	Background

In March 2014, the World Health Organization (WHO) announced that health officials in Guinea had identified a "rapidly evolving outbreak of Ebola virus disease (Ebola)." Retroactive studies indicated that the virus had likely begun to spread in late December 2013, but that weak disease detection and surveillance systems had failed to identify the outbreak. From Guinea, the disease spread to Liberia and Sierra Leone and continued to infect thousands in the three countries until mid-2015, when concerted efforts to contain the disease by the international community began to curb new infections and deaths. WHO declared Ebola a Public Health Emergency of International Concern (PHEIC) in August 2014. Following the PHEIC declaration, the United States and other actors exerted a concerted effort to contain the disease, and cases began to decline rapidly. On December 29, 2015, the fight against the West Africa Ebola outbreak reached a pivotal point. WHO declared that human-to-human Ebola transmission had ended in Guinea, marking the first time all three countries had stopped the original chains of transmission at the same time. By this time, WHO had reported 28,637 confirmed, probable, and suspected Ebola cases worldwide, including 11,315 deaths. In December 2014, Congress enacted the Consolidated and Further Continuing Appropriations Act, 2015 ( P.L. 113-235 ), providing several federal departments and agencies $5.4 billion in FY2015 emergency supplemental appropriations for the U.S. government Ebola response. U.S. Government Ebola Funding in West Africa

Of the funds Congress appropriated for international Ebola responses, roughly half were provided to the Department of State and the U.S. Agency for International Development (USAID) through Title IX, Division J of P.L. The foreign affairs funds, which totaled more than $2.5 billion, were limited to use for the Ebola response, although the law permitted funds from some accounts to be used for preparedness efforts in countries "at risk of being affected by" the outbreak, such as Mali and Nigeria (which both experienced imported Ebola cases). Due to the precipitous decline in new cases towards the end of 2015, the United States has reduced funding for Phase 1 and Phase 2 types of activities. Challenges in Controlling Ebola in West Africa

On March 29, 2016, WHO declared that the West Africa Ebola outbreak was no longer a Public Health Emergency of International Concern PHEIC, since Ebola no longer constituted an extraordinary event, the risk of international spread was low, and countries had demonstrated the capacity to respond rapidly to infrequent flare-ups. Researchers continue to examine the implications of this persistence for survivors' health and for potential transmission of the disease. All three countries continue to face considerable infrastructural constraints. Issues for Congress

Congress has an enduring interest in the status of the Ebola outbreak in West Africa, not least of which involves the disposition of funds dedicated to the Ebola response. The use of these unobligated funds is under discussion, particularly in response to emerging health crises. In February 2016, President Obama requested nearly $1.9 billion to support a U.S. domestic and international Zika response. In May 2016, the House and Senate took separate actions on Zika funding. On May 16, 2016, the Chairman of the House Appropriations Committee introduced the Zika Response Appropriations Act, 2016 ( H.R. Nearly half of the funds are designated as emergency funds. Members of Congress who have opposed reprogramming unobligated Ebola funds have maintained that residual Ebola funds should be preserved and used to strengthen the weak health systems in West Africa that initially failed to detect and contain the outbreak. Since then, country program offices in Guinea, Liberia, and Sierra Leone have led EBOLA responses in the respective countries.
The 2014-2015 outbreak and spread of Ebola Virus Disease (EVD, or Ebola) in West Africa became an international public health emergency that, in no small part due to international intervention, abated significantly by the end of 2015 and early 2016. The issue remains of interest toward the end of the 114th Congress for a number of reasons, including ongoing concerns about the status of disease and risks of future outbreaks, and interest in the disposition of funds appropriated by Congress in response to Ebola, especially in view of the more recent health challenge posed by the Zika virus. This report discusses ongoing efforts to control Ebola in West Africa, analyzes persistent challenges in fighting the spread of the disease, and tracks Ebola emergency funds.
Key milestones in the Ebola outbreak include the following:
In March 2014, the World Health Organization (WHO) announced that a "rapidly evolving outbreak of Ebola virus disease (Ebola)" had begun in Guinea, West Africa. Retroactive studies indicated that the virus had likely begun to spread in late December 2013, but that weak disease detection and surveillance systems had failed to identify the outbreak. From Guinea, the disease spread to Liberia and Sierra Leone and continued to infect thousands in the three countries until mid-2015, when a coordinated, high-level response by the international community began to slow the rate of new infections. In August 2014, WHO declared Ebola a Public Health Emergency of International Concern (PHEIC) and one month later, United Nations Secretary-General Ban Ki-moon established the United Nations Mission for Ebola Emergency Response (UNMEER) to coordinate the U.N. response to the outbreak. WHO came under some broad criticism for what was viewed as a late designation for the emergency. Following the PHEIC declaration, the United States and other actors exerted a concerted effort to contain the disease, and cases began to decline rapidly. By the end of December 2015, the fight against the West Africa Ebola outbreak reached a pivotal point. On December 29, WHO declared that human-to-human Ebola transmission had ended in Guinea, marking the first time all three countries had stopped the original chains of transmission at the same time. By this time, WHO had reported over 28,000 confirmed, probable, and suspected Ebola cases worldwide, including more than 11,000 deaths. On March 29, 2016, WHO declared that the West Africa Ebola outbreak was no longer a PHEIC, although the disease was still in a phase that could experience infrequent flare-ups. In addition, Guinea, Liberia, and Sierra Leone continue to face considerable infrastructural constraints.
Congress appropriated $5.4 billion in FY2015 emergency supplemental appropriations for domestic and international responses to the Ebola outbreak (in Consolidated and Further Continuing Appropriations Act, 2015, P.L. 113-235, December 2014). Of the funds appropriated for international responses (in Title IX, Division J), roughly half were for the Department of State and the U.S. Agency for International Development (USAID). These funds, which totaled more than $2.5 billion, were limited for Ebola responses, although the law permitted funds from some accounts to be used for preparedness efforts in countries "at risk of being affected by" the outbreak.
With some Ebola supplemental funds still unobligated, some in the 114th Congress have looked to these funds as a potential source for responses to the emergent Zika virus. The Obama Administration has requested new funds to support a Zika response and has also reprogrammed some Ebola funds for Zika. The House and Senate have considered legislation in response to the request (S. 2843 and H.R. 5044, respectively. For more information, see CRS Report R44460, Zika Response Funding: Request and Congressional Action). Some Members of the House Appropriations Committee have called on the Administration to expend unobligated Ebola funds before considering the Zika request. Other Members oppose this idea and maintain that remaining Ebola funds should be preserved and used to strengthen the still weak health systems in West Africa that initially failed to detect and contain the outbreak.