Just for a minute or two, let us put the specifics and growing flood of the epidemiological and medical information about Ebola to one side, and, instead, let us focus on the US domestic politics of this disease. And inevitably, too, there is the question of the impact on the Obama presidency, with the midterm election barely two weeks away. By J BROOKS SPECTOR.
In recent weeks, as Ebola claimed its first victim in America, the director of the Centers for Disease Control (CDC), Dr Tom Freiden, has attracted increasing criticism regarding the US government’s response to a potential Ebola crisis in that country. The growing stream of criticism, some of it quite stinging and coming during congressional committee hearings, represents the first real blemish on Freiden’s otherwise highly regarded career in public health. He became CDC director five years ago, following seven years as New York City’s commissioner of health. In NYC, he had been in the forefront of pushing for measures to lower smoking among teenagers and bring down the use of those nasty trans-fats in restaurant cuisine. Prior to coming to NYC, Freiden was at the CDC for over a decade, working on the treatment and control of tuberculosis and he had also been part of World Health Organization in anti-TB initiatives in India. When he took over the CDC, he almost immediately became the national point man in combating the swine flu epidemic that autumn.
But his classy professional profile has been standing him in remarkably little good stead as this newest crisis unfolds. As the most visible federal official on Ebola, save for the president, perhaps, Freiden has been taking the brunt of criticism from Republican congressmen and senators – as well as a rising chorus of vitriol from the more right-wing quadrant of the media. This outpouring of criticism has been coming Freiden’s way despite the fact there has been exactly one fatality from Ebola in America (Thomas Eric Duncan, a Liberian citizen, arrived in the US with the virus already in his body), and just a trio of health professionals have actually been confirmed to have been exposed to the virus sufficiently to be listed now as having been infected by Duncan.
And despite this virtual lack of any actual (as opposed to potential) public health emergency with Ebola infections in America, schools have actually been temporarily closed in one local school district in Ohio on the grounds of possible exposure to the virus. In this case, someone presumably exposed to Duncan had, in turn, exposed others to the threat of the disease. And another person on a cruise ship spent the entirety of her cruise in total isolation on the grounds she may have been exposed as well.
As a result of this, health authorities have started to become much more aggressive in disinfecting possible transportation avenues – such as the airplanes used by some of those presumed to have been exposed to Duncan weeks earlier. In another case, one of the original people exposed to Duncan in his Texas hospital has now been dispatched to one of those total isolation wards on the campus of the National Institutes of Health in the Maryland suburbs near Washington, DC. (The NIH is the nation’s premier medical research facility, and it is an irony that has largely gone unnoticed that Republican-led budget cuts have slashed funding in recent years for grants to unravel a vaccine for Ebola.)
But, still, none of these cases – or presumed or actual exposures – has generated any further fatalities, beyond the ill-fated Thomas Duncan. Regardless of the lack of a full-blown epidemic in the US (as opposed to those raging in several West African nations, of course), a thoroughgoing panic has taken hold in the minds of many Americans over the possibility that a full-blown Ebola epidemic is poised to descend on America and only drastic measures such as a quarantine of West Africa will help.
Throughout the American spring and summer, and now well into autumn, the CDC director was in the forefront in both encouraging and chivvying state and local health departments, and individual private and public hospitals, to adopt rigorous identification and monitoring of anyone exposed to an actual Ebola patient (Ebola is not spread through the air and thus seems to have a slow contagion rate, limited to people in close contact with a victim’s body fluids). This has been in addition to protocols for the stringent isolation of those exposed, hazmat protection for caregivers and disinfectant protocols for treating anyone actually presenting with symptoms of Ebola. This is in addition to recognising the near-inevitability that some people – health professionals, relatives, and even some unwitting strangers – will have been exposed to such patients and that some of those may present symptoms of Ebola, despite all the precautions being taken.
The Obama administration’s message on Ebola, however, seemed to alternate between, on the one hand, periods of upbeat reassurances to an increasingly jittery population from some officials that everything was under control, with worrying messages of sombre and growing concern and the need for some real heavy lifting in preparations by the many parts of the nation’s health care system. The administration’s message seems to have had this awkwardly punctuated rhythm, at least in part, from the fact that various people, at various times, were speaking on behalf of the government – and coordination for the overall message and the planning both had effectively been lodged with Lisa Monaco, a staffer in the office of the president’s national security advisor. Monaco is a lawyer (rather than a public health specialist or doctor), and her primary responsibilities have been policy coordination in the areas of “homeland security” and international terrorism, rather than pressing questions of international public health or other non-traditional, transnational concerns like Ebola.
The result was this less than optimally delivered message, as well as actual gaps in the real planning that had been exposed by the various problems that emerged around Duncan’s treatment and the ensuing efforts to identify, monitor and manage the care of those exposed to him – or those exposed to those who were supposedly exposed to him. This has helped open yet another front for those who dislike Obama, those who distrust him, those who oppose him politically, or those who have what seems to be an almost pathological hatred of him. Typically astonishing broadcast comments have come from people like Rush Limbaugh who charged, “People at the highest levels of our government say, ‘Why shouldn’t we get Ebola?’ ”; there was also Laura Ingrahm’s insistence Obama is willing to expose the military to Ebola “to carry out this redistribution of the privileged’s wealth;” Michael Savage’s equally wild-eyed charge Obama wants “to infect the nation with Ebola” in order “to make things fair and equitable” in the world; or Dr Keith Ablow’s nonsensical statement that Obama “may literally believe we should suffer along with less fortunate nations”.
