This week, three things happened with painfully ironic synchronicity. First, the Democratic Republic of the Congo revealed that it is facing down its ninth Ebola outbreak. Second, President Trump asked Congress to rescind a $252 million pot that had been put aside to deal with Ebola. And third, global health expert Tim Ziemer unexpectedly departed the National Security Council, where he served as senior director for global health security and biodefense.
A retired rear-admiral who coordinated the President’s Malaria Initiative, which reduced global malaria deaths by 40 percent, Ziemer is highly respected by his peers and has been described as “one of the most quietly effective leaders in public health.” Health-security experts called his departure from the NSC a serious mistake—one that jeopardizes America’s already fragile state of preparedness against infectious threats.
Ziemer, among the various roles he took on since joining the NSC last year, was also overseeing the creation of the government’s long-awaited national biodefense strategy. Congress mandated such a strategy in the National Defense Authorization Act of 2017, with a deadline of March 1, 2017; over a year later, it has yet to arrive.
With Ziemer gone, oversight of the strategy now falls to Andrea Hall, the senior director for weapons of mass destruction and biodefense, according to an administration official with knowledge of the matter. Hall had already been working side-by-side with Ziemer, both figuratively and literally—they sat in neighboring offices. Both testified before the bipartisan Blue Ribbon Panel for Biodefense in November last year, during which Hall said that, “Making America safer in the biosphere is a ... key priority for this administration.”
Hall joined the National Security Council in June 2016, having served in government positions related to nuclear proliferation and weapons of mass destruction for the previous 13 years. She is well-versed in assessing the risks posed by nuclear, chemical, and—critically, for discussions of pandemic threats—biological weapons. “Andrea Hall is amazing,” says Thomas Inglesby, who directs the Center for Health Security of the Johns Hopkins Bloomberg School of Public Health. “She’s a great person for that job.”
She also oversees the remaining members of Ziemer’s now-defunct directorate of global health security and biodefense—many of whom carry substantial expertise in pandemic preparedness. Luciana Borio, for example, is an infectious-disease specialist who is affiliated with Johns Hopkins Hospital, and has a wealth of experience leading epidemic responses at the U.S. Food and Drug Administration.
Shake-ups at the NSC have occurred at higher levels, too. During his time at the council, Ziemer reported to H.R. McMaster, the national security advisor, and Tom Bossert, the homeland security advisor. McMaster was replaced by John Bolton in March; Bossert resigned in April.
But Vincent Picard, a spokesperson for the NSC, reaffirmed that the Trump administration is still strongly committed to global health security, biodefense, and pandemic preparedness. “Everyone’s paying attention,” he says. “There’s involvement by senior administration officials, and we’re going to do what we need to do to assist the DRC in controlling the [current Ebola] outbreak.”
Ziemer’s departure, and the restructuring of his team, was described as a move to “streamline” the NSC and “combine a handful of offices with similar mission sets” in the name of reduced bureaucracy, according to a statement from the NSC spokesman Robert Palladino.
But the worry is that Hall and her team may now be stretched too thinly. “Now they have to take on not only epidemic and biological threats, but they have to worry about North Korea and Iran and everything else,” says Inglesby. “The more that you make [epidemic preparedness] a part of other activities, the less time anyone has to focus on any of it.”
Ron Klain, the former Ebola czar, agrees. “Andrea Hall has a good reputation, but I think this is a mistake that puts us all more at risk,” he says. “Combining epidemic prevention and control with WMD issues means that the epidemic work will always take a back seat. It means that no senior level person will be specifically focused on the work that needs to be done to protect us from this serious threat. And it means that the team will tilt their focus more toward intentional attacks using infectious diseases, and less on the more frequent (and just as serious) risk of naturally spread diseases.”
This is a mistake that other presidents have made, Inglesby says. The Clinton administration was the first to formally recognize, during the time of HIV’s ascendance, that preparing for diseases was a national security problem. Clinton’s NSC had a dedicated biodefense person. The Bush administration eliminated that position. But they were reminded of the importance of disease preparedness by the anthrax mailings that occurred after 9/11. Over Bush’s two terms, a biodefense team gradually grew within the NSC.
When Obama became president, the responsibility for thinking about epidemics and biological threats was initially split between two other teams—one focusing on resilience, and another on weapons of mass destruction. But over time, that duty was once again packaged into its own directorate—one that lasted into the Trump administration, and that Ziemer took over. “Eliminating it as its own explicit function is definitely a danger,” says Inglesby.
What is also unclear is who would take charge of the U.S. response to an epidemic that crossed both domestic and international lines, and involved a humanitarian component—as the Ebola outbreak in West Africa did between 2014 and 2016. Back then, after an initial period of chaos as many agencies tried to coordinate their efforts, the responsibility eventually fell to Klain.
Klain and others have since called for a specific directorate and a named high-ranking official, with a clear remit and line of command, to take the lead in future crises. “Knowing who is in charge of coordinating the U.S. interagency response to a cross-border biological threat is vital,” says Beth Cameron from the Nuclear Threat Initiative, who led Ziemer’s former directorate during her time on the Obama-era NSC.
“Health security is non-partisan,” Cameron emphasizes. “It has been a shared national security priority between administrations for more than a decade.”