JOURNAL EDITORIAL REPORT

Containing Ebola: What the US should be doing but isn't

Dr. Scott Gottlieb weighs in

 

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.

Scott Gottlieb, thanks so much for being here.

GOTTLIEB: Thanks a lot.

GIGOT: All right.

When we come back, foreign policy returns to the campaign trail as the ISIS threat takes center stage in some tight races. Could it cost Democrats control of the Senate?

(COMMERCIAL BREAK)

GIGOT: With just over a month to go until Election Day, is foreign policy emerging as the sleeping issue of the midterms. With the ISIS threat domestically naturing the news and President Obama's foreign policy approval numbers still well below 50 percent, Republicans are reviving the soft-on-terror theme of campaigns past, using the charge to attack Democratic opponents in some tight races.

Take a look at a GOP ad released this week against incumbent Senator Mark Udall in Colorado.

(BEGIN VIDEO CLIP)

UNIDENTIFIED FEMALE: With his single-issue campaign, Mark Udall doesn't want to talk about other important issues, like our national security. So with America's national security threatened, warnings of Islamic extremists, ISIL plotting imminent attacks, what does Mark Udall say?

SEN. MARK UDALL, D-COLO.: I said last week that ISIL does not present an imminent threat to this nation and does --

UNIDENTIFIED FEMALE: Really? Can we take that chance?

(END VIDEO CLIP)

GIGOT: Joining the panel this week, Wall Street Journal, columnist and deputy editor, Dan Henninger; Political Diary editor, Jason Riley; and Potomac Watch columnist, Kim Strassel.

So, Jason, what do you think of that Udall ad?

JASON RILEY, POLITICAL DIARY EDITOR: I think Republicans are regaining their foreign policy mojo, Paul, and it's good to see. It's good to see moxy coming back a little bit here.

But as you mentioned, Obama's foreign policy approval rating well underwater here and Republicans see an opening. This ISIS threat has been in the news. Americans don't like to see that. Again, Americans don't necessarily want us in every conflict around the world but they expect their president to lead. Clearly, Obama has not been doing that. I think the Republicans see an opening here.

GIGOT: Kim, who is that ad targeted to? Is it the Republican base, to get them fired up, because they tend to be more hawkish, or is this women voters, who are often said to worry much more than men about security issues? Who is it aimed at?

KIM STRASSEL, POTOMAC WATCH COLUMNIST: It is women. And women and Independents and all of the people that Jason just mentioned that are showing up in the polls saying they are very unhappy with the president's handling of this rising terror threat, and far more open to the idea of air strikes and other things to take out the terrorists. And you see Republicans running versions of these ads now in a lot of key states. You see it in New Hampshire and North Carolina and Colorado. And the crux of the argument is the same in every one, which is you Democrats helped lay the groundwork with withdrawal from the region for the circumstances that led to this threat. You sat by as it was growing and did nothing, and you cannot be trusted to return to the Senate and see this mission through.

GIGOT: All right, Kim, but here's the thing. Cory Gardner, the Republican candidate in that Senate race, he is not in favor of ground troops. In fact, he's ruled them out. How is his policy towards ISIS different than President Obama's?

STRASSEL: I think the important aspect of what Republicans are doing here is they are not talking so much what they would specifically do. Their argument is that Democrats in the past, when things got tough overseas --

GIGOT: Right.

STRASSEL: -- cut and run. They fled from the situation. And that, therefore, they can't be trusted to even continue supporting the president on what limited actions he is taking there now.

GIGOT: Is there a risk for Republicans here, Dan? The number-one issue in voter's minds is still, in every poll, economics.

DAN HENNINGER, COLUMNIST & DEPUTY EDITOR: Yeah.

GIGOT: Economics and jobs. Are they risking changing the subject here in a way that could make them look a little bit out of touch?

HENNINGER: Perhaps. We're adding global anxiety to economic anxiety. But the problem I think for both Republicans and Democrats is that, at bottom, the American people are serious about U.S. national security, regardless of what the opinion polls say. But in our time, politicians seem to just blow with the opinion polls. I mean, before ISIS existed, the Republicans were talking about fatigue and that the American people didn't want to go in. That's what the opinion polls said.

GIGOT: And they followed them. They were --

(CROSSTALK)

HENNINGER: They followed them.

GIGOT: -- in courage, except for people like Lindsey Graham, John McCain, Kelly Ayotte and a few others.

