Christopher Kirchhoff knows how to assess the U.S. government’s response to a public health crisis.
Kirchhoff, an aide at the Pentagon who moved to the White House during the height of the West African Ebola outbreak, was tapped to write a 2016 report about the lessons the U.S. could learn from the epidemic — and the steps it could take to prepare for the next outbreak of an emerging infection.
“It was through that experience that I think we all came to realize that it’s not just Ebola, but actually there’s a number of pathogens that could be super dangerous to our security,” Kirchhoff said.
STAT on Monday spoke with Kirchhoff, a political scientist by training, about what he learned from compiling the Ebola report and what he thought of the U.S. response to Covid-19. Kirchhoff — now a senior fellow at Schmidt Futures, a philanthropic organization — spoke carefully, often pausing for several seconds before answering and continuing on haltingly and sometimes obliquely. He seemed uneager to unabashedly criticize the Trump administration’s response and particularly hesitant to target specific decisions or people, but his overall assessment was not positive.
“We realized that there was a lot more work to do to be prepared for a much more severe scenario” after Ebola, Kirchhoff said. “We also knew, just in looking how Ebola happened, a zoonotic virus that jumped from animals to humans in a part of Africa where it had never appeared before, there was a really strong consensus in the scientific literature and among experts that this was more likely going forward.”
The interview has been condensed and edited lightly for clarity.
You write in your report that, “Merely maintaining the current scale of response activities as a standing capability is likely not sufficient.” You pointed to the fact that scientists have been warning about this. So why aren’t governments more prepared?
Changing the system to make it stronger and more resilient takes leadership, and it also takes a real commitment both in terms of people and budget. Congress during Ebola passed a $5.4 billion supplemental package that had a down payment for not only strengthening our global network of disease surveillance to more quickly detect a pathogen so you could try and stop chains of transmission at the source, but it also had a down payment to improve the preparedness of the U.S. health care system, to designate regional centers that could be better equipped and stocked with [personal protective equipment] to treat higher-end pathogens.
And it’s pretty clear now that we made some initial investments to grow the capacity of the system but we didn’t follow through on more investments that were needed. And as a result we’re in a situation today where we’re not ideally positioned to respond.
So what happened? Why does that progress start and then stop?
I think the general outlines of the story are that the kinds of high-level leadership in the executive branch and the Congress didn’t come through on the policy changes and proposals that were put in place after Ebola.
You also write that, “Future epidemics, especially those that are airborne and transmissible before symptoms appear, are plausibly far more dangerous than Ebola, which is hard to catch, easy to test for, and occurred in a region of the world with minimal air connectivity.” I mean it sounds almost like you were describing what we’re dealing with.
Those of us in the Ebola response knew we got lucky, not only because the pathogen wasn’t airborne, but because the outbreak happened where it did in the world. We knew that we probably wouldn’t get lucky again.
So when did you hear about this outbreak and what did you think?
I read the first news reports in early January. I think it was on the 16th of January I made myself write down a prediction and my prediction then was that this would be at least 100 times worse than SARS. [The 2002-2003 outbreak of SARS caused some 8,000 infections and 800 deaths.] And I’m terribly sorry to not only have been right, but might have been an order of magnitude off.
What made you think that prediction? What was your sense that this could be worse than previous coronavirus spillovers?
It was clear then that the numbers involved and the dynamic of the Lunar New Year in China would spread this particular outbreak far wider and at a much quicker pace than with SARS.
What’s surprised you about this outbreak and what hasn’t been surprising?
What isn’t surprising is the sheer size and scale of it. I think what has surprised me is how our country somehow got so far behind the ball in the response.
One epidemiologist quoted in your report said, “It’s much worse because we failed early.” That stuck out to me, because as Tony Fauci has said, the U.S. failed with testing, which seems like one of the first steps to a response. What have you made of the testing debacle and what can be done to address that?
It’s hard to express in words how our inability to test early and to contact trace has set us back. And I think it’s honestly launched us into a new reality that none of us have clear or clever ideas about what to do.
What we found during Ebola was to respond to the outbreak, which was both abroad and at home, we were having to call up parts of the government that didn’t often work together. And that resulted in all kinds of new and understandable challenges. There had to be incredibly strong leadership from the top down to coordinate all the different capabilities that the government has.
So what does that mean when there’s not that one person?
It’s bigger than one person but that’s why the White House so quickly after Ebola established a whole new office on the National Security Council with the mandate to be the lead in a situation like this and, more importantly, to be the lead in seeing through the growth in preparedness capacity that we knew we needed.
You’re describing the NSC’s Global Health Security and Biodefense directorate, which the Obama administration established after your report and which the Trump administration ended and consolidated into another group in 2018. There has been debate about the impact of that, but how do you view that decision?
It was a clear lesson from the Ebola experience that there was no substitute for White House leadership.
But when that happened, was that something that got on your radar as a potential, I guess, mistake?
A series of things got on my radar as we went on after Ebola. The first thing is that the increased budgets that we had established to expand the number of testing sites, to try to pick up novel pathogens, were cut. Those programs were wound down. And the next tranche of payments to strengthen our domestic preparedness was not made. So those failures I noticed and worried about greatly. And then it was shortly after that that the NSC office was disbanded.
For public health responses, there’s a lot of leeway given to state and local authorities. You write in your report that the cases of Ebola in Dallas and New York “revealed the need for a smoother sliding scale of [the] escalation of government response, from local authorities acting on their own to local authorities acting with some federal assistance,” to a full federal government emergency response. How would you describe what’s happening now with local, state, and federal agencies, and if that sliding scale is in effect?
We’re seeing the failure of that sliding scale. We in the U.S. have a federal system where we have very specific divisions of labor. It requires greater degrees of coordination to work effectively. It takes more effort to make our system work. I don’t think we’re seeing that effort, and I don’t think we’re seeing the system work as well as it could.
So what could be fixed or what could be improved?
I think federal government leadership will be really important to helping the nation as a whole contain and defeat this epidemic.
If there’s some national security aide who’s tapped to write a similar report on this pandemic, given the job that you were given, what advice would you give them?
There will be so much we can learn from this, and we should, so it should be a priority, it should be something that everyone who worked on the response participates in. And hopefully it will help us be far better prepared for the next scenario, which will inevitably come.