Ebola Was Here

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EBOLA

Ebola Was Here

Ebola cases are dropping so rapidly that Liberians are talking about the disease in the past tense. They shouldn’t be.

BY LAURIE GARRETT NOVEMBER 7, 2014

MONROVIA, Liberia — Promised by U.S. President Barack Obama in early September, the Monrovia Medical Unit (MMU), built by the United States Army 101st Airborne division, opened yesterday to the appreciative smiles of Liberian President Ellen Johnson Sirleaf and U.S. Ambassador Deborah Malac. The 25-bed tent facility is the Cadillac of the country's Ebola Treatment Centers, or Ebola Treatment Units (ETUs): air-conditioned, comfortable, and staffed by highly trained members of the U.S. Public Health Service.
"This is a symbol of the strong partnership the government and people of the United States have with the people of Liberia," Ambassador Malac said at the opening ceremony. Noting that the MMU is meant to handle Liberian and foreign health care workers infected on the job, President Sirleaf added, "those that have trained to preserve life, went out there knowing what they were dealing with and then paid the ultimate price -- now they have a place that they can come to. I want to thank President Obama, the Congress, the government, and the people of the United States who have come to our aid."
The sophisticated Ebola facility was just one element of a massive chain of commitments made by the United States government, dozens of humanitarian groups, the African Union, and a long list of other governments back in September, when Liberia's epidemic was raging so out of control that dead bodies could be seen abandoned on the streets of the capital city, Monrovia.
One day Alex Gasasira stepped out of his office at the World Health Organization -- located just two blocks from the U.S. Embassy -- and nearly stumbled over a dead Ebola victim.
One day Alex Gasasira stepped out of his office at the World Health Organization -- located just two blocks from the U.S. Embassy -- and nearly stumbled over a dead Ebola victim.
"You had bodies lying in the streets exposed to dogs, in the absence of war, of natural disaster -- that has never happened in modern times, not due to disease," Swedish infectious disease expert Hans Rosling told me. In early July, Rosling wrote and advised the World Health Organization (WHO) that this Ebola epidemic was easily controllable, and that dedicating excessive resources to it would result in a net increase in deaths due to other ailments such as malaria, chronic diseases, and auto accidents. "You must blame me -- I missed it," Rosling told me, clearly bearing a weight of guilt. When he realized his mistake in September, Rosling took a leave from his professorial job at Uppsala University in Sweden and volunteered to work inside Liberia's Ministry of Health, where he has toiled since, crunching case and death toll numbers. Today Rosling accepts the U.S. CDC's dire predictions -- worst-case scenarios that assume no international response was mustered.
The U.S. Centers for Disease Control and Prevention then predicted that unless the world mobilized on a scale unprecedented in the history of disease outbreaks, the countries of Liberia and Sierra Leone could by Feb. 1, 2015 have a combined 1.4 million cases, including 980,000 deaths.
Just six weeks later, the picture is so markedly different that some Liberians talk about the epidemic using the past tense. And that worries Gasasira, the acting director of the WHO in Liberia, deeply.
"Over the last six weeks efforts by everybody have resulted in a scaled-up response. So now we are slightly ahead of the virus," Gasasira told me in his no-frills concrete WHO office.
"But we are nowhere where we need to be. We are still in a very dangerous situation."
"But we are nowhere where we need to be. We are still in a very dangerous situation."
On Nov. 1, a celebratory mood was creeping into conversations among Ebola fighters, as the Halloween case count was less than 30 for the entire nation. But the numbers have more than doubled since, and are on a clear upward trajectory. What worries people like Rosling is that Ebola is "still in half the country. That's scary. And we have hidden cases in especially remote areas."
One of the lead scientists for the CDC working here in Liberia is Joel Montgomery, who tells me that "super hot, hot spots" for Ebola are located in areas so remote that people are having to hike four to five hours to reach a mud road, and then as much as a half day more to get to the nearest ETU for Ebola diagnosis and care. CDC colleague Frank Mahoney, who has been fighting Ebola in Nigeria and now Liberia for months, lists one example after another of outbreaks that seem to be starting in tiny villages all over the country, and notes that isolated cases of the viral disease can be found in every neighborhood of Monrovia.
Tracing all the contacts of these remote cases to find and isolate the entire chain of transmission is a Herculean effort that has CDC and Ministry of Health teams forging rivers, hiking over mud slopes, and cutting through bush to reach unmapped villages. Montgomery, who usually works out of Nairobi, says the key to ultimately stopping this scourge is in coupling isolation and care with very rapid diagnosis, even in places so remote that phones and cars are never seen. Some of the chains of transmission of Ebola can be traced back to an isolated individual who took ill and was carried on the backs of neighbors for a day, ultimately reaching an ETU. By then the team of good Samaritans was infected, all too often not developing the disease until they returned to their village and passed the virus onto others.

The downturn in Liberia has been dramatic enough that there is real concern the population will slacken in their vigilance, stop washing in bleach, and start hugging and slapping hands, once again putting themselves at risk. Luke Bawo runs the Liberian Ministry of Health's disease and general health tracking office, where he has toiled since June, working 16 or more hours a day logging Ebola's horrible toll on his society. He shared new data analysis that shows Ebola peaked here on Sept. 28, when 69 new cases were found in a single day. And it bottomed out on Halloween, with just 26 cases reported from Liberia's 15 counties. At its worst, during the week of Sept. 28, nearly 450 cases were identified.
On Nov. 3 the nation had 63 new cases. And preliminary data for the rest of this week shows a slow upward trend. Bawo is nervous. He recalls what happened after the initial outbreak was reported in the country's remote Lofa county in March, spreading in April: "There was a lull, 21 days with no cases. Everybody let their guard down."
But that was just the first wave of Ebola, gently washing over the sands of Lofa. It receded, only to roar back in late May not only in Lofa, but also in neighboring counties and in the capital city. "We didn't have sufficient beds to put sick people. They would go home and infect others. We didn't have the ability to pick up sick people, or to remove dead bodies. And a dead body is more infectious than a living case," Bawo explained.

