On Friday, July 10, the CDC confirmed that a second American — a humanitarian worker — has tested positive for Bundibugyo ebolavirus in the Democratic Republic of Congo. This follows Dr. Peter Stafford, the medical missionary physician who contracted Ebola in Bunia in May and was successfully treated — in Berlin. Not in Atlanta. Not in Omaha. Not in New York. In Berlin.
What needs to be part of this is discussion is that the United States built a system to handle exactly this situation and what it means that we are not using it.
We built the infrastructure. It is sitting idle.
In the wake of the 2014 West African Ebola epidemic — the largest in history — the United States made a serious, taxpayer-funded commitment to never again be caught flat-footed. Through the Administration for Strategic Preparedness and Response (ASPR) and the CDC, the federal government stood up the National Emerging Special Pathogen Training and Education Center, or NETEC, a coordinating body anchored at three hospitals that had proven they could do the job: Emory University Hospital in Atlanta, the University of Nebraska Medical Center/Nebraska Medicine in Omaha, and NYC Health + Hospitals/Bellevue in New York City. These institutions weren't chosen because they were prestigious (even though they are). They were chosen because they had already treated Ebola patients safely, successfully, and without a single nosocomial transmission to their communities.
NETEC coordinates a tiered national network that grew to include 13 federally designated Regional Emerging Special Pathogen Treatment Centers, or RESPTCs, spread across the country. These Level 1 centers — which include Johns Hopkins Hospital, Massachusetts General, University of Texas Medical Branch in Galveston, Denver Health, and others — are the apex of the system. They maintain dedicated biocontainment units. Their teams drill, train, and simulate special pathogen care on a continuous basis. They develop protocols. They publish findings. They build institutional memory. They exist for one purpose: so that when an American gets infected with a high-consequence pathogen — Ebola, Marburg, Lassa, whatever it might be — there is a place ready to receive them, treat them, and protect the healthcare workers doing the treating.
This network was not cheap. It was not built casually. Hundreds of millions of dollars in federal preparedness funding have flowed into it over a decade.
And right now, as a second American has tested positive for Ebola in the DRC, every one of those 13 RESPTC biocontainment units is sitting idle.
What these centers actually did in 2014 tells the whole story.
During the 2014-2016 domestic Ebola response, 11 Ebola patients were treated at five U.S. health care facilities. The three institutions that would become NETEC's founding pillars each treated patients and did so in ways that were extraordinary both clinically and in terms of infection control.
During the 2014-2016 domestic Ebola response, 11 Ebola patients were treated at U.S. health care facilities, and the record speaks for itself. Emory treated four patients — Dr. Kent Brantly and Nancy Writebol, the first two Americans evacuated from West Africa, then nurse Amber Vinson, transferred from Dallas after being infected while caring for Thomas Eric Duncan, and later Dr. Ian Crozier, a WHO physician. All four survived. NIH's Clinical Center in Bethesda received Nina Pham, the other Dallas nurse infected while caring for Duncan — she recovered fully. Nebraska Medicine treated three patients: Dr. Rick Sacra, a medical missionary who contracted Ebola while delivering babies at ELWA Hospital in Liberia; Ashoka Mukpo, the NBC News cameraman who contracted Ebola in Liberia; and Dr. Martin Salia, a Sierra Leonean surgeon who arrived too late in his disease course to survive — the one death in the domestic system, attributable to the severity of his illness on arrival, not to any failure of the unit. Bellevue treated Dr. Craig Spencer, who had returned from Guinea after working with Doctors Without Borders, and discharged him Ebola-free. Across all of these cases — different patients, different facilities, different stages of disease — not a single healthcare worker at any of these centers became infected. Zero nosocomial transmission. That is the standard these facilities set and have maintained ever since.
The one facility where an Ebola patient was treated without a specialized biocontainment unit was Texas Health Presbyterian Hospital in Dallas, where Thomas Eric Duncan presented, was initially sent home, returned, and died. Two nurses who cared for him — in an improvised isolation unit — were infected. They were transferred to Emory and NIH.
The lesson from 2014 is not subtle: specialized units staffed by experienced, prepared teams save lives and prevent nosocomial spread. Improvised isolation in unfamiliar settings, without established protocols, kills patients and infects staff.
The aggregate mortality for Ebola patients treated in U.S. and European high-consequence facilities was 18.5%, compared to 37 to 74% in West African field settings. Advanced supportive care — not magic, not exotic drugs, but the painstaking work of fluid management, electrolyte correction, and critical care that requires a real ICU and a team that has run through the scenarios — is what drove that difference. You cannot deliver that type of mastery in an adhoc facility that didn't exist six weeks ago.
