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MAY 2017



Of all the options for staffing this unit, the Public Health

Service of HHS made the most sense. It consists of vet-

ted U.S. government employees subject to discipline and

deployment rules established for this uniformed service

who, as individuals, are highly motivated to use their skills

to fight Ebola. When the call went out for PHS volunteers,

projections for infection were catastrophic. Despite the

substantial risk, more than 1,000 of the 6,000 commis-

sioned corps officers volunteered for duty in Liberia.

Deploying the PHS, however, was complicated. The vol-

unteers all had domestic assignments for which it was dif-

ficult or impossible to find temporary replacements. There

was no direct PHS doctrine or precedent for an operation

of this size and character.

My office, Global Affairs, worked with Embassy Monro-

via, USAID, CDC and the Pentagon to establish responsi-

bility for reporting chains, security and force protection,

and specialized Ebola training. We negotiated the right to

practice medicine and prescribe drugs in Liberia, living

arrangements, water supply and definitions of health

workers for patient access.

In setting treatment protocols, we turned to, among

others, Kent Brantly, the missionary doctor who had been

evacuated from Monrovia. He eagerly advised what would

have been necessary to have saved his own life and the

lives of his patients in Liberia in 2014.

HHS also played a vital role in the response to the Zika

virus outbreak in Brazil. The HHS Office of Global Affairs led

a delegation of senior HHS scientists to meet with counter-

parts in Brasilia to overcome bottlenecks in cohort stud-

ies, sample sharing and institutional arrangements. The

14-point action plan developed, assigning responsibility to

HHS divisions and counterpart Brazilian parastatal orga-

nizations, proved extremely valuable. Though the Dilma

Rousseff government subsequently fell, the institution-

to-institution agreements were carried out with very little

interference or loss of momentum.

Even before we knew Ebola was a problem, in Febru-

ary 2014, then-HHS Secretary Kathleen Sebelius, together

with the State Department and National Security Council,

launched the Global Health Security Agenda. A growing, mul-

tisectoral partnership, GHSA has become the world’s vehicle

for scaling up to prevent outbreaks in the weakest health

systems from becoming pandemics, threatening all of us.

GHSA’s premise is that to contain a naturally occur-

ring outbreak, a lab accident or a bioterrorist attack, the

first response has to be the health system that identi-

fies the pathogen, does the surveillance, finds its origin

and promotes measures to limit its damage. If it is a

bioterrorist incident, security services will, of course, be

involved. But protecting the public relies on a resilient

health infrastructure, and especially the case manage-

ment, emergency operations centers and established

protocols that CDC is so good at. On this basis the U.S.

government was able to convene quite a few govern-

ments and partners, and strengthen the World Health

Organization to promote and scale up worldwide out-

break preparedness and response.

As the HHS presence grows overseas, there is renewed

discussion of an “HHS Foreign Service.”While it could ease

overseas staffing and rotation issues for which the Civil

Service does not have a workable alternative, I don’t see

that as the best option. HHS’ distinctive value is that its

key staff are subject-matter experts, scientists, different

from but mutually supportive of generalist diplomats. An

even more important consideration is that nearly all of HHS

international assignments use PEPFAR, GHSA and the U.S.

President’s Malaria Initiative programmatic money, with no

guarantee of career-long sustainability.

In my Foreign Service experience, contacts between

health scientists and diplomats were rare, and use of scien-

tific data in démarches or political dialogue was haphazard

or non-existent. But today, with the State Department’s

Offices of International Health and Biosecurity and Global

Health Diplomacy, HHS can be an essential partner to help

the two cultures appreciate and take advantage of their

respective strengths.


HHS’ distinctive value is that

its key staff are subject-matter

experts, scientists, different

frombut mutually supportive

of generalist diplomats.