Lisa Hensley of the National Institute of Allergy and Infectious Diseases leads a tiny team of American Army and Liberian scientists toiling inside a converted HIV chimp research center. Long abandoned, the Liberian Institute of Biomedical Research, located about a 90-minute drive from downtown Monrovia, has grounds covered with rusted cages that once housed chimpanzees used by AIDS researchers. When Hensley and her team got here over the summer, they immediately retrofitted one lab building, creating a poor man's version of a maximum containment Biosafety Level 4 (BSL-4) laboratory suitable for working with the viruses found in the bodies and on the cadavers of Ebola victims.
Few American scientists would feel safe in Hensley's jury-rigged lab but it has all the necessities: a bit of negative air pressure, layers of thresholds through which workers pass, donning heavy rubber suits with battery-operated air packs to cool them down and provide virus-free air to breathe. In a jumble of old furniture and nonfunctional sinks the team runs sophisticated genetic analysis of Ebola strains and screens samples for levels of infection. They are doing everything side by side with Liberians Lawrence Fakoli, Yata Walker, and Fahn Taweh, hoping to leave the trio in charge of what would be West Africa's premiere dangerous virus identification lab. It's tough work, without Internet access most of the time, toiling in spacesuits inside a building that has a roof so full of bats that the guano drips down the walls during heavy rains.

Hensley's team has already made important discoveries that help explain these hot spots of Ebola. They have received hundreds of samples swabbed from cadavers, some of them dead more than three days before sampling was done. All of them have enormous amounts of Ebola RNA (genetic material) on them, often far higher than anything found in the blood of living patients. Hensley is cautious in interpreting the significance of this -- the presence of genetic material does not mean the viruses were live, capable of causing infection. But loads of viral RNA this high are rarely found in the absence of live virus.
The CDC's Mahoney thinks that institution of mandatory cremation in Monrovia may have been a key factor in reducing the numbers of new cases. President Sirleaf issued the cremation edict -- which goes against cultural burial practices -- in early August after a burial crew found a safe site in Monrovia, only to return the following day to find bodies floating and mobs shouting in protest. Monrovia's water table is so high that it is impossible to dig deeply enough in much of the area to inter a body. WHO's Gasasira credits much of the Liberian epidemic downturn to "Sirleaf's courageous cremation policy."
In most of the rest of the country burials have continued, but are executed by the Red Cross or government officials without family and friends of the deceased having any opportunity to touch the body. Though many have resisted what they consider indignity and defilement of their loved ones, by October it seemed that people came to understand the link between Ebola and traditional practices of washing and dressing loved ones before burial. In the United States these procedures would be executed in a funeral parlor, but in impoverished rural Liberia they are conducted by family members.
Mahoney of the CDC also credits improvements in hospital precautions, especially health workers wearing Personal Protective Equipment (or PPEs), with halting most of the spread of Ebola inside hospitals and clinics. Pioneered by Doctors Without Borders (commonly known by its French acronym, MSF), the Ebola Treatment Unit (ETU) is a fairly safe environment for the doctors, nurses, orderlies, and others working to save lives. Since March MSF has treated more than 6,300 Ebola patients in Liberia, Sierra Leone, and Guinea, and 24 MSF workers have contracted Ebola, killing 17 of them. Mahoney and Gasasira credit the ever-improving standards of health worker protection with playing a big role in reducing the Liberian epidemic. They also argue that the massive expansion of ETUs across Liberia and a network of more modest Community Care Clinics has provided a way to separate the infected, ailing patients from the rest of the population. Seven major ETUs are running now, including the new military-built facility in Monrovia. If all goes according to schedule, the U.S. Agency for International Development (USAID) and some 3,000 U.S. military personnel will construct about two dozen more ETUs by Christmas, for a total of 3,130 new treatment beds, according to documents provided to me by USAID officials.
The largest MSF facility, dubbed ELWA3 (an acronym based on a pre-existing Liberian phrase, "Eternal Love Winning Africa") spans about five acres and resembles nothing less than a village, buzzing with activity. Outside the first of several layers of hygienic security a parking lot is filled with waiting family and vehicles for MSF workers. From one a radio blasts a reggae tune, "Hey, Ebola is in Liberia! Liberia will rise against Ebola!" the Bob Marley sound-alike sings. The sprawling 250-bed facility is organized in a series of orange net fences that separate staff from colleagues who are in their PPEs, suspected Ebola cases from confirmed ones, and visitors from all points of potential viral contact. American Dr. Darin Portnoy from Montefiore Medical Center in New York showed me around, explaining every precaution and activity in detail. It is hard to avoid the most obvious challenge, however: the heat. The only shade provided is created by plastic tent sheets, and the sun is blistering.
As Portnoy guided me into the admissions and triage area a man arrived by ambulance, suspected of having Ebola. With tender care, a team of heavily PPE-clad MSF workers (all Liberian) led the ailing man to a chair located in a fenced-off zone. Standing six feet away, in street clothes, the intake nurse called out questions to the man, noting that his wife had recently died of Ebola. After completing the man's intake chart she advised that he be taken to the Suspected Cases tent.
As he walked with difficulty, PPE-clad health workers holding his arms, the man passed me at a safe distance, looked me in the eyes, and I saw terror.
As he walked with difficulty, PPE-clad health workers holding his arms, the man passed me at a safe distance, looked me in the eyes, and I saw terror. He had seen his wife die of Ebola, and the reality of this march into a zone filled only by yellow PPE-clad personnel must have seemed a finality for him.
Catching my concern, Portnoy murmured, "The key at this point is psychosocial support."
That's where Ebola survivors like James Harris come in. His entire family of eight contracted Ebola in August and September, killing four of them. Declared disease-free on Sept. 12, 29-year-old Harris tries to offer solace and hope to the patients. He is one of a handful of people who can safely walk about the entire compound, free of PPE encumbrance. He prefers his time inside the compound, despite the pain he felt here during his struggle with Ebola, because the stigma against survivors on the outside is unbearable. "They think we are carrying the virus," Harris told me. "Stigma is everywhere!"
MSF epidemiologist Bernadette Gergonne believes the construction of ELWA3 and the other ETUs erected in August and September was critical to bringing down Liberia's infection rate. But even more critical, she argues, were actions taken in local communities, independent of government intervention. "They organized and focused on who was coming from Monrovia," forcing them to remain separated from the rest of the village or town. In a sense villagers imposed quarantines, and it worked. The Ministry of Health realized the wisdom of the rural people, Gergonne said, and institutionalized the idea in the form of Community Care Clinics -- tiny isolation spaces for suspected Ebola cases. Eventually normal health care services will be restored in Liberia, and CCC-type structures alongside hospitals may be the key to preventing Ebola outbreaks in medical settings.
On the other side of Monrovia the Liberian Defense Forces and USAID constructed a new ETU duplex, Ministry of Defense 1 and 2 (or MOD1 and MOD2). In design they draw from the MSF experience, but in a scaled-down form. And like ELWA3 the MOD facilities are almost unbearably hot. Staffed by Liberian and Cuban doctors in MOD1 and physicians from a variety of organizations in MOD2, the total 300-bed complex opened this week, but has yet to take in patients. The problem? No PPEs.
There is a global shortage of PPEs, fostered by real needs in the Ebola epidemic and fears elsewhere in the world. Though manufacturers are revving up production, it is reasonable to ask whether the health care systems of West Africa will have adequate supplies of PPEs for the year, or perhaps several years, during which the risk of exposure to all patients -- with or without known Ebola infection -- is unacceptably high.
Nothing seems in short supply at the U.S. military-built MMU -- except patients. And that, says Chief Medical Officer Capt. Paul Reed of U.S. Public Health Service Home (USPHS), is "a really good thing." Unlike ELWA3 and MOD, the spacious Ebola hospital is fully air-conditioned, and powered by a powerful generator that will operate even when the nation's electrical grid goes down, as happens on occasion. Any health care workers who contract Ebola in this country -- including Liberians and Cubans -- will get close to state-of-the-art treatment here, including IV-drip hydration, blood-clotting factors to stop hemorrhaging, painkillers, and constant bedside monitoring. The facility was based on an Air Force "platform intended for full range combat support," Reed explained as he gave me a tour. "We carved out the original to create a configuration that's an Ebola unit. This is the first time one has been massaged into an Ebola unit. It took a long time, and a huge partnership. And here it is."
Whether the MMU will ever receive a patient depends on the future course of Liberia's epidemic. And that, in turn, pivots on the hot spots epidemiologists are finding and fretting about. The largest one borders on Sierra Leone, where an epidemic is raging out of control.
Laurie Garrett is in West Africa covering the Ebola epidemic and will be reporting regularly from the ground over the next week.
Photos by Laurie Garrett
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COLUMN
The Myth of the Indispensable Nation

