Sunday, September 14, 2014

A lot has happened over the past few days. There has been a considerable amount of disorganization, diffusion, and lack of direction at the level of HHS as well as the rest of the USG (USAID, DoS, etc.). It has been announced that the President will visit the CDC on Tuesday, September 16. It is anticipated that he will announce that the United States military will get heavily involved in the response to Ebola by providing up to 1700 hospital beds as well as the logistics for transportation and provision of equipment. However, it is very clear that they will not provide medical personnel in the form of doctors and nurses. This might leave us with the situation in which we have equipment but the inability to implement it. HHS (Leslie Dach) is desperately trying to figure out ways to recruit and train medical personnel to man the hospitals. Of note, it might take up to 8 weeks to get these hospitals operational, if in fact, the US military decides to send them. The situation in the West African countries is still dire. I have been on the phone discussing this on multiple occasions over the past few days with Paul Farmer and Mike Gerson. Paul will be leaving tomorrow, September 15, for Liberia in order to set up hospitals under the auspices of Partners in Health, the organization that Paul and Jim Kim founded many years ago. Francis Collins, Cliff Lane, and I are still pushing HHS to suggest that there be a person in the White House who would be the overall Director and point person for the government's Ebola efforts. I have suggested to Francis and Francis has suggested to the secretary that that person either be someone like Gen. David Petraeus, Gen. Stanley McCrystal, or even former majority Senate leader Bill Frist. Again, I am concerned about the lack of organization, direction, and commitment on the part of the department as well as the White House. The President is having a very difficult time in that he is being pressured to respond firmly to the threat of ISIS in the Middle East. I feel that this pressure may make him and the administration less enthusiastic about getting heavily involved with the Ebola issue. Nicki Lurie, who is a good person and a friend, is making things more confusing by trying to suggest how to do clinical trials, train people and other tasks when she knows little about these issues. She is an Assistant Secretary and so officially she outranks us all (me, Peggy Hamburg, Francis Collins, Tom Frieden); yet, she gets in the way more often than not. Had a long conversation about this with Peggy Hamburg on the phone today. Paul Farmer is encouraging me to continue to push the envelope to get the USG to do more. Paul is showing an amazing amount of faith in me that I can fix this. He is basing this on his experience with me with PEPFAR. However, this is different since there are so many “cooks” in this process.