HENNINGER: I mean, Tom Cotton, in Arkansas, accused his opponent, Mark Pryor, of what he called a fundamental un-seriousness about matters of war and peace. I think Mr. Cotton was right about that. The problem is will voters think that all of these politicians are fundamentally unserious? Marginal Republicans, certainly, on national security, but it's not a slam dunk.

GIGOT: How are Democrats trying to defend themselves, Jason?

RILEY: Well, they are trying to defend themselves by doing what the president is trying to do, which is to say, yes, we need to go back in, in Iraq, but it's not going to be like under George W. Bush. If there's any consistency to Obama's foreign policy, if there's any principle there, it's to never do anything that can get him compared to George W. Bush.

HENNINGER: Yeah.

RILEY: And that's all he's -- that's all he's out there saying. And I think Democrats are following his lead on this.

Now, I don't know that this election will turn on foreign policy, maybe if there's a big event, a plane gets shot down, more kidnappers or something like that. But this is of a piece with the problem. You know, the Democrats -- because of Obama's low approval rating, he's dragging down these Democratic candidates. They can't talk about Obamacare. They can't talk about the slow economy. And now, on foreign policy, he's struggling there, too, and so are Democratic candidates.

GIGOT: Don't we see, Kim, some Democrats starting to sound like born-again hawks?

STRASSEL: Born-again Dick Cheneys, yeah. It's astonishing, you looking out there. You have people like Kay Hagan, in North Carolina, out there bragging that she is clear and decisive on the terrorist threat and accusing her Republican opponent of being silent. You have guys out like Bruce Braley, in Iowa, bragging out there that they were the ones that gave the president the authority to do this. So they are worried.

Look, Democrats have had in the past a real problem with this, when their candidates have seemed like they are not serious about terrorist threats and not serious about national security, they have lost elections. In these new attacks that they see from Republicans, some of that fear is coming back again. So they are trying to strengthen their credentials.

GIGOT: All right, we'll be watching.

When we come back, with a final deadline looming, President Obama is reportedly on the verge of striking a nuclear deal with Iran. But who is really calling the shots in these high-stakes negotiations?

(COMMERCIAL BREAK)

(BEGIN VIDEO CLIP)

BENJAMIN NETANYAHU, ISRAELI PRIME MINISTER: Would you let ISIS build a heavy water reactor and develop intercontinental ballistic missiles? Of course, you wouldn't. Then you must not let the Islamic State of Iraq do those things either. They must be defeated. But to defeat ISIS and leave Iran as a threshold nuclear power is to win the battle and lose the war.

(END VIDEO CLIP)

GIGOT: A message to world leaders from Israeli Prime Minister Benjamin Netanyahu this week with the deadline for reaching a nuclear agreement with Iran now less than two months away. The warning comes amid reports that President Obama is considering a deal that would ease economic sanctions while allowing Tehran to keep a large part of its nuclear program intact.

Wall Street Journal foreign affairs columnist, Bret Stephens, joins us with more.

So, Bret, how close is the administration to cutting a deal?

BRET STEPHENS, FOREIGN AFFAIRS COLUMNIST: The administration will cut almost any deal that the Iranians will accept.

GIGOT: Are they close?

STEPHENS: Not as close as they think. Because they are negotiating with Rouhani and his foreign minister, Mr. Zarif, who do a pretty good job of seeming, seeming, reasonable and moderate. But the decision maker in Iran is the Supreme Leader Ali Khomeini, and he has made some extremely hard- line statements that seem to me to put a deal out of reach.

GIGOT: But if the deal that we've seen is going to allow them to continue to enrich uranium, if it is going to allow them to continue to seek to have centrifuges that do enrich Ukrainian under supervision, some kind of inspector regime, if it doesn't include anything on ballistic missiles, and it doesn't deal with the Iranian efforts on weaponization in the past, why wouldn't Khomeini take that deal?

STEPHENS: It would be wise for the Iranians to take that deal because it would allow them to lift sanctions. But Khomeini has -- first of all, Khomeini has called for not simply maintaining their enrichment program in place, but multiplying it by 10. Khomeini has called for the mass production of ballistic missiles, not simply maintaining a program. And Khomeini's calculation is he has never really been made to pay a price by this administration, not even the sanctions. And he also thinks he has a two-year window of opportunity where he's going to have an American president, who is certainly going to take no serious further action, and this is his breakout window.

