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Obama Could Federalize Ebola Control Effort

Obama Could Federalize Ebola Control Effort

By Alexis Simendinger - October 17, 2014

President Obama has legal authority to federalize the response to Ebola in the United States as a national health emergency, which could slice through jurisdictional knots at the state and local levels to protect public health.

Following news that two Dallas nurses tested positive for the virus after caring for Thomas Eric Duncan -- the Liberian traveler who died in a Dallas hospital last week -- the administration’s federal role to combat Ebola in West Africa and in the United States has expanded by degrees.

The president on Thursday softened his stance against a temporary U.S. travel ban from the three Ebola-affected countries in West Africa, but argued that experts in the region and infectious disease specialists advising him in the United States believe a ban would be “less effective” at curbing transmission than the passenger entry and exit screenings now in place.

“I don’t have a philosophical objection, necessarily,” the president explained in the Oval Office after meeting with administration advisers.

Some Republicans in Congress, including House Speaker John Boehner, favor barring travelers from affected countries. But the administration has been opposed because of concerns that bans on commercial flights ultimately contribute to further spread of the virus at its epicenter.

“We’re not considering a travel ban at this point. Does that mean that it could change? I suppose that it does,” White House Press Secretary Josh Earnest said earlier in the day.

Obama also warmed to the idea of appointing a single coordinator for Ebola, a suggestion urged by GOP lawmakers to streamline the federal response and reduce confusion at the overworked Centers for Disease Control and Prevention, directed by Dr. Thomas Frieden. Frieden is serving as an infectious disease expert and the government’s chief communicator, and he has been criticized by some for his performance in both roles.

The president commended Frieden, along with his Health and Human Services secretary, Sylvia Matthews Burwell, and his White House homeland security adviser, Lisa Monaco, who is also a key adviser on the assault on the Islamic State in Iraq and Syria.

“It may be appropriate for me to appoint an additional person,” Obama said.

(On Friday, the White House announced that attorney Ron Klain, a former chief of staff to both Vice President Joe Biden and former Vice President Al Gore, will be the government's Ebola coordinator, reporting to the National Security Council and Obama's homeland security adviser, Lisa Monaco. Klain is president of Case Holdings, owned by Steve Case, a major Democratic donor and Obama supporter. Klain is also general counsel at venture capital firm Revolution LLC, founded by Case, the AOL innovator and philanthropist. Klain's track record in government, management and law are broad, and he is knowledgeable about the private-sector health care industry through Case's foundation and investment interests.

(While Klain is not known as a public mouthpiece, he is a gifted communicator, offering decades of advice and coaching to Democrats seeking the presidency and vice presidency, and more recently to Jay Carney, who credited Klain for his media and communications advice when they both worked for Biden. Actor Kevin Spacey played Klain in the 2008 HBO film "Recount," a story of the 2000 presidential election outcome eventually decided by the U.S. Supreme Court.) 

It will take “months” for the combined efforts of multiple nations and legions of health care clinicians to contain the Ebola epidemic in West Africa, the president said. With that kind of timeline in mind, he said the federal government may need a “regular process” and a specific point person as coordinator.

The government took other steps to assert control, but Obama made no mention of seeking additional appropriations from Congress. On Thursday he spoke individually by phone with top House and Senate leaders, none of whom discussed his or her conversations with the president.

The National Institutes of Health, which recently complained about a decade of budget cuts impacting Ebola research, assumed responsibility for treating nurse Nina Pham, who was flown on a private plane from Dallas to Maryland. The other Texas Ebola patient, Amber Joy Vinson, was transferred to Emory University Hospital in Atlanta.

Obama suggested that the two nurses were moved to access trained and experienced caregivers, adding that both may have been infected because of “problems in how protective gear was worn or removed.” 

The president said he spoke with Govs. Rick Perry of Texas and John Kasich of Ohio, along with Dallas Mayor Mike Rawlings to assure them federal resources are available to deal with additional infections. Ohio joined federal disease monitoring when Vinson traveled to the Cleveland area last weekend to visit her parents.

In addition, Obama issued an executive order shaping part of the 4,000-strong military force already authorized to be deployed to West Africa to establish hospital units and provide logistical help. Obama on Thursday ordered members of the military’s Selected Reserve and Individual Ready Reserve to active duty to help in Africa.

Administration health experts who testified to a House subcommittee Thursday sought to tamp down public fears about the risks of contagion in the United States. Ebola in this country originated with Duncan, who traveled from Liberia on Sept. 20 and died in Dallas on Oct. 8. Pham and Vinson subsequently tested positive for the virus. Vinson flew Monday on a Frontier Airlines flight back from Ohio to Dallas.

Earnest, when asked about the extent of preparations, said hypothetical projections for Ebola contagion in the United States are fact-based and envision limited spread rather imagining a worst-case large outbreak.

“Projections are less important because the risk of a widespread outbreak of Ebola in the United States is exceedingly low,” he said. “We don’t anticipate that that’s going to happen. What we do anticipate is certainly possible, maybe even likely, is that some additional cases of Ebola will occur.”  

Obama, seeking to offer reassurance to the public, said, “Risks involved remain relatively low, extremely low for ordinary folks.” Three times he emphasized that Ebola is not easily transmitted from person to person. “This is something that’s really hard to catch,” he said. Ebola is “a very difficult disease to catch,” he repeated.

In response to an RCP question Thursday, the president’s spokesman said federal officials may have familiarized themselves with powers available to the president to deal with Ebola and its impacts under the Stafford Act and the National Emergencies Act, which allow a president to control public health emergency response when it crisscrosses multiple states and localities and involves public health and safety.

The Stafford Disaster Relief and Emergency Assistance law was enacted in 1988 to bring federal order and coordination to major national disasters, as well as to national emergencies. A presidential declaration under the separate National Emergencies Act triggers provisions of other federal statutes, including for health emergencies, and was used in 2009 to respond to the H1N1 influenza pandemic. And HHS has broad powers to intervene to protect the public health.

“I wouldn’t rule it out,” Earnest said, “but that’s not something that we’re actively considering right now.”

To date, the CDC has provided “guidance,” advice and encouragement to Texas and Ohio officials, to Dallas health authorities, and to the nation’s health care providers. But the CDC stepped lightly in Texas, arguing publicly that its experts could not assert federal control over Ebola treatments or safety protocols.

The jurisdictional challenges, should Ebola involve more than a handful of confirmed cases in the United States, could be significant.

Friedan has repeatedly described the federal government’s need to defer to Texas authorities and the Dallas hospital after offering the government’s best guidance. Obama on Thursday night thanked Mayor Rawlings for being “cooperative,” but did not commend administrators at Texas Health Presbyterian Hospital, where Duncan was initially misdiagnosed. Hospital directors have been criticized by the media for being less than forthcoming about what transpired with Duncan’s initial care, and for bungling training and safeguards offered to nurses there.

Frieden in recent days also praised Dallas officials and caregivers, but he has said they -- and CDC experts -- erred from the moment an ill and feverish Duncan sought help last month but was sent home.

Alexis Simendinger covers the White House for RealClearPolitics. She can be reached at asimendinger@realclearpolitics.com. Follow her on Twitter @ASimendinger.

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