Ebola and the Promise We Should Keep

To the people brave enough to go, and the system we built to bring them home

In the summer of 2014, two American missionaries—Dr. Kent Brantly and Nancy Writebol—were working at an Ebola clinic in Monrovia, Liberia, when they started feeling ill. The organization they worked for, Samaritan’s Purse, began making desperate phone calls. Letters were written to politicians. The question they were asking was the same question every aid organization, every humanitarian NGO, every public health agency was asking: if our people get sick, how do we bring them home?

The answer, it turned out, was a small aircraft charter company in Cartersville, Georgia.

Phoenix Air Group had been quietly developing an Aeromedical Biological Containment System—a self-contained, two-compartment isolation tent fitted inside a modified Gulfstream jet—in partnership with the CDC and the Department of Defense, starting in 2008. When federal funding lapsed in 2010, the government paid Phoenix Air $10 a year to store the system on a shelf. “We just put everything on a shelf,” said Dent Thompson, Phoenix Air’s vice president and chief operations officer, “because we knew eventually there would be an epidemic.”

On July 31, 2014, the State Department called. Phoenix Air pulled the system off the shelf. Within days they were under contract, and between August 2014 and May 2015, Phoenix Air made over 40 flights from West Africa to specialty treatment hospitals in Europe and the United States, saving many lives and assuring medical professionals working in Africa of a “lifeboat” home for treatment should they contract a deadly disease.

What made people go

The logistics of the 2014 response were complicated. Getting NGOs and humanitarian organizations to surge personnel into an active Ebola zone required overcoming a very human question: if something goes wrong, will I be taken care of? The State Department and USAID understood that question wasn’t rhetorical. They built an answer to it.

In addition to the Phoenix Air contract, the Department of State entered into a formal commercial agreement providing the capability to evacuate up to four patients requiring biocontainment per week—available on a reimbursable basis to international organizations, partner foreign governments, and private voluntary organizations registered with and approved by USAID. A signed binding agreement with the State Department was required before the service could be made available. In other words, if your organization wanted access to the medevac system, you signed a contract. The promise was in writing.

On the ground in Liberia, the United States built a high-quality 25-bed hospital in Monrovia—the Monrovia Medical Unit—staffed by licensed physicians and other healthcare professionals from the U.S. Public Health Service Commissioned Corps, with priority care given to Liberian and international healthcare workers and the international UN and NGO staff supporting those efforts.

And when the government’s capacity had gaps, private philanthropy filled them. Paul Allen, Microsoft’s co-founder, pledged $100 million through Vulcan Inc.’s Paul G. Allen Ebola Program. At a time when medical workers were reluctant to travel to West Africa because there was no guarantee of evacuation if they got sick, Allen put up nearly $10 million to build two portable medevac units and to underwrite a fund to cover evacuation costs not covered by insurance. The existence of the fund provided peace of mind for volunteers.

Through a partnership with the U.S. Department of State and MRIGlobal, two first-of-their-kind biocontainment units were developed, large enough for four patients each, along with a medical crew, loadable onto a 747 without requiring decontamination of the entire aircraft.

This wasn’t improvised goodwill. It was a deliberate architecture. Government contracts, private philanthropy, signed binding agreements, dedicated aircraft, and a field hospital with licensed physicians. People built it carefully, over years, precisely so that when the question came again: will you come get me? The answer would be yes, without hesitation.

What’s left of it

Paul Allen died in October 2018. Vulcan Inc. has since wound down its philanthropic operations.

USAID, the main implementing agency for global health efforts, was dissolved in July 2025, with remaining programs moved to the State Department. Of the 770 global health awards identified, 80% were listed as terminated, totaling $12.7 billion in unobligated funding.

USAID contract workers had handled setting up clinics, importing ambulances, contacting people with suspected cases, and staffing isolation facilities. But the Trump administration canceled thousands of foreign aid work contracts as it dismantled USAID.

The infrastructure that answered the question in 2014—the contracts, the medevac system, the field hospital, the coordinating agency—no longer exists in the same form. Some of it is gone entirely. Some of it is being rebuilt from scratch, in real time, as the current outbreak grows.

Which brings us to the policy that emerged this week.

The broken contract

The White House has directed that Americans who get sick during Ebola outbreak response will not be brought back to the United States. They will be sent to a new quarantine and treatment facility being stood up in Kenya. No one with Ebola comes home. Period.

The facility in Kenya has no track record. No established clinical staff. No approved treatment protocol for this strain. It is being built in weeks.

Dr. Craig Spencer, who contracted Ebola in 2014 while working in Guinea, was evacuated to Bellevue Hospital in New York City, and survived, has written directly about what this policy means for the people who would follow in his footsteps. The treatment he received, at one of the country’s premier biocontainment facilities, is precisely what the Americans we send now will not receive.

We have more than a dozen hospitals in this country specifically equipped and staffed to treat Ebola. They exist because we built them after 2014, because we understood that being prepared is the only thing that keeps an outbreak from becoming a catastrophe.

We are not using them.

The policy says nothing about what happens after a patient recovers. There is no framework for their return to the United States, no timeline, no guarantee. The people brave enough to deploy may find themselves in Kenya indefinitely, away from their families, with no clear answer about when they get to come home.

Nobody has addressed this.

The human math

In 2014, we learned something important: fear, when it becomes policy, makes outbreaks worse. Stigma, travel bans, and panic didn’t stop Ebola. Responders did. And responders went because the answer to their question was yes.

To Dent Thompson at Phoenix Air, the principle was simple: “To me, this is no different from a soldier being shot in Afghanistan. The U.S. government is going to get that soldier and bring him home and put him in a medical facility.”

That principle, that we don’t leave our people behind when we’re the ones who asked them to go, is not complicated. Most people, regardless of where they fall on anything else, understand it immediately. It’s the deal.

The people considering deployment right now are doing the same math every responder does. Risk on one side. Trust on the other. The question isn’t whether they’re brave enough. It’s whether we’ve given them any reason to believe the answer is still yes.

Right now, we haven’t.

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