In October 2014, in the throes of one of the worst epidemics in human history and facing mounting and sometimes partisan criticism of what some saw as delayed reaction to a crisis going out of control, then-President Barack Obama created the office of “Ebola response coordinator”—more commonly referred to as “Ebola Czar.”
The Ebola czar was Ron Klain, who prior to his position was the chief of staff for Vice Presidents Al Gore and Joe Biden. Klain had no medical or public health experience, but was able to wrangle together a response that helped contain the virus’ vicious spread and effectively terminate the disease’s existence in West Africa by early 2015.
“It makes sense for us to have one person [coordinating Ebola efforts] so that after this initial surge of activity, we can have a more regular process just to make sure that we’re crossing all the T’s and dotting all the I’s going forward,” Obama said at the time of Klain’s appointment.
A few years later, in light of a recent outbreak that has begun to claim lives and spread at a worrisome rate, the question remains: Did Ron Klain’s legacy as the Ebola czar work? Are all the T’s crossed and the I’s dotted?
Not quite—though Klain, who currently serves as general counsel at Revolution LLC, a Washington, D.C.-based venture capital firm, says he’s cautiously optimistic that the groundwork he laid out during his time as the Ebola czar will have made fighting this outbreak one that doesn’t lead to the horrific public health emergency in West Africa that led to over 11,000 deaths and nearly 30,000 infections.
“I think there’s some good news and some things we should be worried about,” Klain said. “There are clearly tools available this time that weren’t available last time, which most notably includes the Merck vaccine.”
That Merck vaccine could be the game changer in this most recent outbreak, potentially stymieing the rapid advance of a disease whose vicious capabilities to overwhelm the human body’s normally strong immune defenses and cause multiple organ failure with speed and violence has marked it as one of the most frightening modern diseases—one made even more so by its high fatality rate.
Klain noted that the 4,300 doses of the experimental vaccine V920 are reportedly being sent to the area by the World Health Organization—which could be a big first step toward trying to stem the rapid advance of the disease by not only containing it but also protecting individuals who might contract it.
“That’s one tool that wasn’t available last time,” Klain points out.
And that’s important, because as Klain ticked off next, a “perfect storm” of factors made the last Ebola crisis that much more dangerous.
“One, we have an awareness of an outbreak becoming an epidemic,” Klain said. “In 2014, there had never been an Ebola epidemic before. In 2014, we couldn’t have imagined something like this before.”
Outbreaks, if ignored, lead to epidemics that can become unmanageable and increasingly difficult to deal with, leading to a rise in deaths.
Second, and perhaps most crucial at this point of the outbreak, is the fact that there is a vaccine that is close to operational. V920, a genetic recombinant of the rVSV-ZEBOV vaccine, is not FDA approved; its initial form as rVSV-ZEBOV earned rave reviews after the British journal The Lancet published results that suggested its application on patients in Guinea and Sierra Leone in a randomized trials showed “substantial protection,” with patients remaining Ebola-free 10 days after vaccination.
That’s huge, and Klain said the research behind it is overwhelmingly positive and noted the FDA—while yet to approve it—has labeled it a breakthrough therapy, which means it is on the fast track toward approval.
Third, Klain said that we’ve got experience on our side. The last epidemic was one that took thousands of lives, but being on the ground and being able to help teach techniques to public health officials about proper treatment, burial, and disease prevention techniques means that those practices can be revived and put into practice. “The survival rates [before the U.S. got involved] were around 30 percent at the outset,” Klain said. “By the end, they were at 70 percent surviving. People on the ground developed more expertise.”
Still, Klain is unsure if the Trump administration has taken the right steps toward actually addressing the outbreak and ensuring it’s taking all steps possible to help stymie the outbreak.
