THE FOREIGN SERVICE JOURNAL
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
HHS’ distinctive value is that
its key staff are subject-matter
experts, scientists, different
frombut mutually supportive
of generalist diplomats.