By September 2014, the most widespread epidemic of Ebola virus disease in history had claimed more than 1,427 lives in West Africa, mostly in the countries of Sierra Leone, Liberia, and Guinea. The nongovernmental organization (NGO) with the largest working presence in the region, Médecins Sans Frontières (MSF, or Doctors Without Borders), had been critical of the international response since the first cases were reported in March, but on Aug. 27, in the French-language daily newspaper Le Temps, MSF’s president and general director warned that the epidemic had spun out of control; the health care systems in the region had completely broken down, governments were struggling to maintain control, and the region was in “exceptional crisis.” In Liberia, the hardest-hit country, hospitals had become deserted. Many people were dying of easily preventable and treatable diseases such as malaria and diarrhea.

But fewer Americans are probably aware that some of the world’s leading experts in the prevention and treatment of infectious diseases are U.S. military personnel, and that these experts played a crucial role, during the West African Ebola epidemic, in diagnosing cases, preventing the spread of the virus, and researching and field-testing Ebola treatments and vaccines.

“The situation can only be reversed,” wrote MSF’s leaders, “if there is a significant commitment of states with available effective disaster response capacity – be it through civil protection mechanisms, the support of military medicine units or of logistics or medical staff who are used to working with strict infection prevention and control measures.”

Less than two weeks after MSF’s plea, when the death toll had risen to more than 2,200, Liberia’s president, Ellen Johnson Sirleaf, wrote directly to President Barack Obama asking for help: “I am being honest with you,” she wrote, “when I say at this rate, we will never break the transmission chain and the virus will overwhelm us.”

The preference for military assistance was in line with the opinions of international infectious disease experts who believed only the American military had the experience and capability to work with viral hemorrhagic fevers such as Ebola. Just days earlier, Obama had publicly declared the West African Ebola epidemic to be a national security priority, and on Sept. 16, at the Atlanta headquarters of the Centers for Disease Control and Prevention (CDC), he announced a more aggressive, $750 million effort.

The military’s component of the CDC-led government response, Operation United Assistance, was conducted by U.S. Africa Command (AFRICOM) from a Joint Force Command (JFC) headquartered in the Liberian capital of Monrovia. Over the next several months, the military’s unique capabilities would support U.S. government efforts to contain the Ebola virus, save lives, and alleviate suffering while promoting stability in the region.

It probably wouldn’t surprise most Americans that the military capabilities applied to the Ebola epidemic included command/control and logistical support for the transport of equipment, supplies, and people to the region, or the construction, by Navy Sea Bees and soldiers from the Army’s 15th Engineer Battalion, of training and treatment centers. But fewer Americans are probably aware that some of the world’s leading experts in the prevention and treatment of infectious diseases are U.S. military personnel, and that these experts played a crucial role, during the West African Ebola epidemic, in diagnosing cases, preventing the spread of the virus, and researching and field-testing Ebola treatments and vaccines.

 

A Global Engagement

Where did the military’s infectious disease expertise come from, and how did it become so crucial to fighting viral hemorrhagic fever in West Africa? The explanation begins with the simple fact that for decades, diseases killed far more service members in wartime than did enemy combatants. The Army, in fact – under the man recognized as the nation’s first bacteriologist, Army Surgeon General George M. Sternberg – established the first school of public health and preventive medicine in the United States, the Army Medical School, in 1893.

The researchers Sternberg dispatched to the Caribbean and Pacific tropics during the Spanish-American war – including a military physician named Walter Reed – achieved several historic breakthroughs in public health, including the first typhoid vaccine; the use of chlorine as a water purification agent; the identification of two of the first known human viruses (yellow fever and dengue) and the mosquito as their infecting agent; and the dramatic reduction of malaria cases among service members and others working in the Panama Canal Zone.