Crisis management is, by its nature, unpredictable – and errors are inevitable. The ability to recognize, acknowledge, and rectify errors rapidly is critical to effective crisis response. Making a mistake is not cause for condemnation – but failing to rectify and learn from it is. And this is why the Trump administration’s dissolution of the White House office responsible for outbreak and pandemic readiness is so important. The decision, made by Ambassador John Bolton soon after he took the reins as National Security Advisor, actively unlearned key lessons from the 2014-15 Ebola outbreak and left the country materially less safe against COVID-19.
The directorate, known as the “Global Health Security and Biodefense” team on the National Security Council staff, was created to address coordination problems that had arisen during the 2014-15 Ebola outbreak. In the early phases of that outbreak, U.S. response and preparedness strategy was fragmented – various parts of the NSC, each connecting to diverse parts of the federal government, held pieces of the puzzle. But no one of them could see the whole picture. And this led to disjointed execution that came to a head when gaps in U.S. policy on traveler screening prompted several governors to impose involuntary quarantines on any medical personnel returning from West Africa.
Ron Klain was soon appointed as “Ebola czar” and immediately consolidated different strands of the disjointed response into a more coherent operation. This new management structure rapidly produced a new federal policy on traveler screening: all travelers from Ebola-affected countries would be funneled through five designated airports, screened upon arrival, and connected to their local health departments for 21 days of active monitoring. The states accepted it, and the response moved ahead. But simply solving this single policy bottleneck required participation from numerous federal and state partners: the FAA (to engage airlines), DHS (which had tools for tracking the departure locations of arriving travelers), Customs and Border Protection (which flags travelers upon entry to the US), CDC (which arranged plans for arrival health screening), HHS leadership, state-level political leaders, and local-level public health departments (which conducted daily follow-up when people returned to their communities). This sort of complex multi-agency, multi-level policy challenge is inherent to novel crises – and is impossible to resolve without strong and expert policy coordination at the White House.
After the Ebola outbreak, one of the key lessons was that the White House must be better organized the next time around. This prompted the creation of a new directorate on the NSC, focused on global health security and biodefense – in effect, preparing the homeland against future outbreak threats by emphasizing both U.S. and international preparedness. The directorate formalized the whole-of-government, domestic-and-international focus that Ron Klain had instituted as Ebola czar, and created a hub for expertise and institutional memory. The architect and initial leader of that Directorate, Beth Cameron, recently wrote an op-ed in the Washington Post criticizing the Trump administration’s historic error of judgement in closing it. And that in turn prompted former National Security Adviser John Bolton’s rebuttal to defend his decision with what can only be characterized as disinformation.
Let’s dissect Bolton’s defense of the president and his decision to terminate the biodefense directorate.
Claims that streamlining NSC structures impaired our nation's bio defense are false. Global health remained a top NSC priority, and its expert team was critical to effectively handling the 2018-19 Africa Ebola crisis. The angry Left just can't stop attacking, even in a crisis.
— John Bolton (@AmbJohnBolton) March 14, 2020
“Claims that streamlining NSC structures impaired our nation’s bio defense are false.”
A basic rule of bureaucracy is that your structures reflect and reinforce your priorities.
Bolton knows this very well.
The organizational structure that is left after a concerted effort to “streamline” reveals what you actually care about. Bolton’s chosen approach to NSC “streamlining” involved decapitating and diluting the White House’s focus on pandemic threats. He eliminated the Senior Director position entirely, closed the biodefense directorate, and spread the remaining staff across other parts of the NSC. That’s the opposite of streamlining. Instead of giving the issue a distinct institutional presence, expertise, and voice in the policy process, Bolton’s reorganization left it fragmented across other directorates that were focused on other higher priorities.
Bolton’s organizational choices meant the NSC didn’t have a cohesive team able to elevate pandemic readiness expertise directly to senior leaders. Instead, the NSC had director-level subject-matter experts scattered around with limited influence and little ability to reach decision-makers. These people were highly capable and impressive, but their influence was diluted by the new structure. This can cost lives in a crisis. As Cameron wrote, “In a health security crisis, speed is essential. When this new coronavirus emerged, there was no clear White House-led structure to oversee our response, and we lost valuable time.”
Shuttering the biodefense directorate clearly reflected the White House’s misplaced priorities and has proven to be a gross misjudgment. Again, Bolton knows this very well.
“Global health remained a top NSC priority”
That statement is no defense; it’s a sleight of hand. Global health is NOT the same as pandemic readiness. U.S. global health programs focus on all sorts of valuable efforts overseas. AIDS programs. Vaccine programs. Safe childbirth programs. And a lot more – all noble and strategic parts of U.S. foreign policy.
