By Major Matt Cavanaugh
There are three conclusions for the military profession to be drawn from the present Ebola outbreak: the threat is enormous, but ultimately manageable; the desired ends are currently vastly under resourced; and the profession’s lack of intellectual focus on the outbreak may result in the nation bumbling towards unnecessary, potentially catastrophic, strategic shock.
The largest problem with Ebola is inspiring action. We know what must be done to stop the outbreak and we know how to do it. So perhaps we should seek advice from the structure of one of the most action-generating documents ever penned: Karl Marx’s Communist Manifesto. Maybe the Ebola outbreak should have a “manifesto” which lays bare the path ahead? Being game to write this, I looked to Professor David Armitage‘s new book, The History Manifesto, for help on Marx’s method. Armitage describes: “A good manifesto should diagnose something, it should propose something, and then it should mobilize people on the basis of the diagnosis and the proposal.” What follows is an attempt to diagnose the Ebola outbreak in West Africa as a threat, propose a particular general way forward, and (attempt to) mobilize the military profession to action.
Let’s start with how bad pandemics can get, which should provide a suitable reference point. The noteworthy benchmark is of course the 1918 global flu pandemic. John Barry, author of a book on the 1918 flu pandemic, in a public talk described the numbers [see iTunes podcast #10] and growth of this flu pandemic. The 1918 flu pandemic infected 500 million people worldwide, killing 50-100 million (more than all the wars of the 20th century combined). One key part of Barry’s talk was the “basic reproduction number” or “r naught” which is the mean number of new infections created by a newly infected person before isolation. In other words, how many people does a carrier infect on average before getting into isolated medical care. Typically for pandemics the number is 2 or greater, hence the exponential growth. For example, one infected person spreads to two others, those two spread infection to two each, and so on – this is the merciless math of pandemic infectious disease. In 1918, the “r naught” was 2 to 3. Right now, the Ebola outbreak is somewhere between 1 and 2 (depends on where you are; numbers are not solid yet). The goal is to get the number to less than 1, which ensures the Ebola outbreak will not grow or spread.
These numbers chart growth – but we must also map the spread. So far, the Ebola outbreak is clustered in West Africa. Over half the world’s cases are in Liberia. The fact that the spread is localized to one geographic area is a significant advantage, but one which will be lost over time. In comparison, the 1918 flu pandemic was able to go global faster as it was spread through the air, and eventually traveled as far as remote Pacific islands and the Arctic. But, today, the “airborne” threat is different – relatively more people can afford to fly across borders. Though the outbreak has been local in origin, modern air travel has enabled today’s Ebola outbreak to have global reach (i.e. Spain and the United States). One accompanying difficulty is – this virus is stealthy: as one journalist put it, “The difficulty is that you’re fighting an enemy that you can’t see, you can’t hear, and you don’t know if its attacked you until its often too late.” Unfortunately, this includes air traffic – so a person that is acting as a carrier and still incubating the Ebola virus might pass screening and expose the virus into new countries and to new continents. Beyond that, once Ebola is in cities and megacities (i.e. Lagos, Nigeria), the infection will only intensify inside global transport networks, and ride the friendly skies to places like Cleveland.
There is also a major qualitative factor that makes Ebola much more threatening than nearly any other contemporary threat. ISIS may do some pretty horrible things on video, but ISIS can’t stop you from showing affection to other human beings. It’s been remarked that Ebola’s “cultural casualty” has been human contact. One journalist posed the seemingly impossible, but very real scenario in West Africa: “imagine trying not to touch your 2-year-old daughter when she is feverish, vomiting blood and in pain.” We often curse terror groups that use children as human shields; Ebola similarly uses human decency against us by preying on our need for human contact and comfort. Consider that in Sierra Leone, people now tap their chests in place of a handshake. This is part of the government’s “A-B-C” public health campaign there – “Avoid Bodily Contact.” Ebola poisons relationships just as much as it does bodies; we might come to a point where “STD” means Socially Transmitted Disease.
ISIS may strike but does not have the ability to impact our way of life like Ebola.