The world doesn’t need the United States nearly as much as we like to think it does.

BY MICAH ZENKO NOVEMBER 6, 2014

In 1996, political journalist Sidney Blumenthal and foreign policy historian James Chace struggled to come up with a memorable phrase to describe America's post-Cold War role in the world. "Finally, together, we hit on it: ‘indispensable nation.' Eureka! I passed it on first to Madeleine Albright," Blumenthal recalled.
In his memoir of the Clinton presidency, The Clinton Wars, Blumenthal elaborated on what the phrase was intended to represent: "Only the United States had the power to guarantee global security: without our presence or support, multilateral endeavors would fail." Albright, then secretary of state, began using the phrase often, and most prominently in February 1998, while defending the policy of coercive diplomacy against Iraq over its limited cooperation with U.N. weapons inspectors when, during an interview on the "Today Show," she said: "If we have to use force, it is because we are America; we are the indispensable nation. We stand tall and we see further than other countries into the future, and we see the danger here to all of us."
Over the last six months, the notion of American indispensability has resurfaced in a big way. U.S. President Barack Obama has emphasized this point repeatedly, and most expansively in May while giving a commencement address to West Point cadets: "When a typhoon hits the Philippines or schoolgirls are kidnapped in Nigeria or masked men occupy a building in Ukraine, it is America that the world looks to for help. So the United States is and remains the one indispensable nation. That has been true for the century past and it will be true for the century to come." Beyond the White House, this assertion has recently been made by Joe Biden, Hillary Clinton, Chris Christie, Jeb Bush, Bobby Jindal, Marco Rubio, and Michelle Bachman. This bipartisan group may not agree on much, but they are all proudly "Indispensables."
Like many foreign policy concepts overwhelmingly endorsed by officials and policymakers, this one has little basis in reality. If you consider everything encompassing global affairs -- from state-to-state diplomatic relations, to growing cross-border flows of goods, money, people, and data -- there are actually very few activities where America's role is truly indispensable, defined by Webster's as "absolutely necessary." Nevertheless, the notion clearly has political salience, and has even become something of a mandatory mantra for current and prospective commanders-in-chief.
The problem with allowing this classification of America's global role to persist is that it is so patently false, and thus an illogical basis upon which to base and prescribe U.S. grand strategy.
The problem with allowing this classification of America's global role to persist is that it is so patently false, and thus an illogical basis upon which to base and prescribe U.S. grand strategy.
When Indispensables provide specifics to support their claim, they almost exclusively highlight some use of the U.S. military, whether for humanitarian purposes, coercion, or war fighting. More than any other country, the United States retains a far greater capacity to send troops, disaster response professionals, or bombs virtually anywhere in the world in a short time frame. Today, the U.S. Navy has 102 ships deployed around the world, the Air Force 659 strategic airlifters, 456 air refuelers, and 159 long-range bombers, and the Air Force and Navy combined some 3,407 fighter and attack aircraft. Not to mention the over 300,000 active-duty and reserve Soldiers, Sailors, Airmen, and Marines deployed to warzones or stationed at America's 576 active military facilities worldwide.
These unmatched global military capabilities provide U.S. officials with an unmatched spectrum of policy options. However, these can be used for benign and relatively judicious missions, like responding to typhoons, or for profoundly destabilizing and dumb ones, such as invading a distant country to topple its leader with minimal support from other countries and a totally implausible transition strategy. These damaging and tremendously costly missions conveniently tend to be forgotten by Indispensables, yet they are partially a direct result of their crusading mindset.
Indispensables also cite recent U.S. foreign policy activities as evidence to support their hypothesis, but do so in an extremely selective manner. For example, using Obama's examples, nearly all of the more than 200 Nigerian schoolgirls remain in the clutches of Boko Haram, and clandestine Russian security forces continue to operate with impunity in Ukraine. Abuja and Kiev looked to the United States for help, which it provided to the extent that their governments were willing to accept it. But in both countries the help was insufficient to achieve the intended objectives. Again, the reason is, as a senior administration official declared in March: "The American people are not going to war with Russia over Ukraine, full stop." Similarly, even if Michelle Obama herself posts a Twitter photo holding a #BringBackOurGirls sign, U.S. forces will not unilaterally violate Nigerian sovereignty to openly intervene on behalf of the government in a complex civil war to attempt to retrieve them.
Relatedly, Indispensables also omit the vast number of instances where "the world" looks to America for help, and U.S. officials choose to do nothing. Earlier this year, as they have since 2011, mayors in Darfur, South Kordofan's Nuba Mountains, and Blue Nile, again requested a no-fly-zone to protect civilian populations from the indiscriminate airpower used by the regime in Khartoum. It was denied yet again. Similarly, in March, the Ukrainian defense chief asked the United States to impose a no-fly zone over his country's 15 nuclear reactors "so that his troops could at least count on some zones of safety." This also did not happen. Finally, Syrian activists and rebels have asked Obama for no-fly zones, buffer zones, arms and training, and financial support for over three years. The Obama administration has largely rebuffed them, while providing arms, training, and salaries that seemingly all the moderate rebel leaders have denigrated for being wholly insufficient against the brutalities of the Assad regime and the Islamic State (IS).