But arguing that global health somehow equates to health security is wrong. U.S. global health programs focus predominantly on existing chronic health problems and small-scale outbreaks in developing countries, and far less on health security readiness for future pandemic contingencies. And importantly, the modest overseas CDC and USAID efforts supporting basic outbreak readiness in developing countries have repeatedly been targeted for cuts by this administration – a practice made easier by their lack of an empowered defender on the NSC staff.
In any case, global health programs are global; they don’t address US domestic readiness. Hence the other keywords in the title of the directorate that Trump and Bolton abolished: “Global Health Security and Biodefense.” Global health is not a substitute for U.S. domestic readiness or large-scale pandemic response (and placing elements of pandemic expertise under the Weapons of Mass Destruction directorate, as they did, doesn’t achieve that either).
Bolton appears to be either deliberately deceiving his audience or revealing his ignorance of the capacities he dismantled.
NSC’s “expert team was critical to effectively handling the 2018-19 Africa Ebola crisis”
The 2018-19 Africa Ebola crisis was not remotely comparable to today. It posed no real threat inside the United States, posed a far more limited risk globally, and in any case was not a dazzling example of strong US leadership. I delved into further analysis of what went wrong in a tweet thread on Saturday. Suffice it to say here that many experts criticized U.S. policy and performance at the time, including a group of global health experts in the Journal of the American Medical Association, global health experts from John Hopkins’ Center for Health Security and Department of Environmental Health and Engineering in the New England Journal of Medicine, the International Rescue Committee’s Ebola response program director, the Director of Harvard’s Global Health Institute, and others. What explained the source of the administration’s problem at the time? Former White House Ebola czar Ron Klain’s op-ed in the Washington Post in 2019 will sound eerily familiar:
A major challenge is a lack of White House leadership. After Ebola was defeated in West Africa in 2015 (and after I left the post of Ebola Response coordinator), President Barack Obama created a special National Security Council team to oversee epidemic preparedness and response on a permanent basis. Trump retained the unit during his first year in office, but on the day that John Bolton took over as national security adviser in 2018, he dismantled the unit and ousted its leader, the widely respected Rear Adm. Timothy Ziemer. Perhaps fighting epidemics didn’t fit Bolton’s ‘hard power’ view of security.
Current criticism of cutting the directorate is no Monday morning quarterbacking. The point of the directorate was to protect the United States by focusing simultaneously on both U.S. and overseas readiness – institutionalizing the hard-earned lessons from 2014 about the importance of integrating domestic and overseas pandemic readiness and response. Many (including me) objected to its dismantling at the time; we knew the vulnerabilities this would create. A loud chorus of global health experts and political leaders very vocally raised concerns when it was reported that the biodefense directorate was to be abandoned. Moderate Democratic Senator Sherrod Brown of Ohio, for example, wrote the president saying the decision could cost American lives. Lisa Monaco and Vin Gupta wrote that disbanding the office and deprioritizing biodefense was “dangerous, given the steady stream of global reports suggesting that transmission of potentially deadly zoonotic diseases, where pathogens move from animals to humans, is rising at an alarming rate.”
Bolton’s defense is entirely bogus. What emerges inescapably is that he is either confused about the nature and purpose of the team he disbanded, or he just hopes to confuse the rest of us. Now that his blunder is actively endangering US security, he is scrambling to evade responsibility. So too is the president. In response to PBS NewsHour’s Yamiche Alcindor, who asked directly, “You said that you don’t take responsibility, but you did disband the White House pandemic office and the officials that were working in that office left this administration abruptly, so what responsibility do you take to that? The officials that worked in that office said that the White House lost valuable time because that office wasn’t disbanded. What do you make of that?” The president passed the buck, calling it “a nasty question.” “When you say ‘me’, I didn’t do it,” he added.
What Americans need in this dire moment of national crisis is honest and responsible leadership. We are seeing impressive examples of that from Republican and Democratic governors and mayors across the country. Bolton’s defensiveness, and that of his former deputy Tim Morrison too, is revealing. Rather than reckon with their mistakes and try to fix them, Trump, Bolton, and Morrison instead insist that any criticism of ongoing missteps is invalid. “A public health emergency is exactly the wrong time to undermine confidence in the government,” Morrison recently wrote.
They are wrong. A public health emergency is exactly the time when experts should praise and criticize where merited, and the government should be eager to hear both forms of analysis. What undermines public confidence is not the critics who point out government errors; rather it is the administration’s own failure to acknowledge those errors and rectify them.
Photo: PBS NewsHour’s Yamiche Alcindor asks President Donald Trump about decision to close National Security Council Directorate for Global Health Security and Biodefense, March 13, 2020.