THE FOREIGN SERVICE JOURNAL
State’s new, multitiered pandemic response mechanism is the result of
understanding and applying lessons learned during the past decade.
Nancy J. Powell, a retired career ambassador, led the
State Department Ebola Coordination Unit in 2014 and
was senior coordinator for avian influenza from 2005 to
2006. She is the 2017 recipient of AFSA’s Lifetime Contri-
butions to American Diplomacy Award.
Gwen Tobert was a member of the Ebola Coordination
Unit and is the Pandemic Response Team lead in the
Office of International Health and Biodefense in the
State Department Bureau of Oceans and International
Environmental and Scientific Affairs.
n the past decade, we’ve fought multiple global dis-
ease outbreaks, from avian influenza to Zika. One
of the most important lessons we’ve learned is that
there will be more pandemics in the future, and
they are likely to be increasingly complex, particu-
larly if they occur in areas where medical services
are already challenged. Beyond the front page
stories of human suffering, there can be significant
economic and political stability costs if pandemics
are not quickly controlled.
In a world of increasing connectivity, it took only weeks for
the 2014 outbreak of Ebola in a remote border area of three
West African countries to reach Dallas, Texas, via a traveler from
Liberia. After arriving in Dallas, the man began developing
symptoms and went to the hospital, where two nurses became
infected and many others were exposed before doctors recog-
nized his illness as Ebola. The incident sparked public hysteria
ON GLOBAL HEALTH DIPLOMACY
and political pressure to implement restrictions on travel and
The 2009-2010 H1N1 swine flu outbreak infected more than 60
million Americans, according to an estimate by the U.S. Cen-
ters for Disease Control and Prevention, and 87 percent of the
resulting deaths occurred in those under 65 years of age. Direct
economic impacts are difficult to calculate, but numerous studies
indicate that a severe pandemic influenza outbreak could cost
billions of dollars in GDP loss. If not quickly addressed, infectious
disease outbreaks can have significant consequences for our
national security, as well.
Looked at through this lens, it is easier to see why the State
Department must take a leading role in coordinating the U.S.
government response to international public health emergen-
cies. Indeed, as with many deals reached and crises averted in the
international arena, there is a diplomat behind each deployment
of health-care workers and each development of a new vaccine.
Diplomats bring partners to the table. They expedite pro-
cesses. They keep trade flowing and share the latest information
from the field. And when the doctors and television cameras go
home, diplomats stay behind, advocating social and economic
recovery to return countries to a positive development path. Dur-
ing the 2014 Ebola crisis, more than two dozen State Department
bureaus and offices, in addition to embassies across every region,
contributed to the response and recovery effort.
Yet, despite some successes and ongoing efforts to improve
early warning and response systems, the international com-
munity and the United States remain woefully unprepared to
BY NANCY J . POWE L L AND GWEN TOBERT