For 15 years, the face of terror has been that of the young man armed with a bomb, proclaiming the religious righteousness of his violent mission. Today the face of terror is that of the suffering victim of Ebola who appears at a hospital emergency room. Ebola has arrived in the United States, reminding us that we are no more isolated from the tragedies of Africa than we are from the violence of the Middle East. Are we any more prepared today to deal with the terror of Ebola than we were in 2001 to deal with the terror of Al-Qaeda? What lessons should we take from our previous experience with terror?
Of course, a threat to public health is not the same as a threat to national security. Yet both the terrorist and the virus represent the dark side of globalization. We are again living in fear of foreign men arriving on airplanes, bringing with them destruction and chaos. In our cosmopolitan age, tens of thousands of people are moving in every direction at once. We have no more reason to think that the virus will arrive directly from Monrovia, Liberia, than we had reason to think that Middle Eastern terrorists would arrive directly from the Middle East.
Moreover, the terrorist and the Ebola virus generate fear in very similar ways. Whether any particular person will face a threat is entirely unpredictable. Individually, we feel defenseless. We don’t know how to protect ourselves or our loved ones. We cannot choose which airplane to board or which office buildings to visit in order to lessen the threat to us. We respond to both the terrorist and the virus first with a sense of disbelief — “This can’t happen here” — and then with a sense of helplessness. The combination of disbelief and helplessness describes a terrorized population vulnerable to extreme reaction.
What, then, are the lessons for today of 9/11 and its aftermath?
The simplest one is that our ordinary systems of first response are not well suited to deal with threats that are simultaneously very dangerous and very rare. That was the problem of airport security on 9/11; now it is the problem of emergency room care. An entire nation fears the possibility of the arrival of Ebola, but somehow Duncan slipped by. How can that be? But we know all too well how that can be. They were not paying attention; they were tending to other matters or to nothing at all. They had no reason to think that of all the places in the nation where Ebola might appear, it would be there and then.
We need to focus once again on how to keep those who perform routine tasks in emergency rooms alert to a very rare possibility of extreme danger. At airports we learned of the need for systematic protocols, for much practice and for constant testing as well as for ample investment. That lesson must now be applied to health care providers. But we have also learned — most recently in Ferguson, Missouri — not to lose sight of the real problem as we shift resources to first responders. Local police forces didn’t need tanks, and providing them just created new problems. Not every emergency room needs an isolation ward. If we provide them, we may use them even when not medically justified. Already we hear voices intemperately calling for quarantine of those arriving from West Africa.
The larger lesson, however, is that if we wait to deal with a problem until it reaches our doorstep, it will be too late. Our politics can be slow to react, but when it does, it easily overreacts. We failed to respond to the long-brewing threat from Al-Qaeda until the tragedy of 9/11. Then we invaded Iraq, a country with no apparent connection to the attacks. Thousands of deaths and more than a trillion dollars later, we are in a worse position than when we started. The need to be forward-looking and globally responsive is no less true today. We need to be mobilizing as much and as quickly as possible to respond in West Africa. If the worst-case scenario — a million cases by the end of the year — comes to pass, I do not doubt that we will mobilize to isolate that region. Not only will this require far more resources, but it will also cause far more tragedy in West Africa and probably very little benefit to our public health.
What, then, is the bottom line? Act promptly, decisively and with care for others as well as for ourselves. This is not a hard lesson to learn, but it is a very difficult lesson to apply.