GIGOT: But he doesn't need to break out. Why not go to the edge, if those are the terms that I described before, are the real terms of the deal, he can go right up to the cusp of having a weapons. He doesn't have to actually risk world anger by exploding them. Meanwhile, he gets rid of economic sanctions and Europeans will start pouring cash in there because they are dying to do it anyway. Why not take that deal?

STEPHENS: Because the lesson we've had from breakout nuclear powers, not just North Korea, but India and Pakistan, is that ultimately the world cannot contain a nuclear state and so it learns to live with it on that state's terms. 1998, the Pakistanis and Indians tested nuclear weapons. There were sanctions. They've lasted about four or five years and that was it.

GIGOT: Dan?

HENNINGER: The technology that Iran is using, they have imported from North Korea. We had an agreement in 1994 with North Korea not to do what we don't want Iran to do. And North Korea has violated that repeatedly, even conducting an underground test early in 2013. So there is no way to verify or to enforce any agreement that Barack Obama signs with the Iranians. And as a result, agreement or no agreement in this November is that they will move forward to the point we've been describing here.

STEPHENS: And an important point that is worth mentioning is the International Atomic Energy Agency continues to find that Iran is playing games with the --

GIGOT: Right.

STEPHENS: -- with the U.N. inspectors, particularly when it comes to the weaponization aspect, the military dimensions of their program. So Barack Obama is going to try to sign a deal in which -- for instance, one of the ideas on the table they will disconnect some of the pipes that connect the centrifuges that allow them to enrich uranium. To imagine that the Iranians won't cheat on that deal is extraordinary.

GIGOT: Well, then, what was Israel's -- what will its reaction be to this kind of a deal? I don't they can accept it.

STEPHENS: No. I don't think the Israelis can accept it, but -- or want to accept it. But, look, the experience we've had with the Israelis is their talk has been pretty tough, but a lot of people have been thinking Israelis are bound to strike, and I've been one of them, for the past few years, and they haven't. And that may be because there's an Israeli calculation that a strike on Iran is at the outer limit of their military capability.

GIGOT: What would be the reaction domestically in the U.S. to that kind of deal? Because I don't think -- one thing our viewers should understand is that Congress would not get the right to approve this. This would not be submitted as a treaty. Just would just be something that the president sign and would, therefore, be U.S. policy.

HENNINGER: I think it would add to the anxiety the American people feel because they have been -- the details we've been talking about, described to them, the first thing that will be reported is the Saudis will seek a weapon. I think it will be a negative for the administration.

GIGOT: OK, Dan, thank you. We'll be watching that, too.

We have to take one more break. When we come back, "Hits & Misses" of the week.

(COMMERCIAL BREAK)

GIGOT: Time for "Hits & Misses" of the week.

Kim, start with you.

STRASSEL: A hit to Jay Angoff, the former official who was in charge of implementing Obamacare but who now, in a private capacity, is suing the administration for not releasing the details about upcoming rate hikes in Obamacare. Open enrollment for the law begins again on November 15th. It's very clear the administration is sitting on all of these news of all of these big rate hikes, trying to get past the election on November 4th, and avoid more political fallout. Mr. Angoff is actually a fan of the law. He thinks that this would help increase competition, this data. Whatever his motives, he's right that the law requires that this get out there and that people know.

GIGOT: All right.

Jason?

RILEY: Paul, students at Goddard College, in Vermont, have selected convicted cop killer, Mumia Abu Jamal, to be their commencement speaker. He'll address them from the jail cell. Now college students do a lot of foolish things, Paul, but in this case, they are following the lead of any number of celebrities who have treated Jamal like he's some sort of political prisoner hero, Alec Baldwin, Whoopi Goldberg, Oliver Stone, Susan Sarandon, and the likes. The president of Goddard is also praising this choice. Where's the adult supervision?

GIGOT: All right.

Dan?

HENNINGER: Well, I'm giving a miss to Senator Joe Manchin, of West Virginia, who this week said that Mary Landrieu's defeat in Louisiana, a fellow Democrat, would be a disaster because her seat on the Energy Committee would be taken by Democrat Maria Cantwell, of Washington, who is anti-carbon and would hurt energy states like his. All I can say is, "Boo- hoo, Senator Manchin." This is your party. Love it or leave it.

GIGOT: All right.

That's it for this week's show. Thanks to my panel and to all of you for watching. I'm Paul Gigot. Hope to see you right here next week.

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