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U.S. Ebola Treatment Center Costs and Sustainability if Federal Funding Withdrawn

Credit: UTMB

In 2014, a tiered network of facilities to manage patients with Ebola virus disease (EVD) was established in the United States, with 56 hospitals designated as Ebola treatment centers (ETCs) and equipped with specified capabilities to provide safe high-level isolation care for patients with EVD. This network was enhanced with the later designation of 10 regional Ebola and other special pathogen treatment centers (RESPTCs) with enhanced capabilities to care for patients with other highly hazardous communicable diseases (HHCDs). Since that time, efforts have been made to expand existing ETC capabilities beyond EVD in preparation for treating the next HHCD outbreak.


We report in this paper a survey of the ETC costs incurred since 2014 ($1.76 million/ETC), a heavy reliance on federal funding. It is uncertain if, or for how long, ETCs can maintain capabilities should federal funding expire in 2020.

Previous assessments of these 56 ETCs by our team found average costs incurred to train teams, enhance physical infrastructure, and acquire advanced resources totaled nearly $1.2 million/facility ( 2 ). Despite these major investments, only 15–18 months after initially establishing their ETCs, by 2016 most hospitals reported challenges in sustaining ETC capabilities, and 3 centers reported they no longer maintained preparedness for EVD care ( 3 ).

Now, 3.5 years after our last ETC assessment, these specialized units face intensified threats to their sustainability because federal funding of these centers through the Hospital Preparedness Program (HPP) Ebola Preparedness and Response Activities is set to expire in 2020 ( 4 ). We aimed to determine whether additional costs for ETCs have incurred since our assessment in 2015, as well as to assess hospitals’ sustainability plans for maintaining capabilities after federal funding ceases.

Since late 2015, the perceived threat of an HHCD outbreak within the borders of the United States has waned, and the perceived demand for numerous US hospitals to maintain a high level of preparedness for HHCDs has dwindled. In tandem with inadequate funding, more ETCs have elected to forgo high-level isolation capabilities. The establishment of RESPTCs sought to centralize capabilities at a regional level, but many ETCs noted that since 2014, major investments in establishing high-level isolation capabilities could prompt continued internal financial support if federal funding ceases.

However, ETCs reported heavy reliance on federal funding; nearly all reported it as their primary funding stream and leading factor in maintaining capabilities. The 2020 expiration of HPP funds threatens the existence of this network. It is unknown if—and for how long—many ETCs could maintain capabilities solely with internal financial support, or if the United States will revert to the level of HHCD preparedness before 2014.

The ongoing EVD outbreak in the Democratic Republic of the Congo and the rise of 2019 novel coronavirus disease in China are reminders that HHCD outbreaks are increasingly regular occurrences. The high proportion of ETCs surveyed that have used their ETC for a person under investigation since 2014 (63%) further underscores the ongoing need of such specialized units across the country. The US healthcare system has made major strides in HHCD domestic preparedness capability since 2014. However, on the basis of study responses, the US health system could again be vulnerable and inadequately prepared for the next HHCD threat if federal HPP funding is not renewed.

Herstein JJ, Le AB, McNulty LA, Buehler SA, Biddinger PD, Hewlett AL, et al. Update on Ebola treatment center costs and sustainability, United States, 2019. Emerging Infectious Diseases. https://doi.org/10.3201/eid2605.191245


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