To​: Secretary of State Mike Pompeo

From​: Charissa Zhu

Purpose
Determine U.S. response to the Ebola outbreak in the Democratic Republic of the Congo (DRC).

Option 1
Send all 300,000 doses to the DRC
Option 2
Send all 300,000 doses and guarantee $30 million to cover the outbreak demand and replenish
the U.S. supply
Option 3
Abstain from sending all vaccines

Recommendation
The United States should send all 300,000 Ebola vaccine doses to the DRC.

Discussion
The United States can send an experimental Ebola vaccine to the outbreak in the Democratic
Republic of the Congo (DRC). 3,000 cases were reported with the potential to spread to
neighboring countries in the coming weeks due to inadequate containment protocol in the DRC.
Pharmaceutical company Merck and Co. created the only 300,000 experimental vaccines in
existence, but the Food and Drug Administration (FDA) has not approved it for sale or
distribution. This U.S. Department of Health and Human Services (HHS) funded this project to
create vaccines for U.S. citizens. The World Health Organization (WHO) and the Centers for
Disease Control and Prevention (CDC) predict the epidemic response requires at least 1 million
doses. Merck can create more vaccines only with a guaranteed contract and payment. HHS can
provide this, but $30 million would be directed from measles vaccine funding.

The 300,000 Ebola vaccines should be sent to the DRC​ because the United States’ record of
providing international aid is consistent. The decision to withhold resources within the
possession of the United States can create international tension. This could impact future aid that
the United States might require in a time of crisis.

Domestic priorities should also be considered, including whether or not to divert funding from
measles vaccines. With large outbreaks sprouting up in recent years—such as the 2014 to 2015
outbreak in the Western states and the 2018 to 2019 outbreak in New York—the demand for
measles immunization funding grows.​1

Risks of sending all 300,000 Ebola vaccines to the DRC include the possible need for those
vaccines should an outbreak occur in the United States. Containment and oversight measures
already established in the United States through the CDC and the Department of Homeland
Security would alleviate these concerns. Strict domestic screening protocols were established
during the 2014-15 Ebola outbreak of West Africa.​3
Annex 1.

Ebola virus transmission occurs through contact with bodily fluids.​2 ​Historically, the majority of
Ebola outbreaks were isolated in Africa.​2 ​The 2014-16 Ebola crisis was a global epidemic
originating in West Africa.​2

The U.S. response to this epidemic was four-fold, including (1) transmission control;
(2) mitigating consequences within the region; (3) engaging the global arena to provide aid; and
(4) strengthening U.S. global health security.​3

The United States committed over $350 million to the response and sent over 130 medical,
health, and disaster response experts.​3​ Researchers expanded testing capacities.​3​ Healthcare
providers and border personnel received information, guidance, and tools.​3​ The Department of
Homeland Security’s Customs and Border Protection Agency (CBP) created a comprehensive
screening protocol. CBP contributed to the exit screening protocol in West Africa.​3

Political
On an international scale, other nations may look favorably upon the United States if the 300,000
Ebola vaccines are sent to the DRC. These doses are the only Ebola vaccines and are in the
United States’ possession. This donation may point to the perceived generosity of the United
States.

Within the domestic sphere, obstacles may arise in Congress. While the recommendation
suggests that the $30 million in funding not be diverted from measles vaccine funding,
Congressional members may believe otherwise and will fight against this decision. If enough
members feel strongly on this point, perhaps that would create some conflict and obstacles
within Congress.

To address this potential drawback, meet with Congressional members and experts to discuss
different perspectives on this issue.

During the 2014 Ebola outbreak, former Secretary of State John Kerry commended Cuba on its
response to the Ebola response campaign.​4​ This led to collaboration between the United States
and Cuba.​4​ If past outbreak responses can inspire uncommon cooperation between nations,
perhaps this response may ameliorate other international relations.

Economic
Benefits to the recommended course of action include avoiding a change in appropriations from
HHS measles vaccines, as federal funding has been a previous point of contention. Avoiding the
creation of this contract with Merck would also avoid the red tape associated with bureaucracy.

Keeping the $30 million in question dedicated to domestic measles vaccine funding would also
benefit the domestic manufacturers that create the vaccines and the healthcare industry that
purchases them, as it would maintain equilibrium.
Economic costs to withholding the vaccines must be considered. Medical equipment and
personnel must respond to this epidemic. This diverts the medical attention and resources from
their original priorities.

These Ebola vaccines were developed by Merck in partnership with HHS for U.S. citizens. By
distributing the vaccines to the DRC, the economic cost of these doses must be absorbed by the
pharmaceutical company and the funding provided by the government.

The mortality rate impacts the workforce through the loss of able-bodied workers. In the 2014-15
Ebola outbreak, there were over 11,300 deaths in the countries affected.​4​ Domestic and
international economies can be impacted by this decreased productivity. Survivors with
life-changing consequences from the virus are not included in the mortality rate, but can
negatively impact economic productivity.

