By Mel Deaile, Ph.D.
Faculty Member, Military Studies at American Military University
America has seen the first case of Ebola diagnosed in the United States, the first transmission of Ebola in the United States, the first death from Ebola, and, most recently, a case of Ebola in New York, all within a month of the president saying the possibility of Ebola reaching America was unlikely. The recent spread of Ebola stems from trying to solve a ‘wicked problem’ in an environment of overlapping complex systems.
Writing in 1973, Horst Rittel and Melvin Webber laid out the characteristics of ‘wicked problems’ in the article “Dilemmas in a General Theory of Planning,” published in Policy Sciences. Such problems, the authors argued, contrast from problems in natural science that are definable and separable. Wicked problems, by contrast, have neither of these traits and they typically include policy issues. Rittel and Webber offered 10 characteristics that included: solutions to wicked problems have consequences, the problem is not well-defined, and these problems are essentially unique. These problems also offer no opportunity for trial and error.
We have already witnessed this in the evolving protocols the Centers for Disease Control and Prevention (CDC) has offered for health care providers working with infected patients. Ebola, the virus, is not the problem. Preventing the transmission in today’s chaotic, complex world is the issue.
There are two theoretical frameworks that offer further insight into how Ebola has reached America’s shores. Chaos theory describes how minute variations can cause dramatic changes in the behavior of a system. While a butterfly flapping its wings in Africa did not bring Ebola to America, the frailty of human beings (i.e., the nature of human nature) did introduce variations into the system.
The first patient diagnosed in America with Ebola misrepresented his exposure to the disease. An NBC correspondent broke a self-imposed quarantine in order to get takeout food from her favorite restaurant. Finally, the CDC allegedly gave a health care worker who had been caring for an Ebola patient permission to fly while experiencing a low-grade fever. None of these incidents in and of themselves resulted in chaos, but they allowed the flaws in one system to touch other systems and that could have, or may even still have, consequences.
Understanding the complex systems in the world we live in can shed insight into why the transmission of Ebola has become the overriding problem. Complexity theory looks at the interactions in a system, between systems, and between systems and the environment. The rapid rise in cybernetics and networks has fueled interest in how complex the world has become. As highlighted above, human frailty injected flaws into the quarantine and screening systems, but those effects had, and still have, the potential to cause escalating, non-linear effects because one system touches another.
The donning and doffing of personal protective equipment is a 12-20 step process performed every time someone attempts to treat an Ebola patient. Assuming a typical four-day rotation, a health care worker will go through this process at least eight times, which means up to 160 steps performed flawlessly. A mistake in the procedures or the execution of the procedures can expose someone who then potentially touches another system.
The health care worker with a fever flew on a jet that then went on seven other trips before being pulled from service exposing close to 750 people. A doctor who treated patients in Africa rode multiple subways in New York, while possibly contagious, before realizing his condition. Those on the subway potentially rode other subway cars. As the nodes linking these systemic flaws multiplies, the risk for the disease spreading increases.
In a free, open system there are at least two options to combating the spread of Ebola, and with all options in a wicked problem there are consequences. The first is to simply manage the system by relaying lessons learned, improving procedures, and monitoring those coming into the system. The downside of this approach is that, with a wicked problem, trial and error rarely works without possible concerns like infected patients traveling on mass transit.
The second alternative is to lock the systems down and prevent them from connecting. Even if a flaw happens in the quarantine system, it won’t matter since it is not allowed to touch the transportation system. The consequences are eliminating self-monitoring, restricting freedoms and movement, and possibly placing exposed Americans under armed guard. With these options on the horizon, is it any wonder that hospitals have started to question their ethical obligations to treat Ebola patients?
If you enact a travel ban, you prevent human frailty from being a factor since no one can enter the system. Or do you? As noted chaos theorist Ian Malcom famously said in the movie Jurassic Park, “nature always finds a way”—even human nature.
About the Author
Dr. Mel Deaile is an associate professor in the Military Studies Program at American Military University. He holds a Ph.D. in American History from UNC-Chapel Hill, three masters, and an undergraduate degree from the Air Force Academy. His courses focus on military strategy, joint operations, and emerging threats to national security.
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