need to deploy people first?

We don’t have that kind of operation in place. And our U.S. military is not going to play that role. We will have a central command, but it will be commanding U.S. military personnel, not people from other countries and certainly not the Liberians themselves.

And we also see that the response is not a regional one. We are, unfortunately, dividing our response according to kind of old colonial ties. So the French are focusing on Guinea, which used to be a French colony. The United Kingdom is focused on Sierra Leone, which is settled by the descendants of British slaves who came from the Caribbean, and we’re focused on Liberia, which is settled by former American slaves.

And so there’s this sort of distasteful neocolonial feel to things, and it means that the responses are not unified. They are very divided by country. So you have heard of 165 Cuban responders and 59 Chinese. They’re all going to Sierra Leone, where they will be under we don’t know what kind of command, loosely coordinated by the Sierra Leone government.

JUDY WOODRUFF: And, Lawrence Gostin, this is sounding like a very complicated effort, which we already knew, but it sounds even more complicated listening to the two of you.

What about the timing of this? How long is it going to take to begin to make a difference, to begin to get to the people who need treatment and are not receiving it?

LAWRENCE GOSTIN: Well, first of all, we are very late to the game. The fire has nearly burned the house down, and we have arrived. The cavalry has arrived.

It will take a long time, I think, to build the kind of facilities that we want. I mean, the whole idea, for example, that we’re sending 500,000 home kits suggests that we can’t get people into hospitals quick enough to treat them and isolate them, and people who…

JUDY WOODRUFF: These are self-testing kits?

LAWRENCE GOSTIN: These are self-testing kits or self-protecting kits. I’m not sure the community will know what to do with them when they get them.

And so this is a — this is a makeshift response to a huge humanitarian crisis. I don’t think it had to come to this, but now that we’re there, I’m really glad the see the United States military involved.

JUDY WOODRUFF: So, Laurie Garrett, should we be pleased that this is happening or more worried because it’s not the holistic response that I heard you describing that’s necessary?


“…if we can’t get a response on the ground immediately, effectively, across the region … then we’re talking about something equivalent to the Black Death’s impact on Tuscany and Florence in 1346. “

LAURIE GARRETT: Look, I’m delighted, like Larry, to see my country step up to the plate and play a role. And I’m hoping that we can save lots and lots and lots of lives and bring this epidemic under control.

But I agree completely we’re late to the game. And if you just do the math, based on the statement made today by WHO, a doubling time every 10 to 21 days, and you take the number of actually identified and suspected cases existing now and do your math, you can see that if we can’t get a response on the ground immediately, effectively, across the region, we will be looking at a quarter of a million cases by Thanksgiving, and 400,000 by Christmas if this is not abated and brought under control.

And then we’re talking about something equivalent to the Black Death’s impact on Tuscany and Florence in 1346.

JUDY WOODRUFF: Sobering, sobering any which way you look at it. We appreciate both of you joining us.

Laurie Garrett, Lawrence Gostin, thank you.

LAWRENCE GOSTIN: Thank you.

JUDY WOODRUFF: And one country in West Africa that has had relative success in controlling this virus so far is Nigeria.

While this nation has had 21 confirmed and suspected cases of the Ebola virus, including seven deaths, it has not had an explosive surge and spread since its first victim was reported in late July.

Our special correspondent, Fred de Sam Lazaro, is on assignment in Lagos, and he checked in with us earlier today.

FRED DE SAM LAZARO: Nigeria is Africa’s most populous country. It has the largest economy on the continent and its commercial capital, Lagos, has 20 million inhabitants, all of which have raised concerns that an Ebola outbreak would be catastrophic.

But that hasn’t happened, in part due to an early break, and in large part due the a good public health response, experts say. The virus was first brought to Nigeria by a Liberian traveler who fell ill at the airport, and, in a peculiar twist of fate, medical doctors were on strike when he was taken in for health care.

That exposed far fewer health workers to the virus, and health care workers have been especially hard-hit during this epidemic. They have contracted the virus and they have passed it on to their patients. Despite its reputation for chaos and dysfunction, Nigeria has launched a very sophisticated response to Ebola.

Everyone entering the country, including this reporter when we arrived yesterday at the airport, is screened for any symptoms. Those with an elevated fever, for example, are taken in for secondary screening to make sure it’s not related to Ebola.

There’s a call center where people can report suspected cases, and a concerted public awareness campaign that has kept fear from turning into panic. And a sophisticated surveillance system has enabled this country to trace and keep track of all cases and people with whom they came into contact.