From the American perspective, we have largely fumbled the early response to the outbreak. First is the foolish assumption held by some that we can lock the door and completely close Ebola out of the US (or any country, for that matter). We’ve already had mistakes, which will only grow as the disease spreads and we have relatively less resources to bear per case. For example, with the first American patient (Thomas Eric Duncan), the media famously reported there were 76 healthcare workers involved in his ultimately unsuccessful care. There will be fewer health professionals next time, and correspondingly, less oversight to ensure Ebola does not spread to the doctors and nurses. We must first recognize that there is no perfect defense. To believe we ever could construct one goes against the experience of the Confederate States in the American Civil War, who began the war by attempting a “cumulative cordon defense” strategy. We should learn from their example; defending everywhere is impossible.
There is also the assumption that Ebola is somehow only for the developing world, that this is something which happens in Africa but not the US. Sure, we can expect that the relative lack of medical and governmental infrastructure in West Africa, for example, means that the US (and Western nations) will do “better” in this crisis. But a look to history can be helpful. John Barry, our author on the 1918 flu pandemic, has highlighted that there were wild fluctuations in mortality (i.e. the number of deaths divided by the total number of those infected by a given virus). In some places the mortality rate was greater than 50%, while in the US, the number was around 1-2%. In 1918, this mere 1-2% mortality rate killed 675,000 Americans out of a total population of 105 million. Extrapolating these figures to today would mean 2 million dead. So, yes, Ebola’s impact would be relatively less severe in the US – but that “lighter” cost would still be incredibly painful to bear.
Another challenge we face in our response is perhaps the most tragic: a military profession lacking intellectual focus on the threat. There has been little to no interest in the Ebola threat amongst the military strategist community. Nobody is writing about it; nobody seems to take it seriously. Instead we see the usual threats being trotted out. Last week’s essay on the subject of the outbreak received the following representative sample of comments on Facebook:
- “As long as Ebola isn’t cutting of the heads of Westerners, it shouldn’t be considered a threat.”
- “You know who has a lot of trucks and other infrastructure-building equipment in Africa, as well as a LOT of people and money? China. Where are their land forces and why can’t they do something about it? Why does it ALWAYS have to be US troops? Let them take a few risks if they want to be leaders in the global community.”
Interestingly, at the same time, retired Army General Wesley Clark, former Supreme Allied Commander Europe, published an article in the New York Times with the headline “Getting Serious About China.” In short: let’s stick to ISIS and China, those are the threats we’re used to; never mind this Ebola thing; that’s a problem for someone else like Doctors Without Borders or the UN. This line of reasoning ignores the quantitative and qualitative evidence which ought to put Ebola at the top of the threat heap and well within the sphere of military interest.
So what should be done about the Ebola outbreak? The ends we seek have already been mapped out admirably. Dr. Tom Frieden, director of the Centers for Disease Control, has said that the “most effective method for battling the virus is sending trained professionals to the source.” US Chairman of the Joint Chiefs of Staff, General Martin Dempsey: “this needs to be an away game.” Dr. Dan Diekema, Director of the Infectious Diseases Division at the Unveristy of Iowa Carver College of Medicine, on Public Radio International’s “The World”:
“I think the primary effective measures are going to be in the outbreak zone. Bringing more resources to bear there to halt the outbreak. And that’s really going to be the key, that’s how we’re going to get rid of Ebola. The best preparedness here is to quell the outbreak there.”
Our policy objective: sequential containment (defined as: basic reproduction number lower than 1) of the Ebola outbreak in it’s geographic center of gravity in West Africa.
Our mismatch: the resources we have applied to this emerging policy are not sufficient. There is a significant lack of means to achieve this policy objective. The Liberian Army numbers 2,000 soldiers. Yes, you read that correctly: 2,000. Certainly there are other law enforcement entities there, but this is to help control a territory larger than the US state of Virginia. This is simply not enough; the West African governments affected simply do not have enough. And it’s starting to show. In Sierra Leone, as of one week ago, the government and aid organizations announced a “major defeat”:
“…international health officials battling the epidemic in Sierra Leone approved plans on Friday to help families tend to patients at home, recognizing that they are overwhelmed and have little chance of getting enough treatment beds in place quickly to meet the surging need.”
