US officials now concede that if they had, the outbreak might have been stopped outright, or certainly contained before so many people were killed."If we had a GDD center there, if we had active surveillance, could we have picked up Ebola earlier? And I think you'd had to have your head buried in the sand to say no," said Dr. Joel Montgomery, who oversees GDD as the chief of the Epidemiology, Informatics, Surveillance and Laboratory Branch in the CDC's Division of Global Health Protection. "Of course we would have picked it up earlier.""There has always been a plan to have 18 centers and one of them would be in West Africa," Montgomery said. "I don't think it was ever proposed and rejected. It just never went forward because of [a lack of] resources."The lack of a regional center in West Africa is emblematic of bigger structural problems at GDD that have compromised the effectiveness of the CDC's principal program for identifying and containing infectious diseases around the world over the past 12 years, according to documents and more than two dozen current and former CDC officials and other experts interviewed for this story.As of today, significant gaps in the network remain; only 10 of the promised facilities have been built and at least some are still not fully functional. All of South and Central America, for instance, is still covered by one center in Guatemala, despite a broad array of infectious diseases that affect millions of people in the region."Could we have picked up Ebola earlier? (…)I think you'd had to have your head buried in the sand to say no."
In addition to countries covered by the current 10 Global Disease Detection Centers, CDC also tracks public health events all over the world. This map shows major diseases under tracking. (Jin Wu/Medill)
A slide from Dr. Scott Dowell's presentation on Oct. 17, 2011 titled "Responding to the Urgent Preparing for the Future: Global Disease Detection and Emergency Response."
Behind the scenes at the Emergency Operations Center, two officials work late into the evening. The EOC is an information hub where scientists and analysts work to contain and control the spread of disease from CDC headquarters in Atlanta. (Dawnn Anderson/Medill)
The United States said it would pledge more than $1 billion to the effort. More than half of the funding, according to a White House statement, would focus on Africa. Most of the funds are meant to help stop future infectious disease outbreaks by strengthening health infrastructure and laboratory systems and employing "an interconnected global network that can respond rapidly and effectively."And in November last year the CDC announced that it would create a new Global Rapid Response Team to serve as a "deployable asset" to help the US respond to public health outbreaks in Africa, the Middle East and Asia. The 50-person on-call staff, based at CDC headquarters, is supposed to offer assistance with capacity building, epidemiology, and surveillance.Privately, some GDD officials expressed concern that the GDD will have to compete with these new, and often similar, Obama administration-sponsored initiatives for funding and attention. They noted that the new Rapid Response initiative is not part of their program, and declined to comment on whether it was designed to plug holes in the GDD network.Montgomery said he is optimistic that GDD will play a significant role in the US government's post-Ebola expansion of its global disease detection network.In many ways, he said, the program laid the groundwork for the new Global Health Security Agenda, and its successes will help ensure that it stays funded and relevant for the rest of the Obama administration and well into the future, no matter who takes the White House in November.But there still are no plans to build the eight remaining centers to complete the GDD network promised back in 2004.In November, Montgomery ran into Dowell, the GDD founder and former director, at a World Bank meeting in Senegal. They talked about the program's shortcomings: "We agree, it's not finished. West Africa, South America — there are clearly areas where we don't have visibility," Montgomery said. That includes countries where Ebola recently struck.The problem remains the same: The government is not spending enough."It's predicated on funding," Montgomery said, "and I would say right now funding is limited.""It's predicated on funding (…) and right now funding is limited."