Indispensables also hold an unrealistic faith in the latent power of leadership that flows from suppose it indispensable-ness. During a House hearing in September, Gerald Feierstein, Principal Deputy Assistant Secretary of State for Near Eastern Affairs, declared: "When the United States stands up and demonstrates resolve and demonstrates a direction, the international community generally supports and falls into place behind." Really? This hypothesis would surprise anyone who tracks multilateral fora where U.S. officials state their policy positions and then repeatedly fail to compel other leaders to get in line -- see, for example, the Climate Change Conference in Copenhagen in December 2009, and the WTO trade talks since the Doha Round opened in 2001.
And if Feierstein is referring only to warfare, then why do so few countries with deployable military assets participate in U.S.-led campaigns in a meaningful way? The United States provided the majority of the actual combat forces and airpower in Iraq, Afghanistan, and Libya, and is doing so again in the air campaign to counter the Islamic State (IS). Most countries that could participate have either declined to do so, or are taking part by providing such limited and constrained capabilities that they are not significantly enhancing the coalition's capabilities. In each of these military interventions, the United States decried unilateralism, attempted to form a large coalition, and then found itself paying most of the costs, dropping most of the bombs, sacrificing the most soldiers, and losing most of his credibility.
Whether it is multilateral talks or military operations, other governments do not do as Washington demands because, quite simply, it is not in their national interests to do so. Moreover, the United States refuses to employ the political will or coercive leverage to force them to. The point being is that few, if any, substantive and enduring foreign-policy activities can be done unilaterally, and asserting one's indispensability does nothing to alter others' interests.
It is often stated that countries in the Middle East or East Asia are looking for America "to lead," but they actually want U.S. leadership on their terms, and in support of their own narrow objectives.
It is often stated that countries in the Middle East or East Asia are looking for America "to lead," but they actually want U.S. leadership on their terms, and in support of their own narrow objectives. The moment that leadership conflicts with the visions and objectives those countries hold, they cease or severely limit their partnerships with the United States.
Finally, the Indispensables belief that America's role in the world is "absolutely necessary" in all areas is simply arrogant. It discounts the tremendous and essential contributions from non-U.S. countries, international non-governmental organizations, and civil society. This includes the 128 countries contributing 104,184 troops and police forces currently deployed in support of sixteen U.N. peacekeeping operations worldwide. The United States provides only 113 troops to U.N. peacekeeping operations, but, importantly, foots 27 percent of the bill and provides logistics support. Or, consider the billions of dollars from the Gates Foundation, Norwegian Refugee Council, Mercy Corps, International Red Cross and Red Crescent, and countless others, which improve the lives of the poorest and most in need. Each of these public health, humanitarian, and development organizations offer the deep pockets and political neutrality that allows them access to areas where the United States simply cannot or will not go.
The reason that the United States is not the indispensable nation is simple: the human and financial costs, the tremendous risks, and degree of political commitment required to do so are thankfully lacking in Washington. Moreover, the structure and dynamics of the international system would reject or resist it, as it does in so many ways that frustrate the United States from achieving its foreign policy objectives. The United States can be truly indispensable in a few discrete domains, such as for military operations, which as pointed out above has proven disastrous recently. But overall there is no indispensable nation now, nor has there been in modern history. Indispensables may feel compelled to repeat this feel-good myth, but nobody should believe them.
ILMARS ZNOTINS/AFP/Getty Images
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Nathan C Langston 11 hours ago
We rely on the grasp foreign policy analysts have on the present and past, for an educated guess about what is coming down the road from the future. Micah Zenko however, has no idea where this country has been, or where she is now.

America became of consequence in the world with WWI. Her one year of combat in France secured the Allied victory. Whether that outcome was ultimately for the good is debatable, but not that the US contribution scotched Wilhelmian Germany's hopes of European hegemony.

Furthermore, just as the first US troops arrived in France in October 1917 the Bolsheviks took power in Russia. Much of war ravaged Europe was on the edge of starvation. The entire continent was dry tinder ready to erupt in a socialist conflagration. The United States and Wilson offered Europe the only counter ideology to Lenin's world revolution. The president's 14 Points, national self-determination, democracy, prosperity as represented by the tall, well fed Doughboys, were as critical in dousing the Bolshevik's hopes, as Yankee bayonets were in shattering Germany's hopes. For good or bad the US and Wilson were largely responsible for reshaping the post 1918 world. America's quick and complete return home had repercussions no less huge. It countenanced the vindictive Versailles treaty, the failure of the League of Nations, and the resumption of Europe's smallness and pusillanimity.

The US did not beat Hitler, but without her Hitler would not have been beaten. Without America's material and moral support, Westminster, after Dunkirk, would have, acceded to Chamberlain's and Halifax's desire to accept Hitler's peace offer. With the UK out of the war, a US invasion of France would have been impossible. The Reich's cities undamaged by Allied bombardments, its panzers and Luftwaffe free to concentrate fully on Russia, no North African diversion, no Lend Lease convoys from England to Murmansk carrying everything from planes and truck to food and pressed steel, Stalingrad would have gone the other way. The USSR would have buckled. Without the US keeping the UK in the fight, keeping Stalin supplied, the Soviets would not have gotten their chance to break the Wehrmacht's back.