The stigma associated with the Ebola virus may also deter tourism and its associated revenue.​4
Travel patterns in and out of the affected countries can change. Providing the 300,000 vaccine
doses can mitigate the spread of the virus in the DRC. This alleviates the international impact of
the potential for economic loss associated with the Ebola epidemic.

Social
Providing the 300,000 doses could boost the domestic reputation of the federal government.
Citizens and residents might feel pride in the technical achievements and generosity of the U.S.
government. But in sending the 300,000 doses, the U.S. government is not funding the creation
of the total 1 million doses required to address the epidemic. This might be a point of contention
in the media and can impact political efficacy. In response, a publicity plan can be created to
ensure the successful public broadcasting of the U.S. response.

In the 2014-15 epidemic, media response influenced public perception of Ebola risks.​5​ The
frequent risk-elevated messages contributed to increased U.S. public concern regarding Ebola.​5
Polls ranked Ebola as the third most urgent domestic health problem, despite the United States
having two cases of Ebola transmission with both patients surviving.​6​ Considering this 2014-15
response, a publicity plan is recommended. This will circumvent negative media coverage and
widespread panic.

Technical
Adverse side effects or long-term implications are inconclusive. The vaccine is not approved for
sale and distribution by the Food and Drug Administration. This can produce dangerous
implications for Ebola patients that receive the vaccine. The general lack of familiarity with the
technical aspects of this drug pose an extremely large risk in distribution.

This vaccine is not approved for U.S. citizens so the ethics of sending it abroad should be
considered. Legal liabilities for the U.S. government are introduced. These two factors can create
international tension and negative media attention. But lab trials have shown success, indicating
that this vaccine may be a pivotal turning point in the response to this Ebola crisis.
Annex 2.

Immediate next steps include creating a detailed execution plan for the delivery of the 300,000
vaccine doses to the DRC. The United States Agency for International Development (USAID)
will assist with distribution of vaccines. Merck will provide the 300,000 doses from its labs. The
Centers for Disease Control and Prevention (CDC) will monitor the implementation response.
Nonprofit organizations like Doctors Without Borders (DWB) will also contribute through
medical personnel.

These actors should partner with local government agencies to facilitate the implementation
protocol. This will also allow the DRC to create their own sustainable Ebola response systems.
The partnership might also ease the distrust of international involvement.

Healthcare practitioners will administer the vaccines to patients. They will be guided by experts
from the CDC and Merck to properly convey risks and effects to patients. Patients must give
knowledgeable consent to receiving the vaccine. DWB staff possess the ability to communicate
with and translate for DRC residents should that be necessary.

Domestically, the next step should include replenishing the vaccine stockpile. It was originally
created for U.S. citizens in case of an Ebola outbreak which is still a possibility.

An option could include withholding manufacturing of the vaccine. Should the vaccine prove to
be effective after sending it to the DRC, testing for Food and Drug Administration (FDA)
approval could resume. Should the vaccine introduce some problems, further lab testing could be
initiated. But this presents ethical issues regarding human testing. WHO might investigate this as
an ethical violation, which presents a liability.

Observed side effects must be noted due to the novelty of the drug. Within the following year of
the vaccine distribution, the CDC and World Health Organization (WHO) should monitor
patients who received a vaccine. Local health officials and providers should be educated on
possible effects so they can continue to monitor in coming years.

Following the conclusion of the Ebola epidemic response, an evaluation protocol should be
completed. It will assess the effectiveness of the intervention. This information can be used in
response protocols for future Ebola epidemics, should they occur.
 References
1. Centers for Disease Control and Prevention. (n.d.). Measles (Rubeola). Retrieved from
https://www.cdc.gov/measles/cases-outbreaks.html​.
2. Centers for Disease Control and Prevention. (n.d.). History of Ebola Virus Disease.
Retrieved from ​https://www.cdc.gov/vhf/ebola/history/summaries.html​.
3. The White House, Office of the Press Secretary. (2014, October 06). FACT SHEET: The
U.S. Response to the Ebola Epidemic in West Africa [Press release]. Retrieved from
https://obamawhitehouse.archives.gov/the-press-office/2014/10/06/fact-sheet-us-response
-ebola-epidemic-west-africa​.
4. Chattu, V. K. (2017). Politics of Ebola and the critical role of global health diplomacy for
the CARICOM. ​Family Medicine and Primary Care​, 6(3): 463-467.
5. Sell, T. K., Boddie, C., McGinty, E. E., Pollack, K., Smith, K. C., Burke, T. A., &
Rutkow, L. (2017). Media Messages and Perception of Risk for Ebola Virus Infection,
United States. ​Emerging Infectious Diseases​, ​23​(1), 108–111.
6. Steel-Fisher, G. K., Blendon, R. J., & Lasala-Blanco, N. (2015). Ebola in the United
States: Public Reactions and Implications. ​The New England Journal of Medicine​,
373:789-791.