All of these cases have been directly traced to that original index case, the Liberian traveler. This is reassuring, but at a time when there’s so much travel and when the virus is running amuck in other parts of West Africa, Nigeria is nowhere near being able to declare victory. A lot of fingers are still crossed tightly here.

JUDY WOODRUFF: And we will have more of Fred’s reporting from Nigeria in the coming days.


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The Lone Star: The Story of Liberia

The Lone Star, the flag of Liberia

Ton Vriens, Grain Coast Productions

When freedom raised her glowing form

On Montserrado's verdant heights

She set within the dome of night

Midst low'ring skies and thunderstorm --

The star of liberty.

A question of freedom

Six thousand miles from the United States lies a country whose flag bears a striking resemblance to the American one: alternating red and white horizontal stripes and, in the upper left-hand corner, a dark blue square. Against this blue background is a lone white star -- the star of liberty. The flag is a symbol of the history of the Liberian state, its relationship with America, and its search for its own identity.

The present-day Republic of Liberia occupies 43,000 square miles (slightly more than Tennessee) in West Africa. It is bordered on the southwest by the Atlantic Ocean and surrounded by Guinea, Sierra Leone, and the Ivory Coast. From antiquity through the 1700s, many ethnic groups from the surrounding regions settled in the area, making Liberia one of Africa's most culturally rich and diverse countries. Settled in the early 1800s by freeborn Blacks and former slaves from America, Liberia, whose name means "land of freedom," has always struggled with its double cultural heritage: that of the settlers and of the indigenous Africans.

From America to West Africa

In 1816, a group made up mostly of Quakers and slaveholders in Washington, D.C., formed the American Colonization Society (ACS). The Quakers opposed slavery, and the slaveholders opposed the freedom of Blacks, but they agreed on one thing: that Black Americans should berepatriated to Africa. The Quakers felt that freeborn Blacks and former slaves would face better chances for freedom in Africa than in the United States. They also saw repatriation as a way of spreading Christianity through Africa. The slaveholders' motives were less charitable: They viewed repatriation of Blacks as a way of avoiding a slave rebellion like the one that had taken place on the island of Santo Domingo, today's Haiti.

Despite opposition from many Blacks and from white abolitionists, the repatriation program, funded by ACS member subscriptions and a number of state legislatures, moved forward. In 1822, the first 86 voluntary, Black emigrants landed on Cape Montserrado, on what was then known as the Grain Coast. They arrived with white agents of the ACS who would govern them for many years. Many others followed, settling on land sometimes purchased, sometimes obtained more forcefully, from indigenous chiefs.





Settlers shared the land with indigenous tribes. (:48) Watch




The first years were a challenge: The settlers suffered from malaria and yellow fever, common in the area's coastal plains and mangrove swamps, and from attacks by the native populations who were, at various times, unhappy -- unhappy with the expansion of the settlements along the coast; with the settlers' efforts to put an end to the lucrative slave trading in which some ethnic groups were engaged; and at the settlers' attempts to Christianize their communities. Despite these difficulties, the Black settlers were determined to show the world that they could create, develop, and run their own country. And so they kept arriving.

In 1824, the settlement was named Monrovia, after the American president (and ACS member) James Monroe, and the colony became the Republic of Liberia. Over the next 40 years, 19,000 African American repatriates, sometimes known as Americo-Liberians, settled in Liberia, along with some 5,000 Africans recaptured from slave ships, and a small number ofWest Indian immigrants.





Early settlers brought their place names and architecture. (1:48) Watch



Settlers were determined to create a Black America overseas. (1:42)Watch




A two-tiered society struggles to stand on its own feet

The settlers recreated American society, building churches and homes that resembled Southern plantations. And they continued to speak English. They also entered into a complex relationship with the indigenous people -- marrying them in some cases, discriminating against them in others, but all the time attempting to "civilize" them and impose Western values on the traditional communities. After Liberia declared its independence in 1847, Joseph J. Roberts, a freeborn Black who was born in the American state of Virginia, was elected Liberia's first president. It had taken fewer than 25 years for the Blacks from America to begin to govern their own, free country. Soon after his inauguration, President Roberts traveled to Europe, where he was received in the courts of Queen Victoria and Napoleon III. Queen Victoria gave him a gunship to combat slavery, which had continued along the coast with unscrupulous native traders who preyed on weaker ethnic groups. Not surprisingly, England and France were the first countries to recognize Liberia's independence in 1848. Roberts and his senators, all American-born, resolved to create a country based on the principles of justice and equal rights.