After that war with the masses of T-34 in Germany and Austria, with Communist parties rampant in France and Italy, the only thing the Red Army needed to reach the English channel was shoes. The indispensable US, only she, spared the whole of the Continent from eastern Europe's fate and kept the USSR from assimilating the assets of western Europe.

And then? Consider, by the time of WWII it had taken 100,000 years for the globe's population to sustain 2 billion human beings. But just 60 years later that population was 7 billion, and on average healthier, with a higher standards of living and unprecedented access to education, human rights and the gadgets and comforts of modernity. Involved were not just a few white, privileged patches but the masses on all the continents. Never had human kind made such galactic progress so suddenly. How did it happen?

The US did not do it all by herself. But it would not have happened without her at the helm. She had emerged from WWII predominant, economically, politically, militarily, financially, technologically, scientifically, commercially, even culturally. Cleaving to enlightened self interest, her int'l investment decision, her dissemination of know-how, her limiting of wars, her pushing her values, made the difference. While the left chanted, Yankee go home, and better red than dead, the globe achieved 7 billion and the Red Knight died inside his armor (LeCarre).

Now Micah Zenko tells us that because the US has not found Nigeria's 200 stolen girls the idea of America as the indispensable nation is a myth.

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Brandon1 3 days ago
If, by "indispensable" Mr. Zenko thinks the U.S. wants to be the world's policeman, the thinking may be wrong. We didn't spent $ trillions to help expel Russia from Afghanistan, arm and train their non-existent military, give their government a semblance of legitimacy to be indispensible. On the contrary, we got the hell out. Same with Iraq. When the Saudis said they didn't want U.S. bases there, we packed up. We've always been willing to help a needy underdeveloped country get itself up on its own feet, hand them the keys, and say "Good night, and good luck."

On the other hand, when the going gets tough, in either small or large countries, developed or undeveloped, rich or poor, the people automatically pull their money out and put it into dollars. That's why capital flight is growing in Russia, China, S. America, and even Africa.

Whether we're willing to enter cross-border or internal conflicts, the U.S. is till the only place whose economy and politics is closest to a glass pyramid. People everywhere can see the elevators and stairwells with leaders, elected or placed, moving up and down continually. While far from clean, the stock market, corporations, and banking system are still more transparent than anywhere else. Regardless of our relative size, people will trust their assets being protected more by a visible and liquid system than one built in an underground fortress guided by invisible manipulators that have the proven ability to lock down or redirect the flow of money.

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USAF Pilot-RET 3 days ago
Well put!

When we believe our own BS, act on those false myths, we reap the consequences. And then play the blame-game using those false premises as assumptions for why things went bad.

See the Repubs BS: Obama 'lost' Iraq for one of many superb examples. And forget that no Iraq politician (Iranian influenced or not) would or could ever lobby for continued US occupation--especially after BlackWater, Abu Ghraib, et. al.

But they play well with the chattering class and the low-information voters.

Well, we still got the best government money can buy. And our most costly DOD that doesn't win wars - but sure fights well to buy cost-plus weapon-systems to the benefit of well-paid DOD contractors and their political representatives -- from both political parties.

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Natarina 3 days ago
The U.S. encouraged "democracy' in the Gaza strip, and we got Hamas that threw "democracy" down the toilet (and murdered a lot of Fatah people "on the way") and erected a terrorist state instead. Then it encouraged "democracy" in Egypt and we got a new up-and-coming Sunny version of Iran encouraged and supported by the U.S. of A. Thanks to the Egyptian people's good sense of where they are at the moment and to their instincts of self-preservation they helped Al-Sisi get into power and re-establish order. Now the U.S. is preaching that Al - Sisi is not democratic enough. It would be much better to help him consolidate a new economy for Egypt and prevent its deterioration and its possible disintegration that would be catastrophic. As an Israeli, I prefer Al Sisi to not be democratic but prevent the Sinai from becoming a haven for extremist radicals, and Egypt from becoming a second Iran or, worse, a failed state or a state in civil war. I do trust the Egyptian society to eventually find its own way to a decent rule, and perhaps even to a proper democracy, but democracies that turn into totalitarian states following the first election are not democracies, no need to quote well-known examples from history. It is important for all decent democracies to help foster democratic values and and human rights in the societies in question, before promoting pseudo-democracies through elections that have the potential to worsen the situation.

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kerry.n 4 days ago
Not bad argumentation, with a lot of valid complaints about recent US foreign and defense policies. But it is somewhat beside the point. The U.S. is both indispensable and unable to act alone; necessary but insufficient. Therein lies our strategic discomfort as a community of nations.

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America-First 4 days ago
The indispensable nation goes hand in hand with American exceptionalism. Both mantras are forms of self-delusion and supreme arrogance. Didn't the mothers of these so-called "states-people" and politicians ever teach them that conceit is not an endearing quality? One longs for a reality check among our "leaders". We need something to prick their hyper-inflated egos, their sense off self-importance and self-righteousness which they project onto their conceptual notions of the United States. The Soviet Union once suffered from a similar malady until one day they fell apart. Word to the wise: The bigger they are, the harder they fall.

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ttaerum 4 days ago
The question of whether America is "indispensible" depends on which America you're referring to. Being indispensible requires: 1. success, and 2. agreement on what being successful means. After all, we're not indipensible if we're not able to achieve our goals. And we're not indispensible if we're simply looking after our own interests.

On the basis of the first criteria then, has this administration been successful at taking out AQ or ISIS? Did we successfully recapture the kidnapped daughters from Boko Haram? Has this administration taken out Assad? Did we have good Intel on Putin's ambitions? Apparently not.

On the basis of the second criteria then, are we indispensible because our goals line up with the aspirations of other nations? I hope so... but without success, it means nothing.

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hgaffney 4 days ago
The U.S. Services -- Army, Navy, Air Force, Marines, Special Forces -- all love the notion of "indispensability" because they think it may get them more money, or more money than the other Services, from the Congress. They simply never do, but they never stop aspiring, and their program propagandas push "indispensability" forever.

