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Infectious Disease Outbreak in Colombia

Sylvia Matthews Burwell
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Infectious diseases know no borders. In this age of global hyper-connectedness, a disease outbreak anywhere is a threat everywhere. With just a sneeze, a hug or a plane ride, a deadly germ can travel from West Africa to North Texas before we even realize the threat exists.” — Liz Schrayer, president, U.S. Global Leadership Coalition

2.1 The Issue

The number of infectious diseases outbreaks has been rising for several decades. As populations grow and expand into previously forested areas, more people are contracting zoonotic diseases—infections that can be passed from animals to humans. Given increasing trade and travel to and within low-income countries, outbreaks of  infectious diseases such as Ebola and Zika viruses in remote rural villages are more likely to reach crowded cities with limited health systems, which are the ideal incubators for diseases. Since 2000, a series of epidemics, including severe acute respiratory syndrome (SARS), H1N1, Zika, and Ebola, have taken a significant toll, prompting experts to call for increased investment in global health security—efforts to help prepare countries prevent, detect, and respond to epidemic and potentially pandemic diseases.

U.S. government support for global health security has increased significantly in recent years. After an outbreak of Ebola killed eleven thousand and infected twenty-seven thousand in West Africa in 2014, the United States invested $1 billion in building capacity to detect and respond to dangerous disease events in low-income and weak states as part of an international initiative known as the Global Health Security Agenda. Those investments have helped nations make measurable improvements in their preparedness for dangerous disease events, but significant gaps and risks remain. The coordination and funding of the U.S. and international response to outbreaks is still largely ad hoc, which limits its effectiveness. Without a robust, predictable, and well-coordinated international response, an emerging and lethal infectious disease in a country without the capacity to respond and control that outbreak—a fragile or failed state, one that is mired in civil war, or one that is subject to a significant influx of refugees—could have devastating consequences for that country and its neighbors.

Decision Point

NSC Meeting

It is 2019. This week, news reports began to trickle out of northern Colombia, near the border with Venezuela, about a disease that is spreading quickly among farm workers. A dozen patients have visited a rural clinic seeking treatment for intense headaches, muscle pain, and vomiting. Four of those patients suffered convulsions, had seizures, and ultimately died. One nurse who treated the farm workers has contracted the illness. Physicians in neighboring towns have also begun reporting cases. Officials fear possibly dozens more cases of the mystery illness.

The Colombian government has reported the potential outbreak of the mysterious illness to the World Health Organization (WHO) and has begun working with the Pan American Health Organization (PAHO), the regional WHO office, to investigate. The U.S. Centers for Disease Control and Prevention (CDC) has also offered assistance, which Colombia has accepted. CDC officials believe the disease is most likely caused by the Venezuelan equine encephalitis virus (VEEV), which is endemic to Central and South America. VEEV is spread primarily by mosquitoes, and historically has a low mortality rate. CDC scientists believe that the current outbreak might involve an airborne form of VEEV, which would spread more easily and be much deadlier. No specific treatments have been established. Therefore, the fate of sufferers will likely depend on the quality of supportive care, monitoring, and treating complications. No vaccine for VEEV is commercially available, though several candidates have been developed and one has been approved for use in horses.

Outbreaks of infectious disease can be particularly debilitating in areas that are politically or economically unstable. While Colombia’s healthcare system has significantly improved in recent years, it is under increasing strain. The reported outbreak is in a region that borders Venezuela, which is in the midst of an economic, political, and humanitarian crisis that has forced thousands to flee the country, many to Colombia. As refugees continue to arrive, conditions along the border are growing more crowded, increasing the risk of VEEV spreading and straining Colombian health officials’ capacity to monitor and contain the outbreak. As international concern about VEEV grows, Brazil has announced it will restrict trade and travel with Colombia and has moved to secure its borders. The president has called a National Security Council (NSC) meeting to discuss a response. The president has asked the NSC to advise what, if anything, to tell the U.S. public, and whether and how to restrict travel to the United States.

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