If It’s Broke, Fund It

We don’t need a new public health bureaucracy. We need to fund the one that already exists. A response to Ronald Klain.

By James T. Currie

Tagged EbolaFEMAPHEMAPublic HealthRonald Klain

I read with great interest Ronald Klain’s “Confronting the Pandemic Threat” (Spring 2016). While I do not disagree with his analysis of potential pandemic disease threats to our national security, I believe that he has missed the obvious answer to these threats. Despite his service as the “Ebola czar,” it seems apparent that Klain did not learn enough about the Commissioned Corps of the U.S. Public Health Service (USPHS), its history, and its capabilities during his period of government service. His failure to mention the USPHS—which has been around in one form or another since 1798—was most obvious in his discussion of the U.S. response to Ebola. In his listing of all the assets that were devoted to the Ebola fight, including “civilian government workers, volunteers, and contractors, and over 3,000 U.S. troops,” Klain omits the one U.S. government entity that actually treated Ebola patients in Liberia: the Commissioned Corps of the USPHS. I serve as Executive Director of the Commissioned Officers Association of the USPHS, a non-profit group that represents USPHS officers, having come to this position after many years as an Army officer and Congressional staffer.

U.S. government troops who were deployed to Liberia did a fine job of erecting a 25-bed hospital in the Liberian capital of Monrovia, but it was USPHS officers who staffed the hospital and treated Ebola patients there. In addition, Commissioned Corps officers from the USPHS who are assigned to the Centers for Disease Control and Prevention deployed to several countries in West Africa where they conducted disease tracing and worked with local authorities to effect the “hard cultural and behavioral changes” that Klain rightly credits with having mitigated the spread of Ebola. Other uniformed USPHS officers staffed the Emergency Operations Center at CDC, working 12-hour days, often seven days a week. And still other Commissioned Corps officers helped screen air travelers coming into the country.

Likewise, Klain seems completely unaware of the USPHS and how it is configured to deploy domestically when natural and manmade disasters strike. Indeed, there is no need to create a “Public Health Emergency Management Agency” that mirrors FEMA, as Mr. Klain suggests. Such an agency already exists in the form of the officers of the USPHS and their “Tiered Response System.” Under the current configuration of the Commissioned Corps, there are 11 Regional Incident Support Teams (RIST), which can report to the scene of an incident within 12 hours. These teams, which consist of 15 to30 officers each, are available to Regional Emergency Coordinators and Regional Health Administrators. There are also five National Incident Support Teams (NIST) of 72 officers each and five Rapid Deployment Forces (RDF) of 125 officers. Both of the groups are also tasked with reporting within 12 hours. The RDF Teams consist of clinical, mental health, and applied public health specialists. Sounds a lot like the PHEMA that Mr. Klain proposes, doesn’t it?

These teams and the full deployment capabilities of the Commissioned Corps of the USPHS have been tested and proven on many occasions. When Katrina and Rita hit New Orleans and the Gulf Coast ten years ago and FEMA’s “Brownie” was “doing a heck of a job,” some 2,800 PHS officers responded to the disaster, remained on station to assist local authorities in preventing the potentially catastrophic spread of disease, and actually did do a heck of a job. Superstorm Sandy required the deployment of 500 officers to New Jersey, New York, and Connecticut in 2012. Over 300 officers deployed to Liberia to staff the hospital there in 2014 and 2015. Almost 900 Commissioned Corps officers deployed to Iraq and Afghanistan with U.S. forces, and a team of 30-plus officers has recently deployed to Flint, MI, to assist with the public health crisis there.

Indeed, since Katrina and Rita in 2005, the USPHS Commissioned Corps has mobilized to support domestic and global public health emergencies over 260 times. During this 10-year span, PHS has deployed close to 8,200 officers to protect, promote, and advance the health and safety of our Nation.

No, the United States does not need a new bureaucracy to fight pandemic disease. What it needs is better funding for the existing group of highly professional officers who make up the Commissioned Corps of the USPHS. Despite all that it does, the Commissioned Corps is woefully short on funds, not having any money to train the response and support teams that already exist. That’s right, no training funds whatsoever, a situation that exists in direct violation of the federal statute that requires that the Secretary of Health and Human Services ensure that these teams be “trained, equipped, and otherwise prepared to fulfill public health and emergency response roles . . . .” Sad to say, the Office of the Surgeon General (OSG), which would carry out this training, has no line item in the federal budget, and the Department of Health and Human Services has not even made a budget request for OSG since 2012, when it asked for the minuscule sum of $7 million. Even the President’s 2017 budget, coming as it does on the heels of the successful Ebola deployment to Liberia, does not contain any funds for training of Commissioned Corps officers, nor any line item for the Surgeon General.

With appropriate funding, the ad hoc teams of USPHS officers that deployed to Liberia could have trained together for several weeks in advance of their departure, learning how to work together and refine their clinical interactions. The Defense Department, in which I spent 30 years as an Army officer, would never deploy any unit without providing it with the opportunity to train together. Likewise, providing training funds to the Surgeon General would allow the various response and support teams to practice their craft in field settings such as they encounter in the aftermath of a hurricane or at the site of a disease outbreak. Even the most capable and accomplished military teams spend much more time training than they do executing their mission, because they know that successful mission accomplishment stems from good training. The officers of the USPHS are no different.

Rather than following Klain’s idea of creating new, untested, and untried entities that duplicate existing assets, the U.S. government should provide an appropriate level of funds for the Surgeon General to provide training for the largely-unknown, incredibly capable, readily deployable 6600-member Commissioned Corps of the U.S. Public Health Service.

Read more about EbolaFEMAPHEMAPublic HealthRonald Klain

James T. Currie is the Executive Director of the Commissioned Officers Association of the U.S. Public Health Service and of the Commissioned Officers Foundation for the Advancement of Public Health.

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