Now more rational Republicans probably are reluctant to repeat such charges directly, although there have been precious few calls for such people to stop with these calumnies. As such, it should come as no real surprise these wild-eyed charges and the congressional attacks on Freiden have come to a point just as the US midterm election is barely more than two weeks away. And this is happening as Republican opponents of the president sense a real opportunity to grab the majority in the Senate, as well as to hold their current majority in the House of Representatives – and that charging a presidential team asleep at the switch on Ebola can only help the Republican cause.
Sensing this weakness in an already wobbling campaign to hold the Democratic majority in the Senate (the Republicans are advantaged by the fact that a large number of Senate seats up for election are currently held by vulnerable Democrats or which have no incumbent standing for re-election), some Republicans are calling for the removal of CDC Director Freiden, for barring flights into the US from any area now affected by Ebola, and for giving a quick thumbs-down on the president’s newest move to deal with Ebola announced last week. That last is, of course, the president’s decision to appoint an Ebola “czar” in the person of Ron Klain. Appointing a “czar” for a particular policy knot is rather usual practice in the US federal government when the problem seems to widely overlap across many complex, tangled bureaucratic responsibilities and authorities.
Klain has years of experience as a political operative and political manager – most recently as Vice President Al Gore’s chief of staff and the man who finally guided the Gore campaign to end its effort to oppose any further moves to contest the 2000 election in the face of disputed returns from Florida. (Kevin Spacey stunningly portrayed Klain in the made-for-television movie Recount a few years back.) More recently Klain has been managing the investment vehicle established by Steve Case, the founder of AOL.
The initial knock on Klain, even though he is has barely had a chance to get his first briefings on his newest task, has been that, just like Lisa Monaco, Klain isn’t a doctor, an epidemiologist or a public health specialist either. Of course, the real 24/7 tasks Klain will confront are not, strictly speaking, going to be medical ones anyway. Rather, they will be to surmount complex, interwoven managerial and messaging tasks – something Klain would seem to be particularly well suited to carry out, given his curriculum vitae.
Instead of carrying out medical research in a science lab, himself, Klain’s real job is going to be to pull together all of those sometimes widely disparate messages emanating from all those different federal government agencies – the CDC, the NIH, the federal Department of Health and Human Services more generally, as well as the Department of Homeland Security (the department responsible for border control), the Defense Department – in addition to thousands of state, county and municipal health agencies throughout the country. And, of course, Klain will have to take command of the messages on Ebola that emanate from the White House as well, messages that will be coming out of the president’s various visits around the country, his many speaking engagements and all of his responses to questions at media events.
Perhaps the biggest problem for Klain and the president (aside from the hoopla over Ebola in America that may well contribute towards further erosion of Democratic levels in Congress) is that at a broader level, Ebola is simply the latest version of how Americans see their government as incompetent in carrying out its core responsibilities, or in acting inimically on citizens as it attempts to do so. Ross Douthat, the New York Times’ resident conservative critic, wrote over the weekend that the nation’s “conspiracy culture, while always resilient, has had a tough go of it of late. From the Iraq war to Hurricane Katrina and various Obama-era debacles, the public has been steadily conditioned to fear government incompetence much more than it fears secret conspiracies against the public good. Instead of the Bilderbergers and the Trilateralists and the cigarette-smoking man, it’s Mike ‘heckuva job’ Brown and George ‘slam dunk’ Tenet and whoever was allegedly in charge of the V.A. hospital system who haunt our collective unconscious these days. People still indulge the occasional ‘House of Cards’-style fantasy of all-powerful political puppetmasters, but what actually scares us is the idea of the Ebola epidemic being managed by the gang from ‘Veep’…. Wisely or not, Americans have trouble imagining the White House that gave us the HealthCare.gov rollout, micromanaging partisan I.R.S. chicanery, or the national security bureaucracy that couldn’t see 9/11 or the Islamic State coming doing anything all that Machiavellian with a firehose’s worth of online data.”
But Douthat makes the interesting further point that “[b]ecause plausible arguments have been offered for and against a travel ban [a growing demand by some Republicans and others, despite explanations that it will do little more than mask where any potential disease carriers have actually come from], the administration’s actual response will be an interesting case study. As much as the authorities have fouled up so far, we’ve only had a few infections. If the White House continues to resist calls for more dramatic measures, and we manage to contain Ebola domestically, then the president and his appointees will look more competent and level-headed than their critics — a result that’s all too rare these days.”
Moreover, if Klain manages to help guide all those different government instrumentalities into pursuing a cogent, coherent, congruent strategy, as well as the words to describe it accurately, this may actually help the government pursue more tightly targeted, better-focused, and more extensive international interventions on dealing with Ebola in the current West African outbreaks and developing preventive vaccinations for Ebola. Along the way, the reassurance to Americans – as well as the rest of the world – that this disease, like so many others, can be beaten would be a palpable contribution to controlling the global panic over this disease. DM
Photo: A protester stands outside the White House in Washington DC., USA, 17 October 2014 holding a placard asking President Obama to ban flights in effort to stop Ebola , the deadly epidemic that has already reached US soil. The debate surrounding travel bans as a way to curb the spread of Ebola has intensified after a congressional hearing on 16 October 2014, unleashing a flurry of impassioned arguments on both sides. EPA/OLIVIER DOULIERY
- Texas Hospital Director ‘Deeply Sorry’ for ‘Mistakes’ at NBC News
- How the microscopic Ebola virus kills thousands at the Washington Post
- The Ebola Scare at the New York Times
- Obama taps Ron Klain as Ebola czar at the Washington Post
- The Ebola epidemic in West Africa poses a catastrophic threat to the region, and could yet spread further at the Economist