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A review of the Federal government’s response to the Ebola outbreak

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The Ebola outbreak from may have faded from memory for most Americans, but the need to address shortcomings observed during the Obama Administration’s response to the crisis lingers. Together with the Heritage Foundation’s James Carafano and Charlotte Florance, and a substantial task force of experts, we published a report reviewing the Administration’s response to the crisis: The Ebola Outbreak of 2013–2014: An Assessment of U.S. Actions.

Our review included U.S. response, both the domestically and in West Africa. Our overall recommendations include:

  • Prioritize emergency preparedness and planning.
  • Empower officials to coordinate domestic response efforts and communicate with the American public.
  • Improve medical training and increase access to effective and sustainable health care for West African countries.
  • Strengthen lines of authority and narrow the priorities of the World Health Organization to focus on a limited number of core responsibilities.

I encourage you to read the report, not only to better understand the Ebola response, but also to contemplate whether the nation is prepared for a future public health emergency.

We discussed the report’s findings at a recent Heritage Foundation event, which can be viewed here.

The Ebola Jet Set

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In a recent Vanity Fair magazine, there was an article about the early “Jet Set” who traveled the world on the new Boeing 707 jetliner. In those days, the jet was a miracle knocking off nearly 5 hours of transit time from America to Europe. It was expensive to take and only the rich and glamorous could afford it. People wore their best clothes and were served five course meals, says the author of the article. Oh those were the better days – if you were rich.

As anyone who has flown in the past few years can tell you, that era is but a dream. On the other hand, we can now travel the world in less than 24 hours. The Taj Mahal or Monrovia, Liberia can replace the site of my cat sitting in my window in front of my desk in McLean, Virginia in a day. A miracle and a problem. Welcome to the age of the Ebola Jet Set.

In this world, people and their problems can also move around in 24 hours. Terrorist can move about with relative ease. We know that and have taken actions to deal with the problem.

But, diseases, like Ebola, can also spread world wide in a matter of days. So, we have seen in recent weeks that what happens in West Africa can arrive in Dallas, Texas in no time flat. And, thus again, the definition of Homeland Security expands.

Whatever the missed opportunities from the World Health Organization (WHO) and the Centers for Disease Control (CDC) and whatever other health related initials there are out; rarely does a small fever stop anyone from traveling. Being prepared to deal with type of thing is going to take some getting used to by Americans who are already irritated by long and intrusive TSA lines. The Japanese do health screens on the way in to their country. Maybe we need to do the same.

The news media hype and distortion for ratings is not helping inform the public to say the least. And watching the Administration struggle with a response is hardly awe-inspiring. What is really upsetting, however, is after both SARS and H1N1 influenza, our medical establishment is not prepared around the country to deal with mass infectious disease.

Simply put, while international cooperation is nice as is a competent WHO, we need to boost that capability within the U.S. regionally to deal with infectious disease – not just as NIH headquarters in DC. Hospitals and medical centers have not been at the forefront of homeland security efforts and it is now showing.

The early warning reporting system also needs to be strengthened recognizing that people being people do not go wandering into a medical facility unless they think they are sick. The earlier detection among doctors and public awareness is crucial.

So, welcome to the Ebola Jet Set. The nature of travel time today makes it near impossible to stop. And Americans must understand and be prepared as part of our total homeland security effort to deal with it.

The Ebola Czar and the missing Homeland Security Council

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The President has announced the appointment of Ron Klain as his new “Ebola czar”, as numerous news outlets have reported this morning. From the New York Times:

President Obama will appoint Ron Klain, a former chief of staff for Vice Presidents Al Gore and Joseph R. Biden Jr., to manage the government’s response to the deadly virus as anxiety grows over its possible spread, a White House official said on Friday.

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Mr. Klain will report to Lisa Monaco, Mr. Obama’s homeland security adviser, and Susan E. Rice, his national security adviser, the official said. His appointment was first reported by CNN.

The official praised the work already done by Ms. Rice and Ms. Monaco, but said that Mr. Klain would provide “additional bandwidth” in the fight against Ebola, which is important because the two women have to manage other national and homeland security issues.

I view this appointment of an “Ebola czar” and the need for such “additional bandwidth” as a symptom of a broader problem within the policy-making apparatus at the White House, due in part to the decision in 2009 to merge the National Security Council and Homeland Security Council staffs into a single integrated “National Security Staff” (since renamed the “National Security Council staff”).

Prior to the integration of the HSC and NSC staffs, the Homeland Security Council played a very active role on pandemic planning and response issues. It issued the National Strategy for Pandemic Influenza in November 2005, and the subsequent Implementation Plan for that strategy in May 2006, and a progress report on implementation in 2007. During the H1N1 flu pandemic in 2009, the Homeland Security Council was utilized as a primary convening mechanism by the White House.

But since the end of the H1N1 crisis in late 2009, the Homeland Security Council (which was retained as a policy-making entity, in part because it was mandated in law in Title IX of the Homeland Security Act) has almost entirely disappeared from view. From January 2010 to the present, I can find only one public record of the Homeland Security Council being convened: a meeting in July 2014 to address the unaccompanied minor issue on the southern border. (It is possible that there have been additional meetings of the HSC during the last five years, but there is no public record of it).

