Tuesday, May 11, 2021

Biden’s chief of staff has battled pandemics before. Here’s how he plans to beat this one.

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Now Klain is on the verge of returning to the White House as chief of staff to President-elect Joe Biden as the country battles a raging pandemic far more deadly and pervasive than Ebola ever became. As one of the key architects of the incoming administration’s Covid-19 plan, Klain’s experience is already shaping how the next administration will respond.

“Klain’s Ebola work, in particular, has played into things hugely — starting back during the campaign with all our messaging and conversation about what to do,” said Dr. Nicole Lurie, who coordinated pandemic preparedness for the Health and Human Services Department during the Obama administration and served as a public health adviser to Biden’s campaign.

Starting back in the early days of the coronavirus outbreak, Klain was part of a tight circle of longtime Biden allies briefing the then-candidate multiple times a week on the pandemic’s progress and advising the policy team as it put together plans on testing, contact tracing, production of protective equipment and preparations to distribute a vaccine. He also served as the public face for Biden’s strategy — standing before a whiteboard in a series of viral campaign videos, walking viewers through his criticisms of Trump’s pandemic response and explaining what Biden would do differently.

Klain is one of a number of people Biden has tapped for his administration whose views on battling a health crisis were shaped by what happened in 2014. At an event in Wilmington, Del. last week, Biden highlighted how his just-announced pick for Homeland Security secretary, Alejandro Mayorkas, helped combat Ebola and Zika as part of the Obama administration. Linda Thomas-Greenfield, his pick for UN ambassador, “was our top State Department official in charge of Africa policy during the Ebola crisis,” Biden noted. And the former vice president praised Jake Sullivan, who served as his national security adviser during much of the Ebola outbreak, for “helping me develop our Covid-19 strategy.”

The coronavirus outbreak is different from Ebola in important ways. Covid-19, for instance, is spread much more easily — through tiny droplets that can hang in the air rather than direct contact with bodily fluids. And as Klain himself testified to the House Foreign Affairs Committee in February, “We know much less about coronavirus today than we did about Ebola in 2014.” But many of the public health, communication and government mobilization lessons Klain and his team learned then are not only applicable now; they’re also at the core of Biden’s plan for tackling the pandemic when he takes office in January.

Four, in particular, will be critical to the new president‘s — and the country’s — success in finally curbing the virus:

1. Managing the pandemic response is a full-time job.

Klain’s experience coordinating the Ebola response taught him that managing a disease outbreak has to be full-time job and the person doing it has to be as close to the levers of power as possible — a model he’ll bring to the Biden White House as they work to bring Covid-19 under control.

“What we learned in Ebola is that there are assets at the Defense Department, there are assets at the State Department, there are assets at Homeland Security, there are assets throughout HHS,” said Leslie Dach, the senior counselor to the secretary of Health and Human Services during the 2014 outbreak. “And we needed somebody at the White House to pull all that together.”

The lack of centralized coordination in the Trump administration, Klain said in an interview earlier this year, created “this rotating carousel of Covid coordinators” — with HHS Secretary Alex Azar, Vice President Mike Pence, coronavirus task force coordinator Deborah Birx and Jared Kushner, the president’s son-in-law and senior adviser, alternately taking control of different aspects of the pandemic and promoting competing messages and goals. All of them already had full-time jobs, Klain has noted, and none were empowered to pull together the diplomatic, economic, health and national security components of the response.

All that will change once Biden takes over, Klain pledged in his first TV appearance since being named chief of staff.

“He will have a Covid coordinator who works in the White House who has direct access to him and will be briefing him daily,” Klain told MSNBC. “The important thing is that that official will have a team of people he works with: someone coordinating vaccine distribution, someone coordinating fixing the supply chain problems we’re having, someone coordinating the testing problems we were having so that we get this response where it needs to be.”

Biden’s team will soon announce who they want in this pivotal role, and is considering both Jeff Zients, a former director of the Office of Management and Budget, and former Surgeon General Vivek Murthy — both of whom were closely involved in the campaign‘s and transition’s Covid-19 plans.

2. Set appropriate expectations … and let the scientists do the talking.

As they’ve forged plans for tackling Covid-19 — including the rollout of a vaccine and strategies for getting more people to wear masks — Klain and the rest of Biden’s team have focused heavily on which officials should talk about the pandemic and how they should do so.

Drawing on his experience with Ebola, Klain has urged the team to put the career federal scientists who’ve been sidelined by the Trump administration front and center, in the belief that they can help persuade a skeptical and fatigued public to rally behind the measures needed to defeat the virus.

“Our approach on H1N1 and on Ebola was to have the messaging coming from the scientific experts,” Klain told POLITICO earlier this year. “[Biden’s] view then was that information should come from medical experts so it would be seen as neutral, expert-based advice and not shaped by political considerations.”

Still, Klain stressed, there are moments when “people need to hear from your president in terms of the progress of the disease.” And in those moments, leaders need to be careful to stick to hard facts, set realistic timelines, and manage expectations on everything from a vaccine to school reopenings.

“The reality is the reality. People are experiencing it,” he said. “Trying to tell them we don’t have a Covid problem is not going to work, because people are seeing it in their own communities.”