By the way, Fire Walk With Me, in my 52 years in Washington in close association with foreign policy and the military, I have never heard a U.S. official use the words "hegemon" or "hegemony," and I don't think you'll ever find it in a higher strategy document. We never thought that way -- we had problems to solve, and we tried to solve them.

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Jotape 4 days ago
Indispensable nation, exceptional people. Rings to me like a cult. Close to fanatism. Childhood brainwashing. Arrogance.

Somehow reminds me of Marxism, such a beautiful social concept, which History has proven everywhere to be inaplicable long term, basically due to human natural selfishness. Took decades for China and Soviet Union (and others) to learn this the hard way.

America may have good intentions, but their special interest groups (Rich, Military Industry, AIPAC,..) deem its actions usually a nightmare (and thousands of its citizens and those of invaded countries dead, injured or traumatized), with disastrous results, which sooner or later, as with all empires, end up backfiring. A kind of karma. For instance, creating terrorists hating America along the way, like ISIL. Examples: Ukraine, Lybia, Nicaragua, Iraq, Afghanistan, Pakistan, Vietnam...

Every society has the right to find its way on its own, not imposed by foreign "evangelists". There is no "better" way. Each society future is determined by its own circumstances, capabilities, contradictions, traditions,etc. Just imagine other countries invading the US to fix its problems, or impose their way of doing things or "values".

In terms of growth and stability, progress for its citizens, the most succesful nation on earth during the last decades has been China, by far. Should they go ahead and impose their model to the West? Send Armies all over the world? They do not only not try. Do not even suggest any.

If I were a US citizen, I would prefer the Government and Congress to devote all their efforts to improve the life of their citizens, and limit foreign interventions to the unavoidable. China, Europe, Russia, Latin America, Africa, Australia, Japan, have done it.

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Tom Gray 4 days ago
@Jotape China is only successful in so far as it interacts economically with the US. Without the US, China would not have the technology and it would not have a market.

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apiascik 4 days ago
@Jotape

"creating terrorists hating America along the way, like ISIL. Examples: Ukraine, Lybia, Nicaragua, Iraq, Afghanistan, Pakistan, Vietnam"

The U.S. didn't "create" these fanatics. They all hate and despise not America per se, but liberty, religious tolerance, and the rule of law, amongst other principles. The U.S., being the most powerful representative of these ideas in the world, becomes the biggest (but not the only) target. You are blaming the victim.

"Every society has the right to find its way on its own, not imposed by foreign "evangelists". There is no "better" way."

What are you doing in your post but evangelizing nihilism, the belief that there is no "better" way, that totalitarianism, authoritarianism and Islamic fundamentalism are all no better than democracy, as long as the people in those countries choose it?

"In terms of growth and stability, progress for its citizens, the most succesful nation on earth during the last decades has been China, by far. Should they go ahead and impose their model to the West? Send Armies all over the world? They do not only not try."

Bullsh*t. China has used force and coercion in an attempt to get it's way in disputes with surrounding countries. What do you call sending troops into Ladakh, or unilaterally declaring an "air defense zone" over the Senkaku islands, or plopping oil rigs down in Vietnamese territorial waters? Mr. Zenko will rue the day that China applies such tactics to the rest of the world.

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Tom Gray 5 days ago
Mr Zenko has confused the word "indispensable" with "omnipotent".

The US is not omnipotent but its choice of action or inaction have profound consequences on the international system as Mr. Zenko's article illustrates. One cannot conceive of the international monetary system without the US. it cannot control every aspect of the system but without the US the monetary system would not function. Similarly in commerce the US is indispensable. The economy of China depends on the technology developed in the US and the capacity of the American public to buy goods.

The US is indispensable. It is not "omnipotent" but it is "immanent" in that its influence pervades all world affairs.
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Fire walk with me 4 days ago
@Tom Gray

Thank you, I also took issue with his interpretation of what policymakers have been saying. The real question is if the world today would continue to exist as it is without the efforts of the US. Throughout modern history there was been a country that maintains and defends the status quo, whether it be international trade, the geopolitical balance of power, or the assumption of which global system will permeate relations between countries. Right now, and for the considerable future, the US occupies that role. Without the US all the countries which simply "mind their own business" would have serious decisions to make as they would be confronted with a major change in the balance of power, and would soon find that their entire foreign policies would be fundamentally altered when there is nobody to defend the global commons. The US doesn't have control over everything that takes place, but it is still the hegemon, doesn't that make it indispensable?

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Gracchus 4 days ago
@Fire walk with me @Tom Gray But it's up for debate whether the existing status quo that the US upholds is good for anybody but the US.

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COLUMN
#BringBackOurJournalists

The sloppy, pop-humanitarian coverage of the Boko Haram cease-fire-that-wasn't isn't just bad journalism -- it's a missed opportunity.

