This Is What the 'Largest Ever U.S. Response to a Global Health Crisis' Looks Like

U.S. Navy Lt. Jose Garcia prepares samples for further analysis at a Naval Medical Research Center mobile laboratory at Bushrod Island, Liberia. U.S. Navy Lt. Jose Garcia prepares samples for further analysis at a Naval Medical Research Center mobile laboratory at Bushrod Island, Liberia. Chief Petty Officer Jerrold Diederich/U.S. Army Africa

The U.S. government has sent hundreds of personnel to West Africa to fight the spread of the Ebola virus. Thousands more at home are conducting research, setting protocols, screening entrants, quarantining potential carriers and coordinating response efforts. Their actions involve at least a dozen departments and subagencies, and billions of dollars in spending.

How is a trans-governmental, multi-continental effort of this magnitude organized? What agencies maintain which responsibilities? How many employees is each agency involved willing to commit to the effort without sacrificing broader missions? How are these employees protected from the disease they are fighting to eradicate?

The answers to these questions are, of course, complicated, and not easily defined. Many agencies were not able to offer details on their response efforts beyond simply saying they were supplying support. The governmentwide response, while by definition relatively narrow in scope, is immense in scale and requires a certain amount of ad hoc planning and flexibility in operations not typically seen in government.

President Obama aimed to smooth over these concerns by appointing Ron Klain as “Ebola czar.” Klain will coordinate the efforts from the White House.

Hundreds of military personnel are joined in West Africa by hundreds more from civilian agencies, and are working to establish order in nations with poor health care infrastructures, build hospitals and medical facilities, oversee safe burial practices for the deceased, and conduct tests to identify patients with the virus.

These agencies are largely following protocols from the Centers for Disease Control and Prevention to protect their employees, but most agencies were not able to identify any specific training their workers must complete prior to leaving for or upon arriving in Liberia, Guinea or Sierra Leone, the primary areas of outbreak.

The CDC guidance contains best practices for health care workers both abroad and domestically who may come into contact with Ebola, such as those involved in patient care and medical waste management. These guidelines are not necessarily applicable to the federal mission. In fact, the American Federation of Government Employees on Wednesday publicly called on CDC to issue more specific regulations for public-sector workers contributing to the Ebola response.  CDC’s guidance does list details on recommended Personal Protective Equipment, or PPE -- which includes full body coverage; a full face shield, helmet or headpiece; and single-use gloves, gowns and aprons -- and proper hygienic practices, which federal agencies have implemented.

Overall, more than 2,000 federal employees are working full-time every day to contain the Ebola outbreak, and several thousand more are working on the issue in some capacity.  Their efforts are scattered in several nations in Africa, as well as many locations around the United States. The map below shows where each agency has employees working on Ebola response:

Congress is looking to get a clearer idea of what a State Department spokeswoman called “the largest ever U.S. response to a global health crisis.” The House will hold a hearing on the “coordination of a multi-agency response” on Friday, while the Senate will look at the need for additional appropriations after the Nov. 4 elections.

Below is a breakdown of the information Congress is likely to receive, including each agency’s personnel devoted to the effort and their specific areas of work. The government’s response is evolving and the mission is too amorphous for this list to be considered comprehensive, though it paints a picture of the overall operation as of mid-October.

Defense Department

The Pentagon has launched Operation United Assistance, which has to date sent 617 military personnel to Liberia and Senegal. Defense has pledged a total of 3,900 troops and $1 billion as part of the effort.

Service members in West Africa are training health care providers and working with governmental partners in the region. They have established 17 treatment units and constructed (and are operating) a 25-bed hospital in Monrovia, Liberia -- the base for U.S. Africa Command’s operation -- for the treatment of health care workers who contract the virus.

Maj. Gen. Darryl Williams, who is leading the operation from Monrovia, said no military personnel are coming in direct contact with Ebola, aside from two, three-member teams of sailors that are working with bodily fluids to confirm or deny the virus in mobile labs. Those sailors are taking triple-protective precautionary measures, Williams said.

Otherwise, the military is taking general precautionary measures such checking members’ temperatures at least twice daily and exercising “basic sanitation and cleanliness,” such as no handshaking. If a service member were to contract Ebola, quarantine protocols would kick in and military personnel with the proper gear would stabilize the patient. A 30-member rapid response Marines unit currently based in Morón, Spain is ready to deploy for evacuation. 

Pentagon spokesman Rear Adm. John Kirby said Defense Secretary Chuck Hagel “is extraordinarily proud of the skill and professionalism of our servicemen and women and of the unique capabilities they bring to bear in this important effort.” He added, “As always, their safety and security will remain foremost on [Hagel’s] mind.”

Several civilian agencies with the Defense Department are also supporting the efforts, such as scientists and medical professionals who work at various medical commands. The Pentagon did not have a central figure for the total number of civilians working on the effort, but the Defense Logistics Agency alone has deployed 57 employees to Monrovia, Senegal, Italy and Germany to support Defense’s response.

