In the early spring of 2014, the World Health Organization declared that the Ebola virus it had first detected in rural regions of southeastern Guinea had become an outbreak. Over the subsequent weeks, the virus spread to other countries in West Africa and, from there, sparked global panic that would have dramatic socioeconomic ripple effects.
At the White House, President Barack Obama assembled a team to manage the fallout. The main point person was Ron Klain, who had served previously as the vice president’s chief of staff and who was tasked with running the interagency process.
But at the Department of Health and Human Services, it was Leslie Dach, the senior counselor, who was given the task of coordinating the Ebola response. Over the subsequent months, Dach held daily meetings with the agencies inside HHS. He led the communications and intergovernmental teams, met regularly with Obama, and was point person at HHS for the National Security Council.
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Few people have better insight into what challenges the Trump administration now faces as it attempts to mount its own response to the spread of the coronavirus. But as he surveys what the current president has done so far, Dach isn’t just unimpressed. He believes that Trump is actively making matters worse by politicizing the response, muzzling the experts, and dismantling the government apparatuses that were set up to handle precisely this type of situation. Mainly, however, he said the president is hampered by the fact that he has already irrevocably burned his credibility with a good chunk of the public.
“I think the most important thing is that the American people have to have trust in the messengers,” said Dach. “That they believe that what they are being told isn’t sugar-coated and is the truth. That is the only way they have faith in what you’re telling them, whether you are trying to reduce their sense of risk or get them to be prepared for a real problem. And that is the critical currency that, frankly, this president is lacking.”
Below is a transcript of our talk, edited slightly for purposes of reading.
The Daily Beast: Describe the vastness of such a task of organizing an intra-agency, full governmental response to a pandemic.
Dach: When we go back and think about Ebola, what made it particularly complicated was that we were trying to not only prepare America but also help stop an outbreak overseas and trying to bring all of the country’s resources against both of those challenges. Just within HHS you have a number of very large critical departments that play a role in any of these responses. The Centers for Disease Control, CDC, which is responsible, in a sense, for educating American hospitals and American doctors about how to react and prepare; FDA [Food and Drug Administration] which is responsible for being sure that we approve new drugs and vaccines for use; NIH [National Institutes of Health] which is responsible for creating, developing, and testing those vaccines; and a little-known agency called ASPR, the Assistant Secretary for Preparedness and Response, that is responsible for funding the development of a lot of these therapeutics that the private industry won’t fund on their own. It’s also critically responsible for working with hospitals to ensure they are prepared both in terms of giving them the money they need but also giving them the face masks they need and training they need. That is just within HHS.
The Daily Beast: How many people are we talking about who could theoretically be brought into this type of effort?
Dach: Thousands. Again, in Ebola, we had thousands of people overseas helping to stop this epidemic in Africa. We had members of the military in Liberia there to ensure we could land the airplanes that needed to be landed. We also sent over field hospitals to take care of folks who were sick. Quite importantly, we had hundreds of American doctors there on the front lines, by the way, and many of these capabilities that the United States had have been eliminated by President Trump since he took office.
The Daily Beast: What was the thing that surprised you the most about how the government can and does respond to these types of instances?
Dach: These instances really do demand a whole-of-government response. Because so many parts of the U.S. government have to work together seamlessly and without any politics and without really much concern about how the public views our activities everyday to get the job done.
The Daily Beast: If you’re at the center of it, how is it possible to coordinate all of that?
Dach: It is old-fashioned. It is a lot of meetings and a lot of trust; where people are doing their job, when the experts are respected—not muzzled—when you can build on the fact that you’ve had systems in place for a long period of time, and where somebody with authority can sit at the middle of it all and make sure that everyone is doing their job by demanding they do it right.
The Daily Beast: One of the components of Ebola that threw everyone for a loop was sheer public panic.
Dach: I think the most important thing is that the American people have to have trust in the messengers. That they believe that what they are being told isn’t sugar-coated and is the truth. That is the only way they have faith in what you’re telling them, whether you are trying to reduce their sense of risk or get them to be prepared for a real problem. And that is the critical currency that, frankly, this president is lacking.
The Daily Beast: During Ebola there was a huge amount of paranoia and fear that was not tied to science even as you had the experts out there.
Dach: There is no doubt that people were trying to use Ebola against Barack Obama and against Democrats in 2014. I think what we realized was that the best way to solve that threat was to do our job because in the end that is how we were going to be judged.
The Daily Beast: Do you recall a moment when you thought, during Ebola, ‘We can do this. The interagency process is working?’