These concerns about homeland security issues being downgraded were predicted by opponents of HSC-NSC integration at the time. In February 2009, I helped to staff a Senate Homeland Security and Governmental Affairs Committee hearing where we heard a variety of opinions on the potential HSC-NSC merger, including from former DHS Secretary Tom Ridge, who was critical of a potential merger. His prepared remarks highlighted biosecurity as a particular area of concern, and are prescient in light of today’s decision to appoint an Ebola czar (emphasis added):

From HHS to Energy to DOD to the FDA and elsewhere – more than 30 departments and agencies have homeland security functions. Take biosecurity, for example. What the United States needs to do to improve our biosecurity against major biological threats is complex. Biosecurity depends on different programs managed by different agencies – there is no way to simplify it. DHS is in charge of the biological risk assessment that analyzes biological threats. HHS is responsible for the research and development of medicines and vaccines. DOD does its own R&D. The Food and Drug Administration has its role. Let’s not forget NIH. CDC is responsible for our national stockpiles and for coordinating the grant program and technical assistance to state and locals. The intel community is responsible for assessing the biological threats posed by our adversaries. Without close White House coordination, our bio programs will move in different directions to different goals and different timelines. Putting this and other challenges under the NSC’s purview would only complicate the NSC mission and the HSC’s ability to receive adequate attention from a Council that already has Iran, North Korea, Russia, Pakistan-India, the Mideast and other matters in its inbox.

There have been some benefits as a result of integrating the HSC and NSC staffs, in terms of breaking down domestic vs. international policy stovepipes and allowing for integrated decision-making on transnational issues such as cybersecurity. But I have become increasingly concerned over the past few years that the downsides of HSC-NSC integration are outweighing its benefits, largely due to the “bandwidth” issue highlighted in this post, but also because of the decreased public visibility into homeland security decision-making at the White House due to the adoption of NSC protocols, as I discussed in a blog post last year.

In the near-term, the focus needs to be on dealing with the Ebola pandemic, but these broader structural issues also deserve to be reviewed during the last two years of this Administration and/or by the next Administration, whomever is elected President in 2016. And in light of the Homeland Security Council’s statutory role, this is an issue that Congress should also take a fresh look at, including by convening hearings and requesting information on the activities of the Homeland Security Council since 2009.

Who is leading the Ebola response effort in America?

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According to the White House, it is the President’s Homeland Security Advisor, Lisa Monaco, at least the federal effort. Unfortunately, she has many other issues on her plate, including cyber threats, border issues, and the potential for ISIL attacks on the homeland.

The bipartisan WMD Commission’s final report card (January, 2010) gave America a failing grade for bio-response preparedness. Much of that grade was the result of the fact that no one was in charge. This has not changed. Today there are more than two dozen Presidentially-appointed, Senate-confirmed individuals with some responsibility for bio-defense, but no one has this responsibility as a full time job.

The WMD Center, led by the former co-chairs of the WMD Commission (Bob Graham (D-FL) and Jim Talent (R-MO)), issued a far more comprehensive report card on bio-response capabilities in November, 2011 (www.wmdcenter.org). Once again, the number one recommendation was focused on having someone in charge.

This is certainly not a new, radical idea. Both the Clinton and Bush (43) Administrations had such a position in the White House to lead public health preparedness and response. The Obama Administration eliminated this position.

We should look to the examples from the Clinton and Bush (43) Administrations or the work done by Admiral Thad Allen when he was selected to lead all federal efforts following the Deepwater Horizon oil spill and the Haiti earthquake.

Bottom line: America needs someone in charge, reporting directly to the President, with the responsibility, accountability, and authority for preparation and response to biological threats–either naturally occurring or man-made. This is a job that will require a leader’s complete attention…24/7.

Colonel Randall Larsen, USAF (Ret), is a senior fellow with HSPI.

DHS and CDC release details on Ebola screening at airports

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The Department of Homeland Security and the Centers for Disease Control have issued a joint press release and related fact sheet this afternoon that provides key details as to how the screening for Ebola at international arrival areas in airports will work. The release describes how Customs and Border Protection (CBP) and CDC will work together to carry out this screening. From the release:

CDC is sending additional staff to each of the five airports. After passport review:

  • Travelers from Guinea, Liberia, and Sierra Leone will be escorted by CBP to an area of the airport set aside for screening.
  • Trained CBP staff will observe them for signs of illness, ask them a series of health and exposure questions and provide health information for Ebola and reminders to monitor themselves for symptoms. Trained medical staff will take their temperature with a non-contact thermometer.
  • If the travelers have fever, symptoms or the health questionnaire reveals possible Ebola exposure, they will be evaluated by a CDC quarantine station public health officer. The public health officer will again take a temperature reading and make a public health assessment. Travelers, who after this assessment, are determined to require further evaluation or monitoring will be referred to the appropriate public health authority.
  • Travelers from these countries who have neither symptoms/fever nor a known history of exposure will receive health information for self-monitoring.

Given the fact that the number of travelers from these countries is a very small percentage of total inbound travel to the United States, this is likely to be a manageable set of procedures for CBP and CDC, with little disruption to the overall process of clearing travelers through immigration and customs. But these efforts will need to be undertaken carefully, particularly with respect to building and ensuring public confidence in the processes, and could become more challenging if the number of high-risk countries increases in the coming weeks and months.