In March 2014, an EVD outbreak was reported in Guinea, West Africa. The outbreak is the first in West Africa and has become the largest, most persistent ever documented. The outbreak is continuing to spread in Guinea, Sierra Leone, and Liberia ("affected countries") and has ended in Nigeria and Senegal, after having infected 20 people in Nigeria and one in Senegal. As of late October, nearly 10,000 people have contracted EVD, of whom almost 5,000 have died ( Figure 1 ). Due to inadequate disease surveillance capacities in the region, WHO estimates that actual cases may be two to four times higher than reported. Simultaneous multi-country outbreaks. Until October, no EVD cases outside of Africa resulted in secondary cases. In that month, health workers in the United States and Spain contracted EVD while caring for EVD patients. No additional cases have been reported from the health workers. Scale and pace of transmission . Unrelated, Ongoing Ebola Outbreak

A separate Ebola outbreak that is unrelated to the ongoing West Africa outbreak was detected in the DRC on August 24, 2014. To meet the health and secondary effects of the outbreak, the United Nations estimates that it will cost Guinea $194 million, Liberia, $473 million, and Sierra Leone $220 million. In order to stop the spread of EVD, WHO estimated at the end of August 2014 that the affected countries would need more than 13,000 health workers to provide health care, contact tracing, and safe burial. Safe disposal of dead bodies is also improving in Liberia, where roughly 90% of dead bodies are being removed within 24 hours of being reported to the National Call Center. In September, the United Nations (U.N.) established the U.N. Mission for Ebola Emergency Response (UNMEER) to coordinate the international response to the outbreak. WHO Ebola Response Roadmap

As indicated above, roughly half of the U.N. request for tackling the outbreak is aimed at addressing direct health impacts. The World Health Organization is leading that component and has outlined measures the international community would need to take to contain the outbreak by January 2014. U.S. Responses to Pandemic Threats and Ebola

The United States is the leading funder of the international Ebola response and its financial support is continuing to rise. The U.S. Agency for International Development (USAID) reports that as of October 22, U.S. humanitarian funding for EVD responses totaled $344.6 million. In addition, the Department of Defense (DOD) is planning to spend more than $1 billion on containing the outbreak in support of U.S. EVD activities in West Africa, as described below. On October 17, President Obama established an Ebola Czar to coordinate U.S. domestic and global responses to the Ebola outbreak. As of October 25, nearly 900 U.S. Government personnel are stationed in the region, more than 700 of which are among the 4,000 military personnel who will be deployed to the region. Related activities in 18 countries in East and Central Africa and South and Southeast Asia focus on:
viral detection —identification of viruses in wildlife, livestock, and human populations that may be public health threats; risk determination —characterization of the potential risk and method of transmission for specific viruses of animal origin; institutionalization of a "one health" approach —integration of a multi-sector approach to public health (including animal health and environment); outbreak response capacity —support for sustainable, country-level response to include preparedness and coordination; and risk reduction —promotion of actions that minimize or eliminate the potential for the emergence and spread of new viral threats. This section describes issues Congress may consider as it assesses U.S. and international responses. Leadership of the International Outbreak Response

Observers have criticized WHO leadership over the global Ebola response. An accounting of broader health and development needs will likely ensue and may rekindle debate over how U.S. global health assistance funds are apportioned. Prospects for future Ebola outbreaks in urban areas and in countries with limited pandemic preparedness capacity raise several questions, including:
Is the U.S. response to the Ebola outbreak effective?
In March 2014, an Ebola Virus Disease (EVD) outbreak was reported in Guinea, West Africa. The outbreak is the first in West Africa and has caused an unprecedented number of cases and deaths. The outbreak is continuing to spread in Guinea, Sierra Leone, and Liberia (the "affected countries"); it has been contained in Nigeria and Senegal, and has been detected in Mali. As of October 22, 2014, more than 10,000 people have contracted EVD, more than half of whom have died.
Until October 2014, no secondary EVD cases had occurred outside of Africa. That month, health workers in Spain and the United States contracted EVD cases while providing care for Ebola patients. Other factors make this outbreak unique, including
its introduction into West Africa; multi-country outbreaks occurring simultaneously; disease transmission within urban areas; and an unprecedented scale and pace of transmission.
In the aggregate, between 1976, when Ebola was first identified, through 2012, there were 2,387 cases, including 1,590 deaths, all in Central and East Africa. The number of Ebola cases in this outbreak is four times higher than the combined total of all prior outbreaks, and the number of cases is doubling monthly. The U.S. Centers for Disease Control and Prevention (CDC) and the World Health Organization (WHO) have projected an exponential increase in cases. WHO estimated that by the end of November, some 20,000 people may contract Ebola; CDC estimated that "without additional interventions or changes in community behavior," up to 1.4 million could contract EVD in Liberia and Sierra Leone by January 2015. CDC indicates, however, that the outbreak may not reach such proportions since responses are intensifying. In Liberia, for example, improvements in burial practices have resulted in roughly 85% of all bodies being collected within 24 hours of being reported to national officials.
In an August 2014 report, WHO estimated that it would cost roughly $500 million to contain the outbreak by January. In September, international responses accelerated. The United Nations (U.N.) established the United Nations Mission for Ebola Emergency Response (UNMEER) "to utilize the assets of all relevant U.N. agencies" to address the health and broader social impacts of the outbreak. A proposed U.N. response would cost roughly $1 billion, about half of which would be aimed at addressing health impacts.
The United States is the leading funder of the international Ebola response, and its financial support is growing. As of October 25, almost 900 U.S. government personnel had deployed to the region, and some 4,000 military personnel will be deployed to the region. The U.S. Agency for International Development (USAID) reports that as of October 22, U.S. funding for EVD responses totaled $344.6 million. In addition, the Department of Defense (DOD) is planning to spend more than $1 billion on EVD activities in West Africa. On October 17, President Obama established an Ebola Czar to coordinate U.S. domestic and global responses to the Ebola outbreak.
Some global health experts have criticized the U.S. and international response to the Ebola outbreak, decrying the pace and scale of assistance. The limited impact of U.S. and international responses to the Ebola outbreak has raised several questions regarding global health governance structures, international commitment to bolstering pandemic preparedness and response capacity in poor countries, and global support for strengthening health systems. The international community lacks a rapid response team of health professionals prepared to address health emergencies like the ongoing West African Ebola outbreak. Debates about whether WHO should have such capacity have been at the heart of recent WHO reform debates.
While deliberating the appropriate response to ongoing Ebola outbreak, Congress is likely to discuss the breadth of health, social, economic, development, and security challenges that this outbreak is causing, as well as how U.S. global health aid is apportioned. This report focuses on the health impacts of the outbreak and discusses U.S. and international responses to those health challenges.