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Article

The West Africa Ebola outbreak (2014-2016): a Health Intelligence failure?

 

ABSTRACT

The role of health intelligence (HI) has received little assessment in the West African Ebola outbreak (2014-2016). Using newly declassified information on the outbreak, this research finds significant HI problems that hindered an appropriate response to the outbreak. The Guinean government’s low capacity to deal with the crisis, the government’s misleading assessments of the crisis, the US embassy’s failure to contextualize the information properly in terms of the risks the virus posed, and the US embassy’s willingness to accept the Guinean government’s assessment without criticism were contributing factors in the HI failure in the opening months of the Ebola outbreak.

Acknowledgements

I would like to thank my research assistants Keeley Eshenbaugh, Jordyn Green, Thomas Wackman, Christopher Jacox, and Holly Scala for their invaluable help with this manuscript. I would also like to thank Ken Brooke of Congressman Mark Amodei’s staff and Eric Herzik for their support in completing this project. I am also thankful to University of Nevada Scholarly and Creative Activities Committee for its financial support in completing this research.

Disclosure statement

No financial conflicts.

Notes

1. World Health Organization, “WHO | Public Health Surveillance.”

2. World Health Organization.

3. Shaban-Nejad, Michalowski, and Buckeridge, “Health Intelligence.”

4. Morse, “Global Infectious Disease Surveillance And Health Intelligence,” 1070.

5. Grabo, Anticipating Surprise, 1–3.

6. Morse, “Global Infectious Disease Surveillance And Health Intelligence,” 1072.

7. Morse, 1072.

8. French and Mykhalovskiy, “Public Health Intelligence and the Detection of Potential Pandemics,” 174.

9. Donaldson and Wood, “Surveilling Strange Materialities”; Fisher and Monahan, “The ‘Biosecuritization’ of Healthcare Delivery”; French, “Woven of War-Time Fabrics”; and Weir and Mykhalovskiy, Global Public Health Vigilance.

10. French and Mykhalovskiy, “Public Health Intelligence and the Detection of Potential Pandemics,” 175.

11. I use the term ‘risk’ here instead of threat. Risk represents danger and the potential exposure to that danger. Threats imply that someone has intended harm. This distinction is subtle but important as traditional security issues imply an opposite or an ‘other’ that engages strategically or tactically; human security that may emanate from more natural processes like epidemics or earthquakes do not have a strategic or tactical ‘other;’ they just exist.

12. Laqueur, “The Question of Judgment.”

13. See note 5 above.

14. Grabo, 13–16.

15. Caddell, “Corona over Cuba.”

16. Preston, The Hot Zone; and Peterson, Outbreak.

17. The Centers for Disease Control lists 20 separate viral hemorrhagic fevers, each with their own genetic differentiations and sub-variants. For additional information, see The Centers for Disease Control’s website for viral hemorrhagic fevers: https://www.cdc.gov/ncezid/dhcpp/vspb/diseases.html (accessed 12 December 2018).

18. Richards, Ebola.

19. Feldmann and Geisbert, “Ebola Haemorrhagic Fever”; Kinsman, “A Time of Fear”; Kuhn, Filoviruses; and Leroy et al., “Fruit Bats as Reservoirs of Ebola Virus.”

20. Zhang and Wang, “Forty Years of the War against Ebola.”

21. World Health Organization, “Ebola Virus Disease.”

22. See note 18 above.

23. World Health Organization, “Ebola Haemorrhagic Fever in Sudan, 1976”; and World Health Organization, “Ebola Virus Disease.”

24. World Health Organization, “WHO Recommended Guidelines.”

25. See note 2 above.

26. See note 21 above.

27. See note 20 above.

28. Francesconi et al., “Ebola Hemorrhagic Fever Transmission.”

29. See note 21 above.

30. Bullard, A Day-by-Day Chronicle.

31. Baize et al., “Emergence of Zaire Ebola Virus Disease.”

32. The 1994 outbreak in Cote D’Ivoire was the only Tai Forest Ebola incident and originated with a primate autopsy. The incident was isolated to one individual.

33. Medicines Sans Frontieres, “Guinea”; Lazuta, “Emergency Ebola Intervention”; Samb, “Ebola Kills Dozens In Guinea.”

34. See note 30 above.

35. Bullard.

36. Kampen, “To Stay or Not to Stay,” 10.

37. Kampen, 8.

38. “Foreign Affairs Manual.”

39. United States Embassy, Conakry, “Guinea.”

40. Africa Research Bulletin, “GUINEA.”

41. Human Rights Watch, “World Report 2014.”

42. Joint and Coalition Operational Analysis (JCOA), “Operation United Assistance”; and Newman, “Face of Defense.”

43. United States Embassy, Conakry, “Guinea EAC on Ebola, April 4.”

44. United States Embassy, Conakry.

45. United States Embassy, Conakry, “Ebola in Guinea.”

46. See note 44 above.

47. Ibid.

48. Ibid.

49. United States Embassy, Conakry, “Guinea’s Political & Economic Summary Report.”

50. See note 45 above.

51. United States Embassy, Conakry, “Guinea’s Political Summary Report.”

52. Bullard, A Day-by-Day Chronicle, 18.

53. United States Embassy, Conakry, “Guinea’s Political Summary Report.”

54. United States Embassy, Conakry, “CONAKRY.”

55. United States Embassy, Conakry, “Guinea,” 18.

56. United States Embassy, Conakry, “Guinea.”

57. United States Embassy, Conakry, “West African Ebola Outbreak.”

58. See note 44 above.

59. United States Embassy, Conakry, “Guinea’s Political Summary Report,” 11.

60. United States Embassy, Conakry, “Guinea.”

61. See note 44 above.

62. United States Embassy, Conakry, “Guinea.”

63. See note 44 above.

64. United States Embassy, Conakry, “Guinean Government, Embassy Push Back.”

65. See note 44 above.

66. United States Embassy, Conakry, “Conakry.”

67. See note 44 above.

Additional information

Notes on contributors

Robert L. Ostergard

Robert L. Ostergard, Jr. is Associate Professor of Political Science at the University of Nevada. His general areas of research are in national and international security issues, with a specific focus on sub-Saharan Africa. His current research projects include projects on the security implications of the HIV/AIDS and Ebola epidemics and state security responses to global health crises. Additional information on his research can be found at his website http://robertostergard.us.

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