The Heritage Foundation

Issue Brief #4299 on Health Care

November 13, 2014

November 13, 2014 | Issue Brief on Health Care

Nine Questions for the House Ebola Hearing

Over the past seven months, Ebola has infected more than 13,000 people and claimed nearly 5,000 lives. Most of the infected people have been in Guinea, Liberia, and Sierra Leone. Both Nigeria and Senegal successfully overcame transportation-related cases in their countries and were declared Ebola-free by the World Health Organization on October 20. The virus has also spread beyond Africa, infecting individuals in the United States and Europe. While cases have been decreasing in Liberia, the region remains at high risk with infection rates in Guinea and Sierra Leone continuing to increase. Ultimately, to keep the United States safe from the epidemic, it will need to be controlled in West Africa.

Extensive U.S. efforts are already underway to get ahead of the infection in Liberia, with additional support in Sierra Leone and Guinea being led by the British and the French. Congress approved President Barack Obama’s initial request in September for $500 million in addition to the $175 million that was already committed to the Ebola humanitarian effort.[1] As of November 5, the U.S. Agency for International Development (USAID) has spent approximately $400 million in humanitarian assistance for the Ebola virus disaster response.[2] In addition to the original $500 million, the Pentagon has requested authorization to use up to $500 million from the Overseas Contingency Operations funds to support the humanitarian mission in West Africa.[3]

Nine Questions

President Obama is now requesting an additional $6.18 billion to combat Ebola in West Africa and to bolster the U.S. domestic response against a potential outbreak in the U.S. homeland.[4] The breakdown of the request remains murky at best. Members of the House of Representatives should insist that Administration experts answer the following nine questions in testimony in the House Foreign Affairs Committee hearing on “Combatting Ebola in West Africa: The International Response”:

  1. Exactly how much money has been pledged, committed, and disbursed? Where and for what specific purposes? What oversight resources have been assigned to monitor this effort? Why is the Administration asking for emergency funding when Congress will decide spending priorities for fiscal year (FY) 2015 on or before December 11? The Budget Control Act of 2011 defines “emergency” funding as spending for “the prevention or mitigation of, or response to, loss of life or property, or a threat to national security…[that is] sudden,…urgent,…unforeseen,…and temporary.”[5] How much of the funding request meets the Budget Control Act’s criteria for emergency funding?
  2. Has the situation on the ground changed or has additional information made the initial estimates inaccurate? The Pentagon originally estimated that Operation United Assistance would cost $750 million to $1 billion over six months. Based on these changes, has a revised timeline been developed? If so, how long will this money last, and how long will this operation continue?
  3. How are other donors meeting the needs in Guinea and Sierra Leone? The United States has taken the lead in Liberia. How much money have other donor countries and international organizations pledged and allocated to the Ebola response in West Africa? How much of this funding has actually been spent? What mechanisms are in place to ensure that U.S. efforts in Liberia are not wasted if the other countries are unable to get ahead of the infection in other countries and the virus jumps back across the border into Liberia?
  4. What role is the United Nations playing in combatting Ebola? What is the mission of the U.N. Mission for Ebola Emergency Response (UNMEER), and when will it be fully stood up? How much has been donated to support the U.N. Ebola trust fund? How is UNMEER coordinating with the U.S. and other donor countries? Is the U.N. Mission in Liberia (UNMIL) involved in any security matters related to Ebola? How are all of these efforts being coordinated with the World Health Organization?
  5. What role is the Economic Community of West African States, the West African regional body, playing? What monitoring mechanisms are in place to ensure the virus does not spread to more populous and urban countries that remain at high risk?
  6. What will be the mission of the 1,000 personnel pledged by the African Union? How will they coordinate with other bilateral and international efforts?
  7. What efforts are underway to train and staff the new Ebola Emergency Treatment facilities? The New York Times reported that 18 of the 41 proposed facilities still need medical staff.[6] What is the value of building structures if there are not enough doctors and other medical personnel to staff them?
  8. Of the President’s $6.18 billion request, how much will be allocated to emergency operations and how much will be allocated to permanent programs? While many elements of the President’s request are clearly emergency-related needs, such as the emergency evacuation request, other parts appear to be long-term programming requests that should be appropriated through the formal budgeting process. For example, why does a permanent program such as the Global Health Security Agenda need to be funded outside the formal budgetary process?
  9. What is the purpose of the $1.54 billion contingency fund in the $6.18 billion request? Who will have access to the account? How will this money be managed, prioritized, and allocated?

Conclusion

Ebola unquestionably threatens the health of Americans and West Africans, but Congress should exercise its oversight authority and power of the purse to ensure that American taxpayer dollars are being spent effectively to combat and contain Ebola.

—Charlotte Florance is a Research Associate for Economic Freedom in Africa and the Middle East in the Douglas and Sarah Allison Center for Foreign and National Security Policy, of the Kathryn and Shelby Cullom Davis Institute for National Security and Foreign Policy, at The Heritage Foundation.

    About the Author

    Charlotte Florance Policy Analyst, Africa and the Middle East
    Douglas and Sarah Allison Center for Foreign and National Security Policy

    Show references in this report

    [1] The White House, “U.S. Response to the Ebola Epidemic in West Africa,” September 16, 2014, http://www.whitehouse.gov/the-press-office/2014/09/16/fact-sheet-us-response-ebola-epidemic-west-africa (accessed November 10, 2014).

    [2] U.S. Agency for International Development and Centers for Centers for Disease Control and Prevention, “West Africa—Ebola Outbreak,” Fact Sheet No. 6, November 5, 2014, http://www.usaid.gov/sites/default/files/documents/1864/11.05.14%20-%20USG%20West%20Africa%20Ebola%20Outbreak%20Fact%20Sheet%20%236%20FY%2015.pdf (accessed November 10, 2014).

    [3] The $500 million was requested for Department of Defense operations in both West Africa and Iraq. The Africa Command commander has estimated that the first six months of Operation United Assistance, the humanitarian operation, would cost an estimated $750 million. For more information, see David M. Rodriguez, “Pentagon Briefing on DoD Response to Ebola with Gen Rodriguez,” U.S. Africa Command, October 8, 2014, http://www.africom.mil/newsroom/article/23695/transcript-pentagon-briefing-on-dod-response-to-ebola-with-gen-rodriguez (accessed November 10, 2014).

    [4] Patricia Zengerle and Richard Cowan, “Obama Seeks $6.2 Billion to Combat Ebola: Officials,” November 5, 2014, http://www.reuters.com/article/2014/11/05/us-health-ebola-obama-idUSKBN0IP2EE20141105 (accessed November 10, 2014).

    [5] Budget Control Act of 2011, Public Law 112–25, § 102(4).

    [6] Jeremy Ashkenas et al., “Ebola Facts: What Is Being Done to Improve Medical Treatment in Africa,” The New York Times, November 2, 2014, http://www.nytimes.com/interactive/2014/07/31/world/africa/ebola-virus-outbreak-qa.html (accessed November 10, 2014).