THE FOREIGN SERVICE JOURNAL | JULY-AUGUST 2025 27 threats within our borders, like the current measles and bird flu outbreaks affecting our communities. An outbreak of measles in Washington state from 2018 to 2019 cost $3.14 million, or $47,479 per case. The ongoing bird flu outbreak has already cost $1.4 billion. By the end of 2023, COVID-19 had cost the U.S. nearly $14 trillion in economic losses. Preventing additional diseases from entering U.S. borders costs less than responding to them when they come. A Case Study: Investments in Ebola Response In December 2013, Ebola began circulating in Guinea. At the time, Guinea did not have the capacity to detect and address diseases, and the U.S. government didn’t have any health security investments in West Africa. By the time an Ebola outbreak was declared in March 2014, it had spread to Liberia and Sierra Leone, then to other countries in West Africa and beyond. In September 2014, a man traveled from Liberia to Texas. He sought medical attention for a fever and abdominal pain but was sent home. Two days later, he was diagnosed with Ebola, and it became clear he had been incorrectly diagnosed two days prior. Two clinicians contracted Ebola while treating him. One took a flight the day before showing symptoms, causing panic and resulting in financial costs to trace contacts. Just like health systems thousands of miles away, our health system was not ready to manage Ebola cases. It cost the hospital in Dallas $500,000 to treat that single case of Ebola, not including costs to the overall health system, and the original patient ultimately died. Around the same time, an American physician treating Ebola patients in West Africa returned to New York, where he was diagnosed with and treated for Ebola. It cost the New York City Health Department $4.3 million in response measures. The patient in New York and two clinicians in Dallas all recovered. Each hospital incurred significant financial costs to treat them, while also having to triage care of other patients. At the time, the world lacked a viable Ebola vaccine, infections among health care professionals created workforce shortages, and health systems collapsed. By the time the West Africa Ebola outbreak ended in 2016, more than 11,300 people had died, and reduced commerce, travel, and trade had resulted in an estimated $53 billion in economic losses globally. Following these losses, Congress provided a historic long-term investment to ensure that the U.S. never flew blind again. This funding created new global health security programs at USAID and the Centers for Disease Control and Prevention (CDC), which, coupled with the Global Health Security Agenda, became signature initiatives for the Obama and Trump administrations alike and have successfully stopped or contained multiple outbreaks before they reached American shores. In 2018 I deployed to the Democratic Republic of the Congo (DRC) to help lead the U.S. government’s response to an Ebola outbreak there. The virus circulated for at least four months before it was detected, largely due to its spread in the conflict-stricken eastern part of the country. Recalling the costs Nidhi Bouri (front left) and a team from USAID tour a private mpox treatment facility, run by Médecins Sans Frontières, in Bujumbura, October 2024. USAID/BURUNDI MISSION
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