The Foreign Service Journal, May 2017

30 MAY 2017 | THE FOREIGN SERVICE JOURNAL Of all the options for staffing this unit, the Public Health Service of HHS made the most sense. It consists of vet- ted U.S. government employees subject to discipline and deployment rules established for this uniformed service who, as individuals, are highly motivated to use their skills to fight Ebola. When the call went out for PHS volunteers, projections for infection were catastrophic. Despite the substantial risk, more than 1,000 of the 6,000 commis- sioned corps officers volunteered for duty in Liberia. Deploying the PHS, however, was complicated. The vol- unteers all had domestic assignments for which it was dif- ficult or impossible to find temporary replacements. There was no direct PHS doctrine or precedent for an operation of this size and character. My office, Global Affairs, worked with Embassy Monro- via, USAID, CDC and the Pentagon to establish responsi- bility for reporting chains, security and force protection, and specialized Ebola training. We negotiated the right to practice medicine and prescribe drugs in Liberia, living arrangements, water supply and definitions of health workers for patient access. In setting treatment protocols, we turned to, among others, Kent Brantly, the missionary doctor who had been evacuated from Monrovia. He eagerly advised what would have been necessary to have saved his own life and the lives of his patients in Liberia in 2014. HHS also played a vital role in the response to the Zika virus outbreak in Brazil. The HHS Office of Global Affairs led a delegation of senior HHS scientists to meet with counter- parts in Brasilia to overcome bottlenecks in cohort stud- ies, sample sharing and institutional arrangements. The 14-point action plan developed, assigning responsibility to HHS divisions and counterpart Brazilian parastatal orga- nizations, proved extremely valuable. Though the Dilma Rousseff government subsequently fell, the institution- to-institution agreements were carried out with very little interference or loss of momentum. Even before we knew Ebola was a problem, in Febru- ary 2014, then-HHS Secretary Kathleen Sebelius, together with the State Department and National Security Council, launched the Global Health Security Agenda. A growing, mul- tisectoral partnership, GHSA has become the world’s vehicle for scaling up to prevent outbreaks in the weakest health systems from becoming pandemics, threatening all of us. GHSA’s premise is that to contain a naturally occur- ring outbreak, a lab accident or a bioterrorist attack, the first response has to be the health system that identi- fies the pathogen, does the surveillance, finds its origin and promotes measures to limit its damage. If it is a bioterrorist incident, security services will, of course, be involved. But protecting the public relies on a resilient health infrastructure, and especially the case manage- ment, emergency operations centers and established protocols that CDC is so good at. On this basis the U.S. government was able to convene quite a few govern- ments and partners, and strengthen the World Health Organization to promote and scale up worldwide out- break preparedness and response. As the HHS presence grows overseas, there is renewed discussion of an “HHS Foreign Service.”While it could ease overseas staffing and rotation issues for which the Civil Service does not have a workable alternative, I don’t see that as the best option. HHS’ distinctive value is that its key staff are subject-matter experts, scientists, different from but mutually supportive of generalist diplomats. An even more important consideration is that nearly all of HHS international assignments use PEPFAR, GHSA and the U.S. President’s Malaria Initiative programmatic money, with no guarantee of career-long sustainability. In my Foreign Service experience, contacts between health scientists and diplomats were rare, and use of scien- tific data in démarches or political dialogue was haphazard or non-existent. But today, with the State Department’s Offices of International Health and Biosecurity and Global Health Diplomacy, HHS can be an essential partner to help the two cultures appreciate and take advantage of their respective strengths. n HHS’ distinctive value is that its key staff are subject-matter experts, scientists, different frombut mutually supportive of generalist diplomats.