BY LAUREN WOLFE NOVEMBER 6, 2014

There was never any cease-fire. War in Nigeria will not end anytime soon and the hundreds of schoolgirls from the northeastern town of Chibok kidnapped back in April will not -- not now, maybe not ever -- be coming home. So announces the leader of Boko Haram, the militant group that has brought all this havoc to the country, in a video released Oct. 31.
Standing amid scrub and dirt, the group's leader, Abubakar Shekau, reads from papers, standing in front of a line of trucks and men, all clad in dull olive-brown. "We have not made a ceasefire with anyone," he says. "We did not negotiate with anyone." As for the more than 200 schoolgirls: "We married them off. They are in their marital homes," Shekau taunts, according to a translation by the Abuja-based newspaper Premium Times. "If the women of Chibok, I mean the mothers of the Chibok schoolgirls and their fathers, if you know the condition your daughters are in today it could lead some to convert to Islam and some to die from grief."
After weeks of speculation over whether the supposed cease-fire that promised the release of the girls was real, the missive quashed hopes of a suddenly happy ending.
Ever since the girls were first kidnapped and Twitter exploded with hashtag activism (#BringBackOurGirls), the eyes of those who might normally ignore conflicts in faraway African countries have been on Nigeria. Intermittently. And then maybe not for a while, as the story had no new developments and, thus, no striking headlines. People, it seems, lose interest in staying until the end when it doesn't come quickly enough, activist Gloria Steinem told me in August. But this story was, and remains, clickbait. Something about the confluence of such a brazen act -- girls taken from a school that should have been a safe haven -- combined with their gender, combined with the sheer number taken, combined with the mystery that surrounds their whereabouts caught media and citizens' attention.
No wonder the promise that the girls would be released was media and hashtag activism gold. Could it be...good news?
When the government of Nigerian President Goodluck Jonathan announced the deal on Oct. 17, the news hit the wires and spread across the Internet with breathless tweets and hopeful Facebook posts. While many, if not most, media outlets ran stories with caveats about the lack of confirmation by Boko Haram of the cease-fire and imminent release of the girls, a few took hope and ran off the deep end with it. "Finally, Nigeria's kidnapped schoolgirls are coming home," read one particularly egregious headline from Mother Jones. The story was little more than a brief recap of the wires, but its headline offered unwarranted hope that was naïve at best, and at worst irresponsible. The headline on the story now reads "Will Nigeria's Kidnapped Schoolgirls Come Home?" and has an Oct. 24 update on the lack of a cease-fire up top. (The other headline lives on in perpetuity in this tweet.) Lesser-known outlets ran headlines in a similar vein: "Finally: The Kidnapped Nigerian Schoolgirls Will Be Released" and "Nigeria's Kidnapped Girls Are Coming Home."
Anyone who knows anything at all about Boko Haram, however, found the cease-fire intensely suspicious, and within a day or two, many media outlets began expressing skepticism. Counter-terrorism expert Andrew Noakes wrote on Oct. 19 for African Arguments that it "looks very possible that the cease-fire deal is a product of political intrigue rather than a reflection of reality." He'd been given a related e-mail that "bore all the hallmarks of a fake -- written in English, the language of the insurgency's Western enemies, and referring throughout to ‘Boko Haram,' a name the group itself eschews in favour of Jama'atu Ahlis Sunna Lidda'Awati Wal-Jihad (People Committed to the Propagation of the Prophet's Teachings and Jihad)."
Two days after the initial announcement, the Internet was laden with doubts over the credentials of the alleged Boko Haram negotiator, named Danladi Ahmadu, who no one seemed to think had any connection to Boko Haram (something Shekau would confirm in his Oct. 31 video).
By Oct. 23, Boko Haram had kidnapped 25 more girls. By then, the letdown was complete.
"A little more caution on the part of media was absolutely required given how many so-called potential deals have been aired and then faded away since the girls were abducted," says Adotei Akwei, Amnesty International USA's managing director of government relations. "I think people are still hoping for some kind of resolution and are willing to grab at anything."
The most egregious spin was confined to headlines and didn't necessarily trickle down into the stories, but media experts still say damage is done. "If a headline says the girls are returning, but the story says this is probably not going to happen, they've essentially undermined their trust relationship with you," says media ethicist Kelly McBride, the Poynter Institute's vice president of academic programs.
To be sure, the phenomenon of hype and oversimplification is not confined to #BringBackOurGirls. Just look at Ebola: The night Doctors Without Borders volunteer physician Craig Spencer landed in Bellevue Hospital, everyone seemed to suddenly know exactly how this complex disease spreads and why. Or consider the Islamic State: Twitter knows how to fix this scourge. Armchair expertise, clearly, has a far reach.
What was missed, in all the fervor of the story of the missing girls, was a chance to take on a murkier, more challenging story -- which the Chibok tragedy has been from the beginning. "Much as we might wish this to be a single issue with a clear solution, it isn't, and it cannot be. It never was," Nigerian-American writer Teju Cole tweeted about the schoolgirls back on May 8. The previous day, his frustration at naive Western views on how to fix Nigeria was barely veiled: "For four years, Nigerians have tried to understand these homicidal monsters. Your new interest (thanks) simplifies nothing, solves nothing."
The pop-humanitarianism Cole was criticizing has real-life implications for those living in these complex conflict areas. The initial #BringBackOurGirls campaign galvanized global response. Rep. Frederica Wilson (D-Fla.) said in July that she thought the campaign was "lighting a fire" under Nigerian President Goodluck Jonathan to find the girls and bring them to safety, but six months later, what good did it really do? Did it shine a light on the well-documented corruption of the Nigerian government and its army, or funnel resources to attack the problems that let Boko Haram thrive? Back in August, Akwei told me that the Nigerian government's characterization of Boko Haram being "under control" led to everyone "sort of backing off, saying the army is big enough and strong enough."
This is not to say that these hashtag movements and the media coverage surrounding them can't do good. Outcry over the plight of the Yazidi people trapped on Mount Sinjar led to U.S. intervention to help save them from the brutal hands of Islamic State. On the flip side, however, massive attention paid to the "Kony 2012" video campaign did little more than fuel a total misunderstanding of a complicated, ongoing war in central Africa -- and brought little aid to the regional fights that truly matter at this point. "They say it's ‘not about politics and it's not about the economy' [in the video], but it's actually all about politics and the economy," said New York University professor Tavia Nyong'o in March 2012, after the video made a splash. What's happened since? More corruption, more poverty, more warring in the region, little attention to the corrupt politics of a place like the Democratic Republic of Congo, whose army is known to be pillaging and raping the countryside.
But back to #BringBackOurGirls.
A phone call or two, or even a few clicks around the web, probably should have been enough to realize how flimsy the story about the cease-fire was. There is no solid information on how many girls remain in Boko Haram's possession, says Akwei. Originally, police reported that 276 were taken. A few dozen are said to have escaped. Others are said to have died or been sold, some across the borders to Chad or Cameroon. Why even assume the 219 girls (according to most recent counts) are still in the hands of Boko Haram at all? This not-knowing is yet another reason for more caution, says Akwei: "Until the girls are in the arms of their parents nothing that is announced should be taken as more then just a rumor." The feel-good aspect of the story, however, missed by a wide margin the complexity of not only this particular kidnapping, but the politics of Nigeria and the ongoing atrocities committed by an unpredictable terrorist group.
Journalists have an important responsibility in these situations. It's not about applauding little steps toward peace in an attempt to reach it. It's about giving all available information to audiences, and giving it in context, even if that means casting doubt on a hopeful moment -- and especially then, says McBride. "I think skepticism is always good," she says. "To the extent that you are taking a statement or a fact and surrounding it with other statements or facts that give the consumer a broader chance to determine more than they receive from that initial statement, that's what good journalism is."
In a time when children are being kidnapped from Iraq to Syria to Nigeria, among numerous other tragedies, accuracy in reporting -- and presentation -- is key: Good journalism is one crucial tool in the small box that global policymakers have to keep themselves informed of ongoing human rights violations. It can't guarantee a happy ending, but, after all, that's not what the press is here for.
Pius Utomi Ekpei / AFP
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Tom Gray 5 days ago
Mr Zenko has confused the word "indispensable" with "omnipotent".