What the Kenya plan actually is.
In late May, the Trump administration announced that Americans who contract Ebola in the outbreak zone would not be repatriated to the United States. Instead, they would be sent to a newly constructed facility at Laikipia Air Base near Nanyuki, Kenya — a fifty-bed unit, stood up on a military airfield, staffed by approximately 30 U.S. Public Health Service officers who received three days of specialized preparation before deployment.
Three days.
NETEC teams train continuously. They run full-scale simulations. They refine and republish PPE doffing protocols because doffing — removing your protective equipment in the right sequence without self-contamination — is itself a learned and rehearsed skill that has caused infections when done wrong. The teams at Emory, Nebraska, and Bellevue have been doing this for over a decade. They know the physical layout of their units. They know their colleagues. They have practiced every scenario that can go wrong because some of those scenarios did go wrong in 2014, and they adapted. That accumulated institutional knowledge is irreplaceable.
It is true that several of the deployed USPHS officers have previous Ebola experience from the 2014-2015 Liberia response, and that matters. Those individuals are not blank slates but the care they will be able to provide is not equivalent to what the RESPTC system provides.
The administration's framing of the facility has been confused. Senior officials have at different times described it as a quarantine-only site, a quarantine-and-treatment site, and a transit point before evacuation to a third country. Those are three very different things. If a patient develops symptoms at Laikipia and deteriorates, requiring mechanical ventilation or renal replacement therapy, where exactly does that happen? With what team? In what unit? These are not rhetorical questions. They are the questions whose answers determine whether the patient lives or dies.
The Kenyan public and legal system recognized these issues immediately. Kenyan courts temporarily blocked the facility's implementation. Kenyan protesters were shot dead by police during demonstrations against it. A Kenyan high court judge issued a temporary bar, noting the complete absence of transparency from either government. The Kenyan president ultimately struck a separate deal with the Trump administration. And the supplemental Ebola funding request the administration sent to Congress included money for this Kenya facility — taxpayer dollars to build a worse version of something the taxpayers already funded and which is sitting empty in Atlanta.
Lawrence Gostin, a Georgetown legal scholar who has tracked this carefully, put it cleanly: the CDC has no legal authority to quarantine Americans on foreign soil, and under the Constitution, a U.S. citizen has an absolute right to return home. Whatever coercive pressure the administration is applying to steer Americans toward Kenya is operating outside the law and has been applied with zero public transparency.
Dr. Stafford should have been treated in the United States.
Dr. Peter Stafford, the American missionary physician who contracted Bundibugyo ebolavirus while caring for patients at Nyankunde Hospital in Bunia, was evacuated — to Germany. He was treated at the Charité hospital in Berlin, received experimental therapeutics including the MBP134 monoclonal antibody and remdesivir, and was discharged. His family, including his wife Dr. Rebekah Stafford, who was herself exposed, has been released from quarantine. The German physicians deserve full credit for the expert level of care they provided.
But Dr. Stafford is an American. He was working in one of the most dangerous medical settings on earth. When he got sick, the United States should have brought him home. Emory could have received him. Nebraska could have received him. Johns Hopkins could have received him. These facilities are specifically designed for exactly this patient. They have treated patients at least as sick. They have the protocols, the teams, the experience, and the equipment.
Instead, the operating logic of this administration is that the risk of having an Ebola patient on U.S. soil — treated in a sealed biocontainment unit by a specialist team with a decade of preparation — is politically intolerable. So, they transported an American doctor to Berlin, and built an improvised facility in Kenya, and are calling it a response.
This is below the standard of care. Standard of care is a medical and legal concept, not a rhetorical one. The standard of care for a patient with Ebola, established by more than a decade of clinical experience and multiple peer-reviewed publications, is aggressive supportive care in a dedicated high-biocontainment unit staffed by a trained, experienced team. The Kenya facility cannot meet that standard. It was not designed to. It was not built with that goal. And the people staffing it, however dedicated and however experienced some of them may be, were given three days of preparation and sent to a hospital that didn't exist six weeks ago.
As the next American in the DRC is now sick, this is an active question.
The zero-Ebola-in-America fixation is a chilling deterrent, and it is irrational.
There is a deeper dysfunction driving all of this.
