J. Stephen Morrison. "Health Security Downgraded at the White House." CSIS Commission on Strengthening America's Health Security, Center for Strategic and International Studies, June 28, 2018. Accessed February 22, 2019. https://healthsecurity.csis.org/articles/health-security-downgraded-at-the-white-house/
On May 9, the day after the Democratic Republic of the Congo confirmed an Ebola outbreak, the Trump administration dismissed Rear Admiral Tim Ziemer and dissolved his post as senior director for global health security and biothreats. Ironically, the creation of that directorate in the fall of 2016 stemmed directly from the costly mishandling of the response to the prior Ebola crisis in West Africa. We are now at risk of repeating the mistakes of 2014.
In 2014, the United States was ill-prepared to manage a fast-moving, complicated, dangerous Ebola epidemic that was unfolding in an unexpected, remote place. The Obama administration was sluggish in understanding that no international response structure existed to manage both the epidemiological and humanitarian dimensions of the crisis posed by Ebola. Indeed it took months to recognize just how much the World Health Organization and related international UN and regional bodies were failing, prior to the much-delayed declaration by the UN of a full-blown runaway public health emergency in August.
In a late move to break the dread that West Africa would implode and Ebola spread beyond Liberia, Sierra Leone, and Guinea, the president announced on September 16 that up to 3,000 U.S. forces would go to Liberia, the first such deployment of U.S. military forces to battle an infectious disease threat. In this same period, when just a few individuals sick with Ebola entered the United States in the summer and fall (one, Thomas Eric Duncan, infected two nurses in Dallas), an epidemic of fear spread across the United States, exacerbated by 24/7 cable news, confused White House messaging, misinformation, and the partisan sniping borne of the 2014 electoral season. In another late move, the president, amidst the worsening domestic mayhem, appointed an Ebola czar, Ron Klain, in the third week of October.
The costs of the ad hoc, chaotic response to Ebola, by the United States, WHO, and others, were enormous: over 27,000 Ebola cases, including 11,000 fatalities.
Subsequently, the White House created the global health security and biothreats directorate in the fall of 2016. It was an acknowledgement in the aftermath of the Ebola crisis that these issues require a bigger U.S. policy authority and presence, a bigger voice inside the administration’s security policymaking circles, and direct access to the highest levels. It was an acknowledgement of the exceptional mix of challenges we must manage.
Speed is of the essence, in an era when outbreaks are far less ad hoc and far more frequent and recurrent. Vaccines and rapid diagnostics are essential as well, but seldom available rapidly: any solutions are long term and involve a complicated puzzle of engagement with both private and public interests. Bad actors increasingly have the scientific wherewithal to generate new biothreats in geographies that are largely unregulated. The global environment remains murky and confusing, and at critical moments requires enlisting the U.S. president to communicate quickly and effectively with other heads of state.
The U.S. response is spread across multiple agencies and requires far tighter coordination and unity of effort, at home and abroad, if effective action is to be assured. Scarcities of key items like protective gear and other commodities demand careful adjudication between delicate domestic and international demands. Complicated and polarizing issues—the call for quarantines and travel bans—can surface suddenly and gravely strain the willingness of non-governmental groups to be part of the response in inhospitable places like West Africa and test the fragile bipartisan consensus at home that undergird national unity and adequate financing. Deft White House communications remain essential to push back on fear and panic in an era of rampant online falsehoods.
The White House explained that its May 9 decision to dismantle the directorate was intended to “streamline” operations. In reality, it was far more than that. Memories of the Ebola crisis in 2014 have faded, and the Trump administration implicitly is signaling that it flatly rejects the notion that health security ranks as a true national security policy priority.
Politics also play a role. The decision was part of John Bolton’s larger effort, begun a month previous when he assumed the post of national security adviser, of consolidating power (and settling scores) by suddenly dismissing Tom Bossert, then homeland security adviser. Ziemer and his directorate operated under Bolton’s umbrella. The decision was simultaneously a slap at Obama’s legacy of elevating health security, investing $1 billion in building capacity to detect and respond to dangerous outbreaks in weak states, under the auspices of the international alliance, the Global Health Security Agenda. With the directorate gone, Trump could be Trump. No longer in his midst is a senior official who might argue on public health grounds for a regular flow of health workers and travelers in the event of another outbreak like Ebola.
How big will the price be for eliminating the White House global health security and biothreats directorate?
Certainly, all is not lost. U.S. Health and Human Services Secretary Alex Azar recently led the U.S. delegation to the World Health Assembly where he pledged $8 million towards the international response to Ebola in the Congo. Admiral Ziemer’s talented team members remain inside the White House, while many very able senior officials are in place in the multiple U.S. agencies that contribute to U.S. health security. Bipartisan interest in Congress in strengthening health security at home and abroad remains solid. The Trump administration in its FY2019 budget added $51 million to support the Global Health Security Agenda, aware of the need for bridge funding as the $1 billion in emergency Ebola money was spent down.
But we should have no illusions. The price to U.S. national interests will be big, unless corrective action is taken soon. It is not clear who at a senior level will be in charge of the U.S. response to dangerous outbreaks. Fragmentation will worsen if there is no strong, dedicated coordinating oversight from within the White House. Whatever previous insulation health security had from internal White House chaos is now gone. The future of U.S. funding and support to the Global Health Security Agenda is uncertain. There is a high risk of continued drift in policy development and of continued assault upon budgets. The congressionally mandated revision and updating of the U.S. national biodefense strategy, already nine months late, hangs uncertainly in the balance. The FY 2018 omnibus spending bill signed by President Trump on March 23, 2018, mandates that the administration in six months lay out a future strategic approach to health security writ large. As far as anyone knows, that process is not very far along.
It is not too late for the Trump administration to reverse course. Perhaps the renewed threat of Ebola will refocus its imagination and return a sense of strategic purpose to guaranteeing America’s health security.