The US is not omnipotent but its choice of action or inaction have profound consequences on the international system as Mr. Zenko's article illustrates. One cannot conceive of the international monetary system without the US. it cannot control every aspect of the system but without the US the monetary system would not function. Similarly in commerce the US is indispensable. The economy of China depends on the technology developed in the US and the capacity of the American public to buy goods.

The US is indispensable. It is not "omnipotent" but it is "immanent" in that its influence pervades all world affairs.

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A President Riding Off Into the Sunset?

Three reasons why President Obama isn't about to be a second-term foreign-policy free-ranger.

BY KORI SCHAKE NOVEMBER 6, 2014

Republican candidates fared extraordinarily well in the 2014 midterm elections, giving Republicans control of both the House and Senate at the national level and executives governing 31 states of the union. It remains to be seen, however, whether the election is a repudiation of President Barack Obama's agenda, a demonstration of how out of touch Washington elites are with the rest of our country, a thirst for more cooperation in solving the country's many problems, an object lesson in smart new campaigning techniques, or simple evidence that more Democratic seats were up for grabs.
Irrespective of which explanation proves true, the election will have important consequences for American foreign policy. But it is unlikely to produce a flowering of foreign policy activism common for late-stage American presidencies. Don't expect Obama to pull an Eisenhower, focusing on countering the Soviet's space program in 1958 or President George W. Bush trying to resurrect a success in Iraq with the surge strategy in 2006. Many presidents, stymied by Congresses and diminishingly relevant to the political debates late in their terms take refuge in the wide latitude the framers gave our country's chief executive in the conduct of foreign policy. But there are three reasons President Obama probably won't take that route.
First, upheavals internationally and the Obama administration's reactions to them likely contributed to the voter dissatisfaction on display in Tuesday's election. That's not a promising basis for redoubling effort. President Obama was expecting to trumpet ending the wars in Afghanistan and Iraq as his major foreign policy accomplishment; but with the Middle East in flames that's not looking like such a good outcome. In fact, just Wednesday, the president announced his intention to pursue a new Authorization for Use of Military Force (AUMF) to allow the campaign in Syria and Iraq to continue, with congressional approval. In Kabul, meanwhile, the commander in Afghanistan has just publicly suggested (in a Foreign Policy exclusive) that we might need to hold longer in Afghanistan than the president's stated policy envisions.
Dealing with the consequences of how we end our wars will be a major preoccupation of the next two years, but unlikely the welcome diversion many late-stage presidents enjoyed. Nor are other signature policies looking ripe for further progress: the reset with Russia (dead), a world without nuclear weapons (laughable), working through the United Nations (unlikely), and repudiating Bush administration war on terror policies (this White House has only doubled-down). As my Shadow Government colleague Phil Levy has ably argued, even trade is not an unmixed blessing for the president.
The second reason the 2014 election isn't likely to precipitate a foreign policy-centric last two years for Obama is that the issues on which the president would most like to take action without congressional approval would have enormous blow-back from Congress and affect the administration's ability to achieve compromises on other policies. The White House is suggesting to reporters that an Iranian nuclear deal might not be submitted to Congress; but unless such a deal were a draconian roll-back of Iran's nuclear weapons program with expansive verification (a deal, mind you, that Tehran has in no way suggested it will agree to), Congress would surely legislate against the deal. Current sanction waivers would likely be removed from existing legislation and more stringent sanctions passed with bipartisan support. It is hard to see President Obama playing hardball with executive authority and still getting any cooperation from Congress on other issues.
Third, the president may well become anxious about his legacy, and domestic policy is a likelier arena for a liberal Democratic president to want to make his mark. Moreover, this is not an administration that has excelled at execution of its policies, whether bringing the president's signature health care legislation into being, bringing together a robust coalition to fight the Islamic State, or finding a way to close the Guantanamo prison facility. It ought to want as a priority to correct that widespread public perception. That might well lead to a more domestic policy focus for President Obama's final two years in office.
What we are likelier to see in foreign policy than presidential activism is Congress pushing the executive. A Republican Congress may well take the bit in its teeth and attempt to run American foreign policy from Capitol Hill, as it tried to run spending policy after the 2010 midterm elections. This would be especially likely if Sen. Ted Cruz and other firebrands gain sway in the GOP caucus, bringing their take-it-or-leave-it approach from the government shut down, an emphasis on American moral righteousness, and disapproval of the nation building that is a central element of dealing with threats emerging from weak and failing states. Republican leaders in both the House and Senate have some breathing room, though, given the size of Republican caucuses after this election. They may also have opportunities to pick up support across the aisle that reduce the influence of libertarian or the most conservative parts of the Republican tent, meaning we'd see a more centrist foreign policy with broader support, and may see a 2016 incentive to do so (both to set up Republican presidential candidates in 2016 and burnish the Republican brand as a party that can govern).
More likely would be congressional proffering of opportunities to the president that have economic benefits and that the Democratic party has been divided over: fast-track trade negotiating authority, an updated AUMF, progress on North American energy integration. That approach would give Obama opportunities for major foreign policy successes, but also confront him with difficult political choices -- the happiest outcome for Republican partisans.
At the end of the day, though, the best American foreign policy is a vibrant United States. Reaching agreements that put entitlement programs on a sustainable footing and eliminate our national debt would do more for America's image in the world than any foreign policy involvement or disengagement President Obama might undertake. It would also be the best thing he could do to strengthen our national security and the long-term sustainability of American power in the international order.
MANDEL NGAN/AFP/Getty Images
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About Laurie Garrett

Laurie Garrett is senior fellow for global health at the Council on Foreign Relations and a Pulitzer Prize winning science writer.
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