Poor MidLevel Official Writes #Ebola Memo That Never Went Anywhere — Oy!

— Domani Spero
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In September, we blogged that the State Dept Awarded $4.9 Million Contract to Phoenix Air for Air Ambulance Evacuation #Ebola.  Apparently, the last couple of days there was a flap over a State Department memo on a plan to bring non-Americans with Ebola to U.S. soil for treatment. The memo labeled Sensitive But Unclassified – Predesicional is available to read here and notes USG obligation to non-U.S. citizen employees and contractors of U.S. agencies (USAID, CDC, etc.) and programs as well as NGOs and private firms based in the United States.

The  Washington Times identified the memo’s author as Robert Sorenson, deputy director of the Office of International Health and Biodefense (OES/IHB). The Office of International Health and Biodefense is the primary State Department policy office responsible for a variety of international health issues. It takes part in U.S. Government policymaking on infectious disease, environmental health, noncommunicable disease issues, global health security, antimicrobial resistance, and counterfeit and substandard medications.  A clearance sheet attached to the memo reportedly says it was cleared by offices of the deputy secretary, the deputy secretary for management, the office of Central African affairs and the medical services office.

The memo did make it to the Daily Press Briefing at the State Department. Excerpt below:

QUESTION: And then the last one on this is: There was a report last night and again this morning about this memo that was – the State Department memo —

MS. PSAKI: Sure, let me address that.

QUESTION: — about bringing —

MS. PSAKI: Mm-hmm. One, just factually, the document referenced was drafted by a midlevel official but not cleared by senior leaders. It never came to senior officials for approval. And any assertion that the memo was cleared by decision-makers is inaccurate. There are