That’s why in his speeches on Covid on the campaign trail and as president-elect, Biden has taken pains to give sober assessments of the many months left to go before a vaccine is widely available — a sharp departure from Trump’s repeated declarations over the summer that the pandemic was “rounding the corner” and a vaccine would be out by Election Day.

It’s a lesson that Biden, Klain and others learned the hard way during the H1N1 outbreak in 2009, when the Obama administration failed to meet its early promise to have 100 million vaccine doses ready by the start of flu season in October. Beset by manufacturing problems, as few as 11 million doses were available by mid-October, according to one report. And by the time production ramped up, demand for the vaccine had gone down.

Now, with vaccine hesitancy on the rise and the public deeply divided following the election, Biden adviser Jen Psaki said “the public communication portion of this” had been significantly influenced by those past experiences, with a focus on managing expectations.

“We are fully eyes-open that there needs to be a rebuilt trust in government and institutions and what is communicated to the American people, and that’s part of the discussion,” said Psaki, whom Biden has tapped to be his White House press secretary.

3. Hospitals need protective gear and federal support to handle a new disease.

Klain has said repeatedly that one of the darkest moments of the Ebola crisis came in late September 2014, when a Liberian national visiting family in the U.S. tested positive for the virus at a hospital in Dallas and two nurses subsequently became infected, setting off a wave of public hysteria and fears of a widespread outbreak.

“Confusion and a lack of preparation led to missteps when the first case of Ebola arrived in Dallas,” Klain told a House committee earlier this year.

A National Security Council report in 2016 went into greater detail, outlining the “oversights in personal protective equipment use, disinfection, the collection, transport, and disposal of hazardous waste, the provision of social services for those placed under quarantine, and post-event monitoring and travel restrictions for potentially exposed health workers” that characterized the Dallas scare.

Working with several different government agencies, Klain implemented plans to create a network of hospitals where health workers were trained and properly equipped to test for Ebola, treat infected patients and safely transport serious cases.

“Somebody who got sick could go into an assessment center and somebody there would quickly ascertain whether they had Ebola or not and would make sure that nobody else was infected while that process was going on,” said Dach, who worked with Klain on the hospital network plan in 2014 and now serves as chairman of the health advocacy group Protect Our Care. “It was a very rigorous process and Ron was very hands on, working with us at HHS.”

Some of the same shortages of protective gear and federal resources for medical workers have plagued the Covid-19 response, and Biden’s team has made eradicating these issues a top priority.

The president-elect told a group of front-line health care workers in a virtual meeting on Nov. 18 that he planned to use the Defense Production Act to produce enough masks, gloves and gowns to ensure that medical providers and other front-line workers are protected. He also said he would implement and enforce paid sick days to allow infected workers to recover, and push Congress to approve adequate funding for hospitals and state health departments.

“It’s not enough to praise you,” he told the group. “We have to protect you.”

4. A global pandemic demands a global response.

Biden’s pledge to rejoin the World Health Organization on his first day in office can be traced directly to what his team learned from the Ebola outbreak, when the success of protecting Americans from the disease depended on working with international bodies and heads of state to stamp out the virus where it originated.

“This is not just a domestic issue,” Psaki said Wednesday. “It’s also an international issue, and there needs to be coordination across the national security and domestic teams. … Certainly, that was the case with Ebola.”

It’s the subject of some of the very first meetings the transition team is holding with federal agencies, Psaki added.

Dr. Celine Gounder, an epidemiologist who volunteered as an Ebola aid worker in Guinea in 2015 and is now serving as a member of Biden’s Covid-19 advisory board, said she expected that same philosophy to infuse the Biden administration’s vaccine distribution plans.

While Trump moved to cut off funding for the WHO’s vaccine development and distribution work and has pushed for Americans to be first in line for the shots — even though Pfizer’s vaccine was created by German scientists — Gounder says Biden’s views are shaped by an understanding that “we’re not an island.”

“If anything, March and April taught us that supply chains are not just in the U.S.,” she said. “If we withhold access to vaccines, they may withhold access to other critical supplies — for example, gloves and masks and so on. We do have to work with others.”

Biden himself emphasized the parallel last week, in a statement pledging to reinvest in the Global Health Security Agenda that was first set up during the Obama administration and that has had its funding slashed under the Trump administration.

“Whether it’s Ebola or COVID-19, diseases do not respect borders, and the capacity to fight them must be strong, resilient, and accessible the world over,” Biden said in a statement.

End this pandemic, prevent the next one.

Despite some missteps that Klain and others have openly acknowledged, his and his team’s efforts in 2014 calmed the public panic and squashed the Ebola outbreak with only a single fatality on U.S. soil. Now, as he rejoins the White House, he faces a far more daunting challenge with Covid-19, which has killed more than 265,000 Americans and infected more than 13 million, with a widely available vaccine still months away. Still, those who worked with Klain on Ebola say they believe he can actually “turn the corner” on the pandemic the way Trump has been promising since March.

“I literally sleep easier at night knowing that Ron Klain will be part of the administration’s response,” former CDC Director Tom Frieden, who worked on the Ebola response, said in an interview.

Natasha Korecki contributed to this report.

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