It is important to remember that, for all our efforts, this will not be the last Ebola outbreak, and so investing in vaccines today will either help defeat this outbreak or be vital to beginning the response to the next one…The Ebola outbreak is one of our top global health priorities, and it will remain so until it has been stopped.
As Prepared for Delivery
Good afternoon everyone, and thank you for having me here today. I’d like to thank the U.S. Global Leadership Coalition for welcoming me, and for convening this important gathering about how the United States can and does lead around the world.
This is not necessarily the kind of stage I expected to be on when I was a young Washington lawyer, two decades ago, before my first job at HHS. Many of you may never have expected to need to attend gatherings like this in your professional roles, either, but we are united here by the shared recognition that American leadership on the world stage is indispensable to American prosperity and peace at home.
When I was first asked to serve at HHS, in 2001, as general counsel, I certainly didn’t imagine that national security and foreign policy would become a significant focus of my work at the federal government’s largest domestic department.
But I was confirmed in August, 2001—one month before 9/11, when everything changed. The day of 9/11, I quite literally experienced how much HHS needed to start thinking of ourselves as an integral part of the national security establishment.
On 9/11, HHS had no central command center to keep us linked up across the government, to track the public health threats that could arise from a terrorist attack—or other significant event, natural or manmade. Our main phone system had gone down, so our only way to communicate with other agencies was on our personal cellphones. I’m sure a few people in this room had that same experience, here in D.C. or in New York, and experienced the same kind of realization about the need for better preparedness.
HHS’s role in national security and foreign affairs became more prominent when we suffered the anthrax attacks shortly after 9/11, our first real bioterrorism attack on this country.
We had to come up with countermeasures, like Cipro, and we had to procure and develop anthrax vaccine.
Anthrax was far from the last infectious threat we had to handle in my first turn of duty at HHS—there was pandemic flu, SARS, and many more.
All of this was a bracing reminder that infectious disease threats are not just a health issue, but a national security and foreign policy issue. Sometimes, the threats we faced were so foreign as to be almost comical. I remember waking up and seeing The New York Timesone morning was talking about monkeypox getting into the United States.
How was it getting here? Through collectors importing giant Gambian rats. And how was it spreading? It was spreading by prairie dogs, and people who collect prairie dogs. So, we banned the importation and inter-state sale of giant Gambian rats and prairie dogs. Just so you know, there is, and remains, a very active prairie dog lobby in the United States. I had no idea those little animals could generate so much hate mail.
In any case, hate mail can be a fact of life in public service, but once you’re dealing with hate mail involving the word Gambian, you’ve definitely entered the realm of foreign policy.
So I knew, when I returned to HHS last year, that my position would demand thinking about how to keep America, and the world, safe from all kinds of health threats, especially infectious diseases.
During President Obama’s administration, the 2014 Ebola outbreak in West Africa, the deadliest Ebola outbreak in history, was a serious wakeup call about our global preparedness. Thanks to hard work on the ground, by heroic West Africans, and huge levels of support from generous Americans and other partners, eventually that outbreak was brought under control.
In its aftermath, we recognized that the international structure we had for responding to these outbreaks, including the World Health Organization, needed reforms, and needed to place its primary focus on infectious threats that can cross borders.
We also needed further investments in all countries’ ability to respond to these threats on their own, and we needed better biomedical tools to respond to Ebola in particular.
Thankfully, trials on experimental treatments and vaccines were launched, at the invitation of local governments and health ministers, as the outbreak was still raging in West Africa.
By the time of the next major Ebola outbreak, which lasted several months last summer in the northwestern Democratic Republic of the Congo, these efforts had begun to bear fruit. In part thanks to the work of HHS components, including through the President’s Emergency Action Plan for AIDS Relief, the DRC government had the ability, with some international help, to bring that outbreak under control. There are 150 disease detectives in the DRC, for instance, who have now been trained by the CDC to detect and identify outbreaks.
But now, we have been reminded by how far we still have to go, by the Ebola outbreak that is now raging in the eastern part of the same country.
We have a perfect storm of factors in the eastern DRC: The outbreak is not far from the borders with Burundi, Rwanda, Uganda, and South Sudan.
Even more worryingly, the outbreak is occurring in one of the world’s most unstable conflict zones. There is almost no place on earth where it could be more challenging to respond to an infectious disease outbreak than the eastern DRC.
More than 2,000 Ebola cases have been reported, more than 1,400 Congolese have died, and the outbreak shows little sign of slowing. As many of you have recently heard, last week, we had our first confirmed cases and the first confirmed death outside of the DRC.
The first victim to die outside of the DRC was a 5-year-old boy from Uganda, who had crossed the border to attend the funeral of his grandfather, who died of Ebola. His grandmother has now died of Ebola as well.
Because of the sheer scale of population movements between the DRC and its neighbors, we knew that the first cross-border case was almost certainly only a matter of time. But Uganda also deserves significant credit for containing this particular situation, and working incredibly hard throughout this outbreak, with the help of our CDC experts and others, to monitor border crossings.
