Klain a Good Pick for Ebola Czar, Experts Say

October 22, 2014

President Barack Obama has taken heat for picking former White House aide Ronald Klain — someone without any clinical or public health credentials — to coordinate the federal government's initially ragged response to Ebola.

However, the new Ebola czar enjoys the enthusiastic support of two leading infectious diseases experts who say that the job requires a proven manager able to coordinate agencies ranging from the Centers for Disease Control and Prevention (CDC) to the Department of Homeland Security, and not necessarily someone with a healthcare pedigree.

"I read all of his qualifications and I thought he was close to ideal," said William Schaffner, MD, chair of the preventive medicine department at Vanderbilt University School of Medicine, in an interview with Medscape Medical News.

"We've got all the medical talent we need across the spectrum," said Dr Schaffner, naming examples such as CDC Director Tom Frieden, MD, MPH, and Anthony Fauci, MD, director of the National Institute of Allergy and Infectious Diseases at the National Institutes of Health (NIH). "What Ron Klain brings, I hope, is a vast acquaintance with Washington and how it works.

"He knows how to get things done. He's really the conductor of the Ebola orchestra. The conductor doesn't have to play the violin."

Michael Osterholm, PhD, MPH, the director of the Center for Infectious Disease Research and Policy (CIDRAP) at the university of Minnesota, Minneapolis, calls Klain "absolutely the right guy" to be the government's Ebola response coordinator. Dr Osterholm likens Klain to Leslie Groves Jr, the Army general and engineer who directed the Manhattan Project, which developed the atomic bomb during World War II.

"Groves knew nothing about nuclear fission," Dr Osterholm told Medscape Medical News. "But he could cut through red tape. He got things done. That's why the Manhattan Project remains a widely read case study in project management in business schools."

In terms of the nation's Ebola project, "we need to react in virus time, not bureaucratic time," said Dr Osterholm. "Klain will make that happen."

Those kinds of comments run counter to allegations that Obama erred in choosing an unqualified political crony to prevent the spread of the Ebola virus in this country. "This administration is looking at Ebola as a political problem, not a medical or public health problem," said Steven Bucci, PhD, a foreign policy expert at the conservative Heritage Foundation, in a posting on the group's Web site.

The President's Man

There's no denying that Klain, a lawyer by training, has the words "political operative" written across his resume in 48-point type. Among other positions, he worked in the 1992 and 1996 presidential campaigns of Bill Clinton, served as chief of staff to vice president Al Gore, and assisted Gore not only in his 2000 election campaign, but also in the vote recount in Florida. In 2008, he became chief of staff for Vice President Joe Biden and helped implement the massive stimulus program under the American Recovery and Reinvestment Act (ARRA) of 2009. The Obama administration touts Klain's success in rolling out ARRA as proof of his managerial talent.

In the private sector, Klain has served as a lobbyist for Fannie Mae and other companies, and general counsel for Revolution LLC, a venture capital firm that has invested in a number of healthcare-related companies.

The White House has said that Klain's job experience makes him the right person to lead a "whole-of-government" response to Ebola both here and in West Africa. Agencies involved in this effort extend beyond the CDC and the Department of Homeland Security to include the Department of Defense, the US Food and Drug Administration, NIH, and the United States Agency for International Development.

According to White House Press Secretary Josh Earnest, the Obama administration anticipates Klain acting as its Ebola coordinator for five or six months. He will receive a salary, the amount of which will be disclosed later in an annual White House report. Klain will report directly to Lisa Monaco, Obama's Homeland Security advisor, and National Security Advisor Susan Rice.

However, Klain's most important connection will be to Obama.

"He will speak with the president's voice," said Dr Schaffner. "The various federal agencies will take his [telephone] call and do what he says."

Having the president's ear is a more important job qualification than having a public health background, added Amesh Adalja, MD, a member of the public health committee of the Infectious Diseases Society of America as well as the federal National Disaster Medical System. Of course, an Ebola czar needs to "understand the science and the medicine behind what the interventions are," Dr Adalja told Medscape Medical News in an email.

James Carafano, PhD, a national security and defense policy expert at the Heritage Foundation, said it's an advantage to enjoy "the trust and confidence of the president," but that relationship may not necessarily make Klain more effective in his new job. The steep learning curve he faces could make the government's Ebola response less efficient at first, Dr Carafano told Medscape Medical News.

Like Dr Schaffner and others, Dr Carafano said Klain does not need healthcare experience for crisis management, which "is a skill unto itself." However, he said he can't judge whether Klain is the right choice for Ebola czar because his new job is ill-defined. It's not clear whether Klain was appointed merely to allay public fears of Ebola or to actually pull the levers of government machinery, Dr Carafano said. "We really don't know."

Why Not the Surgeon General?

Some analysts and politicians have suggested that the nation's Surgeon General could spearhead the war against Ebola, and that the lack of a Senate-confirmed "top doc" is a handicap. Obama's nominee for the position, Vivek Murthy, MD, finds himself roadblocked by Senate Republicans who criticize his support of gun control. During this limbo, Rear Admiral Boris Lushniak, MD, MPH, serves as Acting Surgeon General — a title not considered to carry much weight.

However, even with a Senate-confirmed Surgeon General in place, such an individual would not be suited for the role of Ebola czar, said Dr Schaffner. The power of the Surgeon General, he said, lies in the bully pulpit that he or she occupies, "not from the administrative structure that the Surgeon General runs," said Dr Schaffner. "He has influence, but he really doesn't have any direct power."

Dr Osterholm at CIDRAP agrees.

"Surgeon generals have no unique expertise in command and control, and programmatic response," he said. "I'm very supportive of the surgeon general, but we need somebody who can cut through the red tape. We need somebody who can take one plus one and get three.

"From everything I know about Mr. Klain, that's exactly the kind of person he is."

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