The settlers built schools and a university, and during the early years, agriculture, shipbuilding, and trade flourished. Yet as Liberia expanded its borders, a government of repatriates located largely on the coast attempted to establish control over a growing native population located largely in the interior. Over the next few decades, escalating economic difficulties began to weaken the state's dominance over the coastal indigenous population. When the financially burdened ACS withdrew its support, conditions worsened as Liberia tried desperately to modernize its largely agricultural economy. The cost of imports was far greater than the income generated by exports of coffee, rice, palm oil, sugarcane, and timber. Liberia was also struggling under the burden of heavy loans, primarily from Britain. By 1909, the government was bankrupt and forced to borrow further, in large part from the United States.




Forced labor was very much like slavery. (2:23) Watch



To bring in more revenue , the Liberian state leased large areas of land to American companies such as Firestone, which operated a massive rubber plantation in the African nation. The terms of the leases were strongly in favor of the private companies. The final straw came in 1930 when an accusation by the League of Nations, of "forced labor ... hardly distinguishable from slavery," turned out to be true. The government collapsed, and the new president, Edwin Barclay, dealt with the mounting discontent among his people by introducing increasingly repressive laws.

An international profile, and trouble at home

 

Despite its political, economic, and social troubles, Liberia, as the only free republic in Africa, was a model for African colonies struggling to achieve independence. William V.S. Tubman, elected president in 1944, further highlighted the country's world profile by traveling abroad and allowing international investment in Liberia. With this investment and the income from the newly discovered mineral deposits, he modernized parts of Liberia (mostly along the coast) and built schools, roads, and hospitals. Tubman also expanded the incorporation of indigenous populations into the social and economic mainstream, granting them, for example, the right to vote. Under Tubman, Liberia was a founding member of the United Nations as well as of the Organization of African Unity, and he strongly championed the independence of other African states.

Despite these developments, the gap between the ruling elite and the indigenous populations increased. Tubman was criticized for being too influenced by the United States and its interests in the area (i.e., the fight against communism), and for repressing political opposition. Tubman's rule became gradually more authoritarian : He changed the constitution to allow himself to remain in office for seven consecutive terms, gagged the press, and introduced a system of government spies to report on all political activity.





Tolbert wanted Liberia to be a force for African unity and civil rights. (1:12)Watch



Tolbert became a tragic figure. (1:03)Watch




By the time Tubman died in 1971, frustrations in Liberia were running high. His vice president and successor, William R. Tolbert, attempted to improve the economic and political climate by introducing many new changes. But the damage of the past seemed irreparable. The majority of the population was poor and lacked basic amenities such as access to safe water and electricity. Tolbert's attempt to liberalize Liberian society backfired -- some thought he was moving too quickly, while others thought he wasn't moving quickly enough. Many could no longer bear the political dominance of the descendants of American settlers. At the same time, Tolbert's own administration opposed his efforts to bring more indigenous Liberians into the upper echelons of government. Tolbert's proposal in 1979 to increase the price of imported rice, a basic part of the Liberian diet, as a tactic to encourage local production was interpreted negatively, and this provided the spark for demonstrations which rapidly turned violent.




Doe led the coup that resulted in the assassination of Tolbert. (1:10) Watch



Doe's supporters thought the coup would get rid of Americo-Liberian domination. (1:20)Watch



Doe didn't understand the complexities of the task ahead. (1:00)Watch




Violence spreads

Some soldiers in the army sympathized with the demonstrators, but others strongly believed in the power of the military. In 1980, a group of enlisted men led by Samuel K. Doe, a 28-year-old indigenous master sergeant, fought their way into the presidential mansion and shot Tolbert to death. Shortly afterwards, 13 members of the Cabinet were publicly executed. Hundreds of government workers fled the country, while others were imprisoned.

Many people welcomed Doe's takeover as a shift favoring the majority of the population that had been excluded from power. The new government, led by the leaders of the coup d'ètat and calling itself the People's Redemption Council (PRC), lacked experience and was ill prepared to rule. Soon there were internal rifts, and Doe began to systematically eliminate Council members who challenged his authority. Paranoid about the possibility of a counter-coup, Doe began to favor people of his own ethnic background, the Krahns, placing them in key positions. Among ordinary Liberians, support for Doe's government soon dampened.

In 1985, Doe declared himself the winner of a presidential election he had actually lost. His corrupt government became more repressive, shutting down newspapers and banning political activity. The government's mistreatment of certain ethnic groups, particularly the Gio (or Dan) and the Mano in the north, resulted in divisions and violence among indigenous populations who until then had coexisted relatively peacefully.




