Why Obama wants Congress to spend $6.2 billion more to fight Ebola

The Obama administration has asked Congress to approve $6.18 billion in funding to fight Ebola. This is a huge increase from the $88 million the White House requested in September and the $750 million allocated from the Pentagon budget in October.

"It represents a real commitment by the US to combat Ebola in Africa and elsewhere if it travels," said Dr. Howard Markel, a physician who researches epidemic responses at the University of Michigan.

The money is desperately needed, experts say, to fight what is still "persistent and widespread" Ebola transmission in the three most-affected West African countries. And it appears that's where the bulk of the money would go.

More than half of the funds would go to the global Ebola fight

This is what a breakdown of the funding request looks like:

• $2.43 billion for the Department of Health and Human Services;
• $1.98 billion for the US Agency for International Development;
• $112 million for the Department of Defense;
  
• $127 million for the Department of State;
  
• $1.54 reserved in a contingency fund "to ensure that there are resources available to meet the evolving nature of the epidemic."

While part of the HHS's $2.43 billion would be invested in fortifying the domestic response to Ebola — procuring personal protective equipment in the US, increasing monitoring at US airports, researching Ebola vaccine and treatment candidates — the other part of the monies would go toward controlling the epidemic in Africa through "infection control, contact tracing and laboratory surveillance and training," the White House said in a fact sheet.

Meanwhile, all of the $1.98 billion for USAID and $127 million for the Department of State would go to the crisis in West Africa: boosting the US troops there, expanding the CDC effort, enhancing burial teams to stop Ebola transmission, and addressing food insecurity in the region.

"This will help limit the spread of Ebola beyond Liberia, Sierra Leone, and Guinea to other vulnerable nations and will increase preparedness and response capacity for future outbreaks," said the White House.

So more than half of the funds will go to the global outbreak response and vaccine and therapeutic research, while the rest of the money is either going to be invested at the domestic response to Ebola (helping hospitals and airports readiness for cases) or has an unclear target.

This emphasis on the global Ebola fight makes sense, said Jennifer Kates, Vice President and Director of Global Health and HIV Policy at the Kaiser Family Foundation.  "The epidemic in West Africa is very severe, and resources are needed to continue fighting Ebola," she explained.

"We have one case of Ebola in the country," she added. West Africa is grappling with more than 13,000.

The Ebola funding request is nearly half the discretionary budget for HIV

"If you look at the global health budget that the US provides money for — including HIV, Malaria, family planning aid sent abroad— that's approximately $9 billion a year," said Kates. "So $6.18 billion is large compared to all the other global health issues [the US invests in]."

To put the amount into further context, the White House requested $13.9 billion in discretionary funding for 2015 to fight domestic and global HIV. But more than 30 million people around the world are living with HIV and it affects more than a million Americans.

Again, there is one American with Ebola right now. So there's a mismatch between the proportion of funds requested for Ebola and Americans currently impacted by the disease.

But Ebola is much deadlier than any other known pathogen, and if the epidemic is not contained at the source, countries like the US will need to constantly grapple with the threat of Ebola turning up in emergency rooms. Unlike other diseases, we have no treatment or vaccine for Ebola. Plus, the epidemic in West Africa amounts to a humanitarian crisis.

This is also a disease that stokes public fear, and therefore, stirs up political will, said Kates.

"The Ebola outbreak has shown that the global community is not immune to such outbreaks and underscored the importance of preparedness," she added. "It has also tapped into something that underlies many epidemics — fear and in some cases panic, which tends to drive immediate and urgent responses.

"The real question will be: will attention remain over time to ensure that West Africa is able to combat this outbreak and rebuild and bolster its public health infrastructure?"

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