DLA, with support from its headquarters staff, has provided supplies and equipment as part of Operation United Assistance, including food, cots, tents, protection suits and surgical masks. The agency has warehouse storage space in Ghana, Liberia and Senegal and arranged for fuel delivery and construction materials.  

State Department

The overall government Ebola response effort in West Africa is being coordinated by the U.S. Agency for International Development, which works in conjunction with State abroad.

All government personnel permanently stationed in West Africa, such as embassy workers in Liberia, Guinea and Sierra Leone, remain on active duty despite the outbreak. Family members of embassy staff were sent home, but the embassies themselves remain fully operational.

State employees deployed to the region have helped set up 65 community care centers, two laboratories (with four more on the way) and  56 safe burial teams. They have also assisted with the Defense Department’s 17 treatment centers. State has worked with corporate partners for resources and donations and foreign government leaders to secure their assistance; it has provided medevac capabilities and issued travel warnings to Americans. 

A State spokesman said the agency has “worked closely to implement safety precautions for all individuals accessing the embassies, including visa applicants.”

CDC

CDC has deployed 239 staff to West Africa to track the spread of the virus, improve control practices and health communication, provide advice to embassies, coordinate activities with the World Health Organization and assist local government in establishing emergency management systems.

An additional 124 staff are pending to deploy, while 218 workers have already completed deployments, according Joanne Cox, a CDC spokeswoman. CDC currently has a presence in Liberia, Guinea, Sierra Leone and Nigeria.

Employees are instructed not to participate or engage in direct patient care, patient wards of Ebola treatment centers or isolation hospitals, burials or laboratories -- except for specially trained lab personnel -- Cox said.

An additional 30 CDC staff have been deployed to Dallas, Texas, and Columbus, Ohio for “epi-aid” support.

Prior to deployment, CDC staff members are undergoing a “fitness for deployment” medical evaluation; health, safety and security briefing; science updates and briefings; training in the use of protective equipment; and information about resilience and mental health support. While Cox maintains no CDC employees are in direct contact with the virus, the agency has established medical risk assessment procedures for someone exposed to Ebola. If necessary, CDC would coordinate a medevac with State.

Overall, nearly 1,200 CDC employees have worked in some capacity on the agency’s Ebola response.

National Institutes of Health

Research into vaccines and treatments for Ebola have been primarily performed by the agency’s National Institute of Allergy and Infectious Diseases subcomponent, which has 100 employees working full time on the virus.

This work is being done at Bethesda and Frederick, Md., as well as Hamilton, Mont.

Other NIH components have deployed units to West Africa, though the agency could not verify the exact number. An agency spokeswoman said NIH is taking an “all hands on deck” approach to curbing the outbreak.

Health and Human Services Department

HHS’ Office of the Assistant Secretary for Preparedness and Response has taken the department’s lead on the Ebola front, and has more than 275 employees working on the response.

The office is working with industry and federal partners to develop and manufacture an Ebola drug, as well as to prepare for large-scale vaccine production. It is coordinating patient movement and repatriation, as well as dealing with environmental management.

Customs and Border Protection

CBP declined multiple requests for detailed information on its role in the government’s Ebola response. Its staff, however, has taken the lead at ports of entry where individuals from affected areas could enter the United States.

It has consolidated all flights originating in Liberia, Guinea and Sierra Leone to five airports where it has beefed up screening efforts: JFK Airport in New York City, N.Y.; Newark Airport in Newark, N.J.; Dulles Airport outside Washington, D.C.; Chicago O’Hare Airport; and Hartsfield-Jackson Atlanta Airport.

CBP employees have been trained in illness recognition from CDC and are tasked with taking the temperature of travelers entering the country after traveling to West Africa. John Wagner, acting assistant commissioner of field operations, told a congressional hearing last week that the “health and safety of CBP employees is also our priority as CBP carries out this critical assignment.”

He added any contact with body fluids assumes the worst and triggers a response as if the employee were infected. CBP officers generally employ “universal precautions” as dictated by CDC.

Labor Department

Labor’s Occupational Safety and Health Administration is tasked with enforcement of CDC protocols and employees throughout the agency’s 10 regional offices are on call to ensure compliance. OSHA can levy fines on those who violate CDC regulations.

An agency spokeswoman said OSHA has deployed a team to Dallas to work with CDC at Texas Presbyterian hospital, where the first individual diagnosed with Ebola on U.S. soil went for treatment. OSHA is also part of a multiagency investigation into how multiple health care workers at the hospital contracted the virus.

Peace Corps

All 340 Peace Corps volunteers in Liberia, Guinea and Sierra Leone have been sent home. However, 80 permanent Peace Corps staff are still in the region helping CDC with transportation and language translation.

“Peace Corps staff has detailed knowledge of country culture, context and key local leaders, as well as the credibility and trust of people across these countries, which is supporting CDC’s collaboration with country health teams,” said an agency spokeswoman. She added participating employees volunteered to help the CDC, are not working in hospitals, clinics or any treatment centers in West Africa, and are not in direct contact with patients.

All volunteers returning home were monitored as a precaution.

Kellie Lunney contributed to this report.

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