In September 2014, the United States mounted its largest response to date to an Ebola outbreak that devastated West Africa, claiming over 11,000 lives. As a watch officer in the U.S. State Department’s Operations Center at the time, Elizabeth Shackelford witnessed firsthand the scope and coordination involved in the effort to contain the epidemic, including the evacuation of American healthcare workers infected with the virus. One such patient was her friend, Dr. Ian Crozier, who contracted Ebola while working in Sierra Leone and survived only with access to advanced medical treatment upon his return to the United States.

Shackelford cautions that the current U.S. approach to the ongoing Ebola epidemic in Central Africa differs markedly from the response during the 2014 crisis. She points to significant policy shifts, including the U.S. withdrawal from the World Health Organization (WHO), substantial cuts to foreign aid, the dismantling of the U.S. Agency for International Development (USAID), and reductions in global health personnel at the Centers for Disease Control and Prevention (CDC). According to Shackelford, these changes have weakened both domestic and international capacities to detect and respond to infectious disease outbreaks.

U.S. foreign assistance once played a critical role in supporting healthcare infrastructure across high-risk regions in Africa, financing clinics, laboratories, testing facilities, and protective equipment for frontline workers. USAID-backed programs also enabled the employment of community health workers who were essential in monitoring, diagnosing, and treating infectious diseases at the local level. The disruption and reduction of these programs have, Shackelford argues, left many vulnerable communities with limited capacity to respond effectively to new epidemics.

She further highlights that the decision to retract funding and expertise from the WHO has eroded the capabilities of the organization widely regarded as the primary global institution for epidemic response. While some leaders within the current administration acknowledged the importance of Ebola prevention—citing an incident in which funding was reportedly “accidentally” cut and then restored—Shackelford contends that the cuts were never fully reversed, leaving America less prepared.

The 2014 U.S. response had involved billions of dollars in funding, deployment of nearly 200 USAID and CDC experts, and the mobilization of approximately 1,800 Defense Department personnel. That effort was coordinated with WHO and affected nations to leverage existing healthcare infrastructure to facilitate early detection and containment. Despite some shortcomings, the experience provided lessons that, Shackelford argues, should have better prepared the international community for the current outbreak.

The present epidemic, which started in the Democratic Republic of Congo and has spread to Uganda, faces distinct challenges. Roughly 900 suspected cases and over 220 suspected deaths have been reported, though the true scale remains uncertain. This strain of Ebola features a longer incubation period—two to three weeks compared to the usual two to three days—which allows infected individuals to travel and spread the virus undetected. Conflict in the affected region, porous borders shared by eight countries, attacks on health facilities, and widespread suspicion of external responders have further complicated containment efforts.

The Africa Centers for Disease Control and Prevention has launched a response campaign aiming to raise $319 million to tackle the outbreak, though this sum is considered modest relative to past efforts. Shackelford underscores that the evolving crisis offers a critical moment for the U.S. government to reconsider reinvesting in global health programs and international partnerships before the consequences of underpreparedness deepen further.