For one thing, he’s worried that early statements from the World Health Organization and other locally based organizations are similar to the last outbreak, and that the “everything is fine!” tone in these messages may not reflect the situation at hand. “There’s a perennial underreaction in the early phases,” Klain said. “We still don’t really know what the status or situation of the outbreak is.” Sure, we know what the death toll is as it stands (25, with at least 45 confirmed cases, according to The Washington Post), and that the disease has migrated about 80 miles from its source into a nearby metropolitan area, but Klain stresses that we don’t really know yet “what’s going on. I think there’s a little too much optimism and almost self congratulation in the first couple days last week.”
And the fact that the disease has no moved to a city strikes Klain as a warning, a “flashing light,” particularly as locals and on-the-ground public health officials await vaccinations. “No one’s been vaccinated yet,” Klain reminded. “It’s a logistical challenge. The vaccine has to be kept very cold and we don’t know who many people will accept the new vaccine”—which means we don’t quite yet have a hold on the disease, and that the disease is still therefore spreading and uncontained. That’s dangerous.
Having the vaccination on the ground is only part of how the United States should respond, said Klain. “It’s only step one,” he emphasized. “Something else to consider is what role the U.S. will play.”
In 2014, that response included what President Obama referred to as the equivalent of a medical SWAT team with two organizations: CERT, or CDC Ebola Response Team, and FAST, the Facility Assessment and Support Teams. CERTs had between 10 and 20 people drawn from the Centers for Disease Control and Prevention in each team, sent to hospitals and laboratories to help confirm cases; FAST helped hospitals deal with these diseases. This was in addition to a military response and working with NGOs in distributing medical help and information to help contain the disease, such as education on how to properly bury the dead and proper quarantining procedures to help contain the disease.
But this most recent Ebola outbreak has not received any official attention yet. The Daily Beast reached out to the White House and asked about what plans the administration had to respond to this most recent crisis and whether another Ebola czar would be put in place (Klain’s term ended in February 2015), but received no response.
Klain also believes that criticism of the Obama administration to the Ebola crisis of 2014 in October of that year—nearly a year after the first case was reported in December 2013 in a small village in Guinea when an 18-month-old child was probably infected by bats—as “too little, too late” was unfair and incorrect.
“I certainly don’t agree with that, that with 2014 it was ‘too little, too late,’” he said. “Obviously, in 2014, the U.S. was the leader in the effort against Ebola. President Obama mustered the government response. We sent thousands of Americans to West Africa to fight the disease”—which included medical response teams and the American military to help coordinate efforts to contain Ebola.
“In October [when Klain was made the Ebola czar], leading experts were predicting a million deaths,” he said. “The actual death toll was less [final estimates were over 11,000]. President Obama summoned the largest ever response, and it certainly played a role in saving hundreds of thousands of lives. We played an essential role in bending the curve in 2014.”
But Klain said that the fact that the Trump administration hasn’t announced any plans to address the outbreak is troubling. “What the U.S. will do to be be active remains unclear,” he said. “Obviously with President Trump in charge, it’s hard to know.” Klain was not only referring to the administration’s silence in future plans of handling the outbreak but also Trump’s previous reaction to the treatment of American Ebola patients within the country:
“We know what Donald Trump said in 2014, and how he opposed efforts in West Africa and opposed brining U.S. aid workers who got Ebola home,” Klain said. “His position [was] that they should be left in Africa to die. That mindset is not helpful if we are going to send people to help as well.”
So if Klain was Ebola czar again, what would he do? That all depends on how the on-the-ground efforts are going, and how quickly the outbreak escalates. “If there are a few dozen cases, I think it can be managed,” he said. “But if it’s more significant than that, then we need a greater commitment from the U.S., like DART (the Disaster Assistance Response Teams).”
The trajectory of this current outbreak will rely on how local medical and health efforts are working to contain the disease, which is unclear at this point as vaccination efforts have not yet begun in full force. “If it were my decision as a government official in the DRC to authorize its [the as-yet-unapproved by the FDA vaccination’s] use, I would authorize its use.”
Klain emphasized that regardless of how quickly vaccines get delivered to the DRC and how quickly public health measures get implemented, with or without the U.S.’ help, it’s important to be vigilant and not become complacent. “The one thing we have to remember with Ebola is that it’s never over until it’s really over,” he warned.