• With: Scott Gottlieb, Jason Riley, Kim Strassel, Dan Henninger, Bret Stephens

    This is a rush transcript from "Journal Editorial Report," October 4, 2014. This copy may not be in its final form and may be updated.

    PAUL GIGOT, HOST: This week on the "Journal Editorial Report," as Ebola comes to the United States, a look at what more we could be doing both here and abroad to stop its spread.

    Plus, foreign policy returns to the campaign trail as the ISIS threat becomes an issue in the midterm elections. Could it cost Democrats control of the Senate?

    And President Obama is reportedly on the verge of cutting a nuclear deal with Iran. But who's really calling the shots as the deadline nears?

    Welcome to the "Journal Editorial Report." I'm Paul Gigot.

    Well, many believed it was only a matter of time, and this week, the first case of Ebola was diagnosed in the United States after a Dallas man fell ill with the virus upon returning from a trip to Liberia. But my guest this week says the real threat to the United States is still building and could emerge a few months from now.

    Dr. Scott Gottlieb is the former deputy commissioner at the Food and Drug Administration and a fellow at the American Enterprise Institute.

    So, Scott, welcome back.

    DR. SCOTT GOTTLIEB, FELLOW, AMERICAN ENTERPRISE INSTITUTE & FORMER DEPUTY COMMISSIONER, FDA: Thanks for having me.

    GIGOT: You've been predicting for months this would get worse and now it has, unfortunately. Let's talk about the Dallas case first. How worried should we be about that right now, just one case?

    GOTTLIEB: Right. I think the health officials are going to contain this case. It looks like there might be some other infections that spring from this, unfortunately, because this individual wasn't handled well initially and some other people will get sick. But it looks like they'll be able to bring this in.

    The real risk will come a couple of months from now. If you see the continued spread in West Africa at the current pace, what's likely to happen you'll reach a tipping point where you get migration out of the region and you'll see clusters of infection simultaneously pop up in major metropolitan cities around the world.

    GIGOT: So how many cases now are they anticipating in West Africa? It's really in the tens and thousands now.

    GOTTLIEB: Right. The current predictions are that it's going to double every month. So you're looking at, by the end of this year, upwards of 100,000, and one of the out of bounds estimates is over a million cases by early January. It seems to be building. And the lower-bounds cases, you know, getting this to top out at a couple of 100,000, is predicated on getting a lot of resources in there. We haven't been successful in doing that. Even the resources that have been announced, these 3,000 troops, haven't really arrived yet. We haven't built the first facility.

    GIGOT: They are just starting --

    GOTTLIEB: Right.

    GIGOT: They just starting, arriving there now. So what did we miss? Because we have the Centers for Disease Control in the United States who are supposed to be very professional, and the World Health Organization, whose main mandate is to stop outbreaks like this.

    GOTTLIEB: I think we were making confident predictions of what the scope would be based on faulty information and we were very slow to change those estimates. If you look at the World Health Organization, they were still predicting this would top out at 20,000 cases, right up until the point where the CDC came out with an estimate of 1.4 million. So we didn't get the resources in there that we should have early enough. What we're doing right now is what we should have been doing, frankly, two or three months ago.

    GIGOT: We're behind the curve?

    GOTTLIEB: We are.

    GIGOT: So you mentioned clusters that might emerge in American cities, cities around the world, in Western Europe and so on, Asia, what is it that mean in terms of public health? How many cases are you talking and what do we do about it?

    GOTTLIEB: Right. I think the concern is that you might have the emergence of simultaneously 20 or 30 cases in several cities at the same time. If this coincides with flu season, when the early symptoms of flu might resemble Ebola, you're going to have doctors wanting to quarantine and test a lot of individuals. And you need to test it at a special laboratory. We could quickly exhaust the resources we have. I think that's the really worrisome scenario. Two or three months out from now, you see more infection spreading in the United States right to coincide with flu season.

    GIGOT: Does that mean that the typical way of controlling these things, which is tracking, tracing and isolating through -- isolating people, keeping them separate from everybody else for 21 days, does that mean that's no longer going to work?

    GOTTLIEB: At some point, it doesn't work. You reach a tipping point. Certainly, in Western Africa, we're close to the point where that's going to be hard to implement because you have so many cases. Here, we have vastly more resources so we have more capacity. But at some point, you see enough cases that that starts to break down. That's the worrisome scenario. That's where we become dependent potentially upon on therapeutic.

    GIGOT: So what do we do? I mean, I want to talk about therapeutics later, but what do we do with that scenario of these clusters? Is it just a triage? You do what you can?

    GOTTLIEB: Well, I think what's going to happen, as you start to see many more infections in the United States and you see clusters of infection, they are going to reach for what I would call more draconian policy tools, you know, actually implementing forced quarantine.

    GIGOT: Right.

    GOTTLIEB: We haven't really done that, except with this single family, and it seems to somewhat voluntarily, that they are self-isolating. But the CDC does have authority to force people into quarantine. And I think you start to do that with larger groups of people when you have sort of exhausted your resources to titrate this.

    GIGOT: Should we, right now, be cutting off flights from West Africa and just saying, look, we don't want these clusters to form, so let's shut it down and have a kind of global quarantine of that part of the world for a while?

    GOTTLIEB: Yeah, it's probably not going to be effective. It's going to further --

    GIGOT: Really?

    GOTTLIEB: -- destabilize those countries and it's going to discourage aid workers from going in. And the border there is very porous. And also, this time of year, you get an agricultural migration out of that region as workers go to other parts of Africa following some range and some work. So you're going to see probably this virus spread through other parts of Africa.

    GIGOT: So it will do more harm than good, do you think?

    GOTTLIEB: I think it would do more harm than good just in terms of destabilizing the region and not being effective. You can implement better tracking of people getting on flights and better testing. And you can also trace people when they arrive, follow me up with a phone call, for example, rather than just shutting down the flights.

    GIGOT: All right, let's deal with this question of vaccines and therapeutics. You're saying that that's really got to be in our focus now, because if quarantine doesn't work, those traditional methods, this is where we have to attack the disease.

    GOTTLIEB: Right. Public health officials are saying we shouldn't be putting our stock in a drug or vaccine. It's not going to arrive on time. We have to rely on traditional public-health tools. But the reality is that the scope of this is growing so exponentially in Africa that we might exhaust our ability to contain with those tools and be dependent on a therapeutic. We might also be in this a lot longer than we suspect right now. So nine months from now, we might still have a very big epidemic.

    GIGOT: Are there any vaccines or therapies that are new are on the verge of coming through?

    GOTTLIEB: Yeah. The good news is that this is not a virus that should immune from being drugged, if you will. And there are vaccines that are pretty far along and some therapeutics that look very effective, including some cancer drugs that are approved for other indications that look effective against Ebola. We really need to be accelerating the development of those therapeutics, and maybe even manufacturing some of them right now and stockpiling them before we know if they work just so we can have a supply on hand.

    GIGOT: All right, fascinating.