Ebola Specialists Think Globally, Congress Thinks Domestically

With President Obama’s new Ebola czar invited but absent, a House oversight panel on Friday quizzed officials battling the virus on ways to reassure the American public of agency competence.  But the committee elicited mostly a consensus among experts that the highest priority is containing the disease in West Africa.

Rep. Darrell Issa, R-Calif., chairman of the Oversight and Government Reform Committee, convened the hearing expressing disappointment that Ron Klain, a Democratic attorney and former White House administrator whom Obama appointed a week ago to coordinate the effort against Ebola, had declined to testify. “His appointment sadly shows that the administration recognizes its missteps, but it has not chosen to put a medical leader in charge,” Issa added, allowing that Klain is new on the job, and will be expected to testify in the future.

Rep. Trey Gowdy, R-S.C., was harsher, citing suspicions about Klain’s political background. “Why a dadgum lawyer as Ebola czar instead of someone with your vast experience?” he asked Dr. Nicole Lurie, assistant Health and Human Services secretary for emergency preparedness and response.

Klain has "tremendous experience, and I have a full-time job,” she replied. “One of the wonderful things about government is we have a tremendous number of doctors, nurses and infectious disease experts,” she added, naming Centers for Disease Control and Prevention Director Thomas Frieden and the top executives at the National Institutes of Health. “I have confidence in Mr. Klain. It’s important for the public that there be only one or two spokesmen.”

Rep. Danny Davis, D-Ill., said, “There are those who know things, and those who know how to make things happen.”

The participants welcomed Friday’s news that Dallas-based nurse Nina Pham had been cleared of Ebola, and members praised New York City’s rapid response to the recent revelation that physician Craig Spencer had contracted the virus in Africa, had circulated in the city, and is now in treatment.

But Issa said recent public statements by the CDC had “eroded confidence in our response,” jabbing Frieden for “guessing” from long-distance about how much protective equipment nurses should be wearing in the Dallas hospital that treated the first Ebola patient diagnosed in the United States. “We all know the system is not yet refined so that it is working properly,” he said.

Ranking Member Rep. Elijah Cummings, D-Md., said he “understands why the American people are worried since health care workers and men and women in uniform are putting themselves on the line.” But, he said, “The Ebola crisis is in Africa, and it is in our self-interest as a nation to get it at its source.”

Lurie defended the administration’s progress, despite some missteps. “We are learning new things about Ebola in West Africa every day and adjusting as we go,” she said. She stressed HHS’ education and communication efforts, pointing to a single conference call that included 10,000 hospital workers. “It’s a whole of government approach, including state and local coordination. I can assure you that our team and the department is working 24/7 to make efficient use of resources,” Lurie added, noting that when possible officials proceed with “an abundance of caution.”

But that characterization met skepticism. “I would warn against panic but also against happy talk,” said Rep. Stephen Lynch, D-Mass. “When agencies come to me and say ‘It’s all under control,’ I start to worry.”

Deborah Burger, a nurse who is co-president of National Nurses United, said the CDC’s voluntary guidance needs stronger enforcement through a new law or presidential order. As many as 85 percent of her members say they’re not adequately trained in handling diseases such as Ebola, 80 percent say they have no opportunity to interact with authorities and ask questions, and 46 percent say they have insufficient supplies of protective clothing, she testified. “You wouldn’t send troops into battle without armor,” Burger added.  “Give us the tools we need.”

Several lawmakers said their constituents worry about the safety of the 3,000 U.S. troops that will be in West Africa helping with logistics and building of infrastructure in a region where 4,000 have already died of Ebola. Assistant Defense Secretary Michael Lumpkin reminded the panel that the troops have no duties involving health care of patients and that daily medical checks are in place.

 “But we have unique capabilities so we were called upon to provide an interim solution until other agencies can provide their own,” he said, referring to the U.S. Agency for International Development’s need to build roads and clinics in nations where it rains 200 inches a year. “Our government deployed a top-notch team to an effort that is increasingly regional, and the speed and scale of our response matters,” Lumpkin said. “It’s truly a national security issue in that Ebola brings a risk to the U.S.” The United States, he added, “is leading and galvanizing support, so the international community is coalescing.”

The notion of the United States as world leader against Ebola was seconded by Rabih Torbay, senior vice president of International Operations for the nonprofit International Medical Corps, which has staff on the ground in West Africa. “The U.S. is pivotal, but other countries are following the U.S. lead on this global issue,” he said. He praised the United Kingdom for contributing money toward resources and training but noted that France and other European countries have not. “We need to contain Ebola at its source,” Torbay said, stressing the importance of managing burial procedures, evacuating health care workers and building over the long term a stronger health care system in that region.

The Homeland Security Department came in for criticism by its inspector general, John Roth, who reviewed an audit last month saying the department was not ready for an Ebola pandemic. It had mismanaged purchases of anti-viral drugs and equipment such as respirators, neglecting to plan for replacement of items with a finite shelf-life, proper storage and operating under a strategic needs assessment, Roth said.

Several lawmakers called for strengthening CDC and the Defense Department’s authority to impose emergency quarantines, perhaps a new 21-day delay in Africa before people fly out.  And Issa lamented that the World Health Organization, highly active against Ebola, had declined to attend the hearing, even though half its funding comes from the United States.

Rep. Jim Jordan, R-Ohio, confronted Lurie with a $38 million list of NIH expenditures he considered silly, among them fruit and vegetable puppet shows stressing healthy menus for children and studies on encouraging senior citizens to join choirs. “Wouldn’t we now have two Ebola vaccines if we hadn’t spent money on those?” he asked.  

Looking pained, Lurie said, “I don’t think that’s the case, it’s a long process. You misunderstand how the NIH budget is allocated.”