Dach: There is no magic moment on this. For many months, I slept with the phone underneath my pillow because I would be among the first of a handful of people called if someone came into the United States with a fever or showing some symptoms. And we would have to make immediate decisions about where that person would be tested, if they had to be quarantined, did we have to wake up the governor of that state who would have to know immediately? We were waiting on pins and needles throughout the night to get the test back to see if we had a case in the U.S.
There were three inflection points. One was when we could see, finally, that the outbreak in West Africa was being contained, through old-fashioned epidemiology but also increased testing and the beginning of therapeutics being shown to work. The second was knowing that we could save lives with people with Ebola. And a third was just when we felt that we had the U.S. hospital system prepared.
The Daily Beast: Were you called the night that the New York doctor went to the bowling alley?
Dach: Yes. Yes I was. And the other bit, just to use an anecdote that was striking to me about what a whole-of-agency response meant, was there was only one incinerator in America that could incinerate sheets from hospital beds where Ebola patients had been treated. These sheets needed to be driven to Texas. So, one, we needed the EPA to get us more incinerators.
The Daily Beast: You had to call the EPA to say we need more incinerators?
Dach: Well, they were at the meeting. Thankfully we had these daily meetings.
The Daily Beast: Who flagged it?
Dach: I don’t remember. But to add to that, there were a number of governors who would not allow the trucks with the sheets to be driven through on the way to the incinerator. So we needed to have police escorts for the sheets.
The Daily Beast: Did you have to go around state lines?
Dach: No. But this is another issue where credibility matters. We had to have the experts explain to the governors, so that they could explain to these people as these trucks went through, that nobody was at risk. These were the issues you kind of had to face for the first time.
The Daily Beast: I mean, why would you ever need to know about the number of Ebola-capable incinerators in the U.S.?
Dach: Yes. Now, one other complicating part is we did not institute a travel ban.
The Daily Beast: Yes, quite famously you did not.
Dach: A lot of careful consideration went into that and it hinged on two things. One was because we felt there was a limited number of travelers that, by funneling them through airports and having a quite rigorous protocol, we would identify anybody who needed care or needed to be tested. But also, we felt that travel to and from those countries was important to keep those countries functional and keep their economies and public health systems functional and that we would have caused more Ebola to occur—both here in the U.S. and around the world—if we shut those economies down. That was a difficult decision, one of the decisions that we took a lot of partisan heat for, which was just not based on science.
The Daily Beast: This is what Trump jumped on. He did the media tour and, if I’m remembering correctly, in a look-back report you all put together, you identified his efforts as a turning point in terms of disinformation and making this into a massive public crisis. In real time, did you realize it was happening?
Dach: We were too into the work. But also, look, there were also people insisting that we had to close our southern border because people were going to come in with Ebola, which was playing to the worst of America. There were no cases south of the border. So that was just an attempt to politicize this.
The other thing that just strikes me, in retrospect, as a difference between Trump and Obama is the nurse who was flown to NIH and who recovered there. The president [Obama] brought her to the White House to showcase and congratulate the people who saved her. And to show that the myths of infection were not correct and that she should not have a stigma. And that we did not have to be afraid. Could you imagine Donald Trump, the germophobe in chief, ever inviting an Ebola survivor [to the White House] and to have physical contact with that person to show America it was OK?
The Daily Beast: With the experience behind you, what do you think the current administration is doing right and what do you think they are doing wrong right now?
Dach: There are a number of things they are obviously doing wrong. One is they are completely politicizing their response. They care more about the stock market and more about their re-election. Donald Trump cares more about being the hero than he does about keeping American people prepared. And that undermines Americans’ trust, the business community’s trust in the information that they are hearing. It’s very harmful.
He’s muzzling the experts. That’s a big problem in terms of trust but also in getting the kind of information you need to make the right decisions. Does anyone really think [Vice President] Mike Pence [who’s been tapped to lead the coronavirus response] is going to contradict the president of the United States in any way or basically be another person in the partisan machine. Those all affect people’s trust but also the nature of our preparedness.
They dismantled the underlying structure that was keeping America safe from pandemics. One of the things we learned is that you can’t predict when the next one is going to happen but you need to be prepared for it. They dismantled that operation and refused to put it back together.
And they are not working with Congress effectively to get the supplemental through quickly and spend it the right way. And I would say they have not worked adequately to prepare the hospital system and our frontline health care workers. We see that both in the whistleblower complaint but also in California where a person had to wait days for testing and then possibly infected health-care workers who were not adequately protected themselves.
Unfortunately, I don’t think the corner has been turned. We still don’t have a clean chain of command. The vice president takes time to go off to CPAC before he has his first meeting and is doing fundraisers. He is not doing his job.
I don’t think much right has been done yet. But hopefully that will change.