I had the chance to thank Uganda’s health minister personally for this work last month, when I attended the World Health Organization’s annual meeting in Geneva. I was encouraged that my fellow health ministers and WHO’s leadership recognized the threats we face, and understood very well that this outbreak is not under control.
I was extremely pleased that the WHO’s director general, Dr. Tedros, was highly engaged on this issue, understood the need for an even more comprehensive response, and had begun to lay the groundwork for further action.
I am immensely grateful for his leadership at WHO, where he has led their work on infectious threats and closely tracked this outbreak.
I’ll highlight a couple of the key challenges we still face, and some of the efforts we’ve undertaken, with WHO, the DRC, and partner nations, to tackle them.
One troubling issue is the security situation, which requires careful decisions about how to provide security for WHO’s health workers without impeding their work or disturbing the local communities they need to reach.
Another is the importance of sound financial management, because donors are most supportive when they can be confident that their dollars are being used wisely, and we’ve been pleased to see that WHO understands this need.
We are also encouraged that WHO has recognized the need for better relations with the communities in the eastern DRC, who are sometimes skeptical of a massive surge in international aid to combat an outbreak, when they already have suffered so much from conflict and lack of economic opportunity. Responding to the outbreak should mean lasting, useful investments in the DRC’s ability to keep its people healthy, and we look forward to working with WHO on that goal.
Addressing these challenges will allow even better use of the response tools that have already been deployed.
As of June 1, more than 129,000 people have received an investigational Ebola vaccine, a product that we didn’t have when the 2014 outbreaks began. Late last year, the DRC government, the U.S. National Institutes of Health, WHO, and other international partners began a new trial in the DRC for new investigational Ebola treatments, bringing the total number of investigational treatments we have to four.
Think about that: just a few years after Ebola research really ramped up, there are hundreds of Congolese patients, able to receive an investigational treatment, in a clinical trial run by scientists from the DRC, America, and elsewhere, in one of the most challenging places to work on earth. That, along with so much else about the response to this outbreak, is a tribute to American generosity and leadership.
All of the actors involved still need to do more to bring this epidemic to an end, including through more support for vaccines. We were pleased that, at the recent WHO meeting in Geneva, Germany announced a new commitment for the purchase of vaccines, but we all may need to step up further. As the outbreak continues, there may be an urgent need to buy significantly more vaccine doses.
It is important to remember that, for all our efforts, this will not be the last Ebola outbreak, and so investing in vaccines today will either help defeat this outbreak or be vital to beginning the response to the next one.
The United States has so far provided approximately half of the governmental and nongovernmental funding to confront this outbreak, and we are committed to seeing this battle through to the end.
The Ebola outbreak is one of our top global health priorities, and it will remain so until it has been stopped.
But even once it has been halted, we will continue our work to help places like the DRC build even better capacities to respond to these challenges on their own, and stop outbreaks before they have a chance to steal so many innocent lives.
Ebola is far from the only global health threat on our radar today.
I have also spent a significant amount of the last year or so engaged on a public health crisis in our own hemisphere, caused by the illegitimate Maduro regime’s destruction of Venezuela’s healthcare system.
The country’s economic collapse has sent more than 3 million Venezuelans fleeing to neighboring countries, often with infectious or noncommunicable disease that could not be prevented or managed by the country’s failed healthcare system. Diseases like measles, for instance, are seeing a resurgence because Venezuelans have not been able to access healthcare services as basic as vaccines.
The Trump Administration has taken a leading role on this challenge, providing more than $200 million in aid to neighboring nations, which are hosting huge numbers of Venezuelan refugees, and preparing to help rebuild Venezuela’s healthcare system when the time comes.
I hosted a meeting of health ministers at Blair House here in Washington last fall, and then helped support a meeting led by the Peruvian government in Lima at the beginning of May. In August, we’ll be attending the next regional health ministerial on this topic, hosted by Colombia.
Until Venezuela’s legitimate government is able to begin rebuilding the country, I expect to continue this work with our regional partners, supporting Venezuelans and the countries around the region in meeting these health needs.
As I mentioned at the very beginning, when my career led me into the healthcare industry, I didn’t expect that it would lead to so much exposure to the vital role America plays on the world stage.
But it is little surprise that, on public health and global health, America is an indispensable leader.
Our institutions at HHS, like the CDC, NIH, and FDA, have been a model for every nation that seeks to stop infectious disease and improve their public health.
Our scientists and universities have laid the groundwork for so many of the tools that all nations need to prevent and cure disease.
We built these resources in part to keep our own country safe and healthy, but generously sharing those tools, and offering our expertise, to every nation in need will help keep us safe and healthy, too.
As we see today, from South America to central Africa, America will always be willing to lend a hand, and lead where necessary, to help every nation work toward a healthier future for their people and for the world.
Thank you for your role in making that work possible, and thank you so much for having me here today.