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A Success Not to Be Repeated

Ronald A. Klain , External Advisor to the Skoll Global Threats Fund and former White House Ebola Response Coordinator
September 29, 2016

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In October 2014—after the first death from Ebola on U.S. soil, the first transmission of the disease here, and in the wake of a rapidly escalating epidemic in West Africa—President Obama asked me to become the White House Ebola Response Coordinator, or Ebola czar. We got a late start, and had some shaky moments at first, but in the end, we helped save hundreds of thousands of lives in West Africa, protected the American people, and increased our health care system’s readiness for a future epidemic.

Now, with the AAMC’s help, we can try to make sure we don’t have to undertake such an effort again.

Make no mistake: The Ebola response effort delivered critical results, and the AAMC and its member institutions were major contributors to that work. We accelerated Ebola response efforts, learned from early missteps, and assembled resources to battle the disease at home and abroad. Academic medical centers like Emory University, the University of Nebraska Medical Center, and Bellevue Hospital Center were prepared and equipped to treat Ebola patients in the United States and to keep the virus contained, while many others led local preparedness efforts and continue to help advance medical research on Ebola. These facilities and the AAMC provided valuable advice in our strategy to prepare American medical facilities to screen suspected Ebola cases, and treat those with the disease safely and effectively. The association was among the earliest supporters of President Obama’s emergency Ebola response funding package on Capitol Hill, which won prompt bipartisan support and was signed into law only six weeks after it was sent to Congress. As a result, the United States was able to provide generous help to the global response effort in West Africa, and make much needed investments in our preparations to combat infectious disease at home.

Now, our challenge is to make sure that this is a success we never need to repeat.

“A preparedness strategy that only takes us from crisis to crisis—often with unreliable funding—is not ideal, and maintaining readiness for both expected and emerging threats is a long-term and expensive endeavor.”

We can’t prevent the threat of other dangerous infectious diseases: far from it. Indeed, with the increased interaction between humans and animals through habitat incursion, the impact of globalization and expanded global travel, and the consequences of climate change, the world is entering a phase of accelerated emergence and re-emergence of dangerous infectious diseases. Middle East Respiratory Syndrome in 2012, Ebola in 2014, and now Zika in 2016—with Yellow Fever on the horizon—show how serious and frequent these sorts of epidemics are becoming.

It is precisely because such epidemics are increasing in frequency and spread that we need to change the way the U.S. government responds to them. Yes, we had an Ebola czar, but we should not need a Zika czar, a Yellow Fever czar, or some future pandemic flu czar. And yes, we got emergency funding through Congress to fight Ebola—but the package to fight Zika has been stalled for months, and future epidemics will move faster than Congress can in assembling a response.

Medical schools and teaching hospitals are frequently on the front lines of these epidemics, and the public has come to count on these institutions to partner with the broader public health community to scale up rapidly for the highly specialized expertise in research, education, and clinical care needed to combat such challenges. A preparedness strategy that only takes us from crisis to crisis—often with unreliable funding—is not ideal, and maintaining readiness for both expected and emerging threats is a long-term and expensive endeavor.

As a result, the AAMC’s help is needed to make two critical changes in how the United States responds to these threats in the future.

First, instead of appointing ad hoc czars after an epidemic breaks out, the next president should create a Pandemic Prevention and Response Directorate in the National Security Council, much like those that already exist to fight terrorism and climate change. This team would have the responsibility of developing epidemic prevention and response strategies, funding proposals, and working with private partners—before the next outbreak. The directorate would be responsible for both naturally occurring epidemics as well as potential bioterrorist threats. This permanent effort should be led by a senior White House official, a deputy assistant to the president who would report directly to the national security advisor and have access to the president. The AAMC should continue its engagement with the broader public health community and support the creation of a new, permanent White House effort to coordinate epidemic prevention and response.

This change in how the government manages epidemics should be at the top of the list for the next president and should be in place on Inauguration Day 2017.

Second, when a tornado, earthquake, or hurricane strikes, the president does not need to wait for Congress to act to send help—the president has authority under the Stafford Act to send immediate assistance. But as we learned with Ebola, and now with Zika, the same is not true for epidemics. These natural disasters are not covered by the Stafford Act, and the president must plead with Congress to provide funding for prevention and response efforts. In the face of a public health emergency, however, the time that such wrangling consumes can put us further behind the epidemic, render our counter measures less effective, and even cost lives.

The bipartisan group—led by Sen. Brian Schatz (D-Hawaii) and Sen. Bill Cassidy (R-La.), and Rep. Rosa DeLauro (D-Conn.)—has proposed a solution: a Public Health Emergency Fund that would make immediate assistance available for epidemic response when the secretary of Health and Human Services declares a public health emergency. When a public health threat requires an emergency response, either at home or abroad, such a fund would ensure that lack of immediate access to funds does not prevent necessary action. Backing from the AAMC for this type of emergency fund would help move this proposal closer to reality.

The AAMC played a major role in America’s response to the Ebola epidemic of 2014–15, and as a result, lives were saved in Africa and a health crisis was prevented here in the United States. Now, its leadership can make a major difference in making sure we have the direction and resources in place to combat the next such challenge—before it becomes a public health crisis.

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