Rebels were ready to be organized by Taylor. (1:28) Watch



Taylor was rumored to have the backing of affluent Liberians who wanted to get rid of Doe. (:50)Watch




Civil war

The brutal treatment they faced at the hands of the Liberian army drove some indigenous northerners across the border to the Ivory Coast. There, a man named Charles Taylor organized and trained many of them. Taylor had previously served as deputy minister of commerce under Doe, but was imprisoned for allegedly transferring millions of government funds into his own account. He was reported to have bribed his way out of a Massachusetts jail. When Taylor and his force of 100 rebels reentered Liberia in 1989, on Christmas Eve, thousands of Gio and Mano joined them. While they formed the core of his rebel army, there were many Liberians of other ethnic backgrounds who joined as well. A brutal civil warensued.




Military peacekeeping forces gave a fragile sense of security. (3:35)Watch



People hoped that a vote for Taylor would mean an end to the bloodshed. (1:31)Watch




In September 1990, Doe was captured and tortured to death by another rebel group originally associated with Taylor, while fighting between the rebels and the Liberian army escalated into civil war. Entire villages were emptied as people fled. Soldiers, some of them still children, committed unspeakable atrocities, raping and murdering people of all ages, in what became one of the world's worst episodes of ethnic cleansing .

Five years later, at a conference sponsored by the Economic Community of West African States (ECOWAS), the United Nations and the United States, the European Union, and the Organization of African Unity, Charles Taylor agreed to a cease-fire and a timetable to demobilize and disarm his troops. In a climate hardly conducive to free movement and security of persons, he won a 1997 presidential election against 12 other candidates. Liberians had voted for him in the hope that he would end the bloodshed.

The bloodshed did slow considerably, but it has not ended. Violent events have flared up regularly since the end of the war. Taylor, furthermore, has been accused of backing guerrillas in neighboring countries and funneling diamond monies into arms purchases for the rebel armies he supported, and into luxuries for himself.

The end of the turmoil?

Seven years of civil war undid much of what Liberia had achieved. Most of the country's infrastructure and public buildings were destroyed. Two hundred thousand people were killed, and another 800,000 displaced from their homes. Close to another 700,000 became refugees in neighboring countries. Recent reports from international political, environmental, and humanitarian groups point to Liberia's sky-high unemployment, continuing human rights violations, and the uncertainty of the upcoming 2003 elections.

Today, the Liberian people are just beginning the slow process of recovering from the economic, social, political, and psychological trauma of the war. The world waits and watches to see if the cycle of clashes between different populations has truly been broken, and if Liberia can rebuild itself as a unified nation to achieve the promise of its star of liberty.

Then forward sons of freedom march

Defend our sacred heritage

A nation's call from age to age

A nation's loud triumphant song

The song of liberty!

The Lone Star forever, the Lone Star forever

Oh, long may it flow over land and o'er sea

Desert it, no never!

Uphold it, forever!

Oh, shout for the Lone Starr'd banner, all hail.

Related links

Africa: South of the Sahara: Liberia:
http://www-sul.stanford.edu/depts/ssrg/africa/liberia.html
An extensive list of links to dozens of Liberia-related Web sites, from Stanford University Libraries and Academic Information Resources.

Liberia's History: Time Line:
http://www.denison.edu/~waite/liberia/history/index.htm
Prepared by a former Peace Corps volunteer to Liberia, this timeline focuses primarily on the achievements and challenges of the many men who have held the top office in Africa's oldest republic. The timeline ends with President Tolbert's execution in 1980, and a literal question mark as to how the country's problems escalated to this point.

Liberia: History:
http://www.infoplease.com/ce6/world/A0859267.html


Cartage (Central Array of Relayed Transaction for the Advance of General Education): Liberia:
http://www.cartage.org.lb/en/themes/GeogHist /histories/history/hiscountries/L/liberia.html


The Liberian Connection:
http://www.Liberian-Connection.com/


Liberian Embassy: Liberia at a Glance:
http://www.liberiaemb.org/info.html


History: Liberia:
http://www.ku.edu/history/VL/africa/liberia.html


African Studies: Liberia:
http://www.sas.upenn.edu/African_Studies /Country_Specific/Liberia.html


African-American Mosaic: Colonization:
http://lcweb.loc.gov/exhibits/african/afam002.html


Time Line:
http://memory.loc.gov/ammem/gmdhtml/libhtml/liberia.html



Contributors

Anjali Mitter Duva is a freelance writer and consultant based in Cambridge, Massachusetts.

This essay was reviewed by D. Elwood Dunn, a professor of political science at the University of the South in Sewanee, Tennessee, and by Womi Edith Neal, a District of Columbia public school teacher and founder/executive director of the Grass Roots Theatre Company in Bethesda, Maryland.

© 2002 WGBH Educational Foundation

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