Even with this, what is perhaps most alarming is that a recent New York Times story found “Nobody knows exactly how many have died from Ebola in this country. The government figure of 900 to 1,000 is thought by international officials to be a serous underestimation.” Not only are these countries lacking response resources, they even lack the ability to track the spread. This violates business principle #1: what you can count, you can manage. If these countries in West Africa cannot fill this function, then the Ebola outbreak really has grabbed the initiative and is in the lead.
There is exactly one organization designed to rapidly hold and control territory and the people on it: the military. For support, for infrastructure, for speed, for rigid adherence to protocol, for transport, for commitment, for a host of other reasons – the military clearly has a role in halting the Ebola outbreak in West Africa. My back-of-the-envelope calculation was on the order of 40-70,000 soldiers, a figure that will be insufficient should the virus spread to neighboring countries beyond Liberia and Sierra Leone. Though it is true, as one Wall Street Journal op-ed writer put it, “Liberia, a country of 4.4 million people, can’t be encircled.” But that’s not the objective. We do not need to “encircle” Liberia or West Africa. We must, however, slow the spread down to a manageable rate, providing time for a vaccine or other effective countermeasures to kill Ebola’s 2014 tour in West Africa. Landpower has a hand in making that happen.
None of this is meant to scare; it is one perception, one calculation of the threat posed by the Ebola virus in West Africa. Frankly, people are not always very good at perceiving threats (if we were, as Jared Diamond points out, we’d be a lot more afraid of our daily shower!). One good gauge of our fears might be what movies we watch – fear driving us to the big screens to take in a “good scare.” Entertainment Weekly magazine did an “Apocalypse Issue” this past summer in which they charted all the apocalypse movies in history back about 100 years. The authors found some interesting trends. First, that 65% of all apocalyptic films in the 1960s were about nuclear war or accident. In the 1970s environmental destruction was popular.
But the broader trends were informative too, particularly the closer you get to the present. Of the 71 “apocalyptic” movies released from 2003 to 2013: 28 were about “aliens, zombies, and monsters”; 9 were about “comets or asteroids”; 9 were on “environmental destruction”; and just 5 were on “plagues or scientific error.” *Note: other categories included “machines,” “biblical events,” and “other/unknown.”
Considering that over the past ten years, the American public consumed nearly six times more movies about aliens, zombies, and monsters than about plagues (like Ebola) demonstrates a distorted perception about realistic threats. There is space here for the military (and health) profession to remind the public, in a useful way, of the longer history with global pandemics and the threats they may actually pose.
Strategists must also be up to this task to meet Colin Gray’s #1 rule about defense planning: “minimum regrets.” Moreover, one undertakes this planning to avoid strategic shocks, which Gray considers at length in his new book, Strategy and Defence Planning (p. 198; emphasis added):
“Considered strategically, shock is to be understood as an unexpected event that seems likely to have deep possible consequences. The surprise may not lie literally in its having been completely unanticipated by all, let alone unpredictable, especially when reconsidered more comfortably in historical retrospect. But for the integrity of its status as a shock it must clearly have been officially unexpected. There is no strict requirement that a strategic shock should have appalling consequences, but it is prudent to anticipate such a probability…
How can a defence planning process attempt to prepare against hostile strategic shocks, when one chooses prudently to regard such events rigorously? The beginning of prudence in this troubling case needs to be acceptance as a viable assumption that the events will be entirely unexpected by socially and politically accepted expert assessment. This need not mean literally that no academic, journalist, novelist, or religious seer, will have ever speculated as to the happening’s distant possibility. But, it would mean that any such speculation would be totally lacking in public credibility, let alone official acceptance. I am suggesting that a polity’s defence planners should take seriously the possibility that their country, our community, will be the victim of strategically shocking events.“
It’s time for the defense community to start taking the Ebola outbreak seriously and focus their considerable intellectual resources toward viable solutions. Those military professionals that do will find that this is a massive yet manageable threat, and that there is a large ends-means (or, if you prefer, goals-resources) mismatch. If these are not addressed, the nation will stumble along into an unnecessary, potentially catastrophic, strategic shock.