The political goal of this administration's Ebola policy is to maintain a count of zero confirmed Ebola cases on U.S. soil. That is the metric they are optimizing for. Everything else flows from that — the travel bans on DRC, Uganda, and South Sudan; the Kenya facility; the refusal to repatriate Dr. Stafford; the deliberate opacity about what the Kenya facility is actually for. The administration wants to say that Ebola hasn't touched America.
But this goal has no medical or epidemiological meaning. A patient with Ebola in a biocontainment unit at Emory poses no risk to the public. We have proven that repeatedly. There was no community transmission from any of the 2014-2016 US cases — not from Brantly, not from Writebol, not from Spencer, not from Pham or Vinson after they were transferred to specialized care. The biocontainment works. The risk to the American public of a patient at a RESPTC is, practically speaking, zero.
What the zero-cases fixation actually accomplishes is the deterrence of people willing to go fight the outbreak. Right now, there are American physicians, nurses, epidemiologists, and public health professionals who might otherwise volunteer to work in the DRC or Uganda, knowing that if they got infected, they would be brought home to state-of-the-art facilities designed for exactly this. That knowledge is part of what makes it possible to take on extraordinary risk to fight for civilization against this virus.
The current policy inverts that. It tells any American healthcare worker contemplating work in the outbreak zone: if you get infected, you will not come home. You will go to a hastily constructed facility in Kenya, staffed by people who had three days of training, in a building they've never worked in before. You will be treated there, or transferred to some unspecified third country, and the U.S. government will have maintained its clean count of zero. The administration is actively making it more difficult to recruit the fighters we need to put this outbreak out.
The Obama administration's response to the 2014 epidemic — deploying military and public health assets to West Africa, building treatment capacity at the source, and, repatriating infected Americans to specialized units in Atlanta and Nebraska — was not a risk to the American public. It was a model of exactly what works.
In fact, in August 2014, when Kent Brantly and Nancy Writebol were being evacuated to Emory, then-private-citizen Donald Trump tweeted that "our leaders are incompetent" for allowing it, that Ebola patients must "suffer the consequences" of going to help in dangerous places, and that "the U.S. must immediately stop all flights from EBOLA infected countries or the plague will start and spread inside our borders." He was wrong then. The science was clear, the facilities were ready, and both patients survived without a single person in Atlanta becoming infected.
Now he is president, and that sentiment— keep it out, don't touch it, zero cases at any cost — has become policy. Secretary of State Marco Rubio said it plainly at a Cabinet meeting: "We cannot and will not allow any cases of Ebola to enter the United States. Just: keep it out. That is not a public health strategy. It is a political posture dressed up as one.
The irony is that the institutions that helped build this preparedness architecture have themselves been deliberately weakened. The CDC programs that supported emerging pathogen readiness have lost personnel and leadership, while expertise accumulated over years has become harder to sustain. That makes the decision to bypass the existing biocontainment network even more unjustifiable. At a moment when specialized capability is more valuable than ever, the United States is choosing not to use one of the few preparedness systems that has already demonstrated its effectiveness under real-world conditions.
The Real Question Is Why We Built the System
There is a larger question underneath all of this.
The United States did not stumble into the NETEC system. It was built deliberately after the 2014 West African Ebola epidemic exposed the consequences of being unprepared. Congress appropriated money. Hospitals invested in specialized facilities. Clinicians spent years training. Protocols were written, tested, and revised. Institutional memory was created.
Preparedness is expensive precisely because it is built for events that may not happen for years. Biocontainment units exist for the rare moments when a patient infected with a pathogen such as Ebola, Marburg, or Lassa fever needs care.
An American physician contracted Ebola while providing care in one of the most challenging medical environments in the world. A second American has now tested positive. This is not a hypothetical exercise. It is exactly the type of situation the United States spent a decade preparing for.
Yet instead of relying on the system that was built, funded, tested, and proven, policymakers have chosen an alternative that depends on newly assembled personnel, a newly established facility, and uncertain lines of authority and care.
Preparedness is not the construction of buildings. It is the accumulation of expertise. The value of the RESPTC network is not simply that it contains isolation rooms. It is that the teams staffing those rooms have spent years developing the experience, trust, and operational competence required to safely care for patients with high-consequence infectious diseases.
When a nation spends a decade building a capability and then declines to use it when the exact scenario arrives, it raises a fundamental question: what was the preparation for?
The thirteen RESPTC biocontainment centers remain ready. The clinicians who staff them remain ready. The protocols refined through years of training and real-world experience remain ready.
They should be used.
This American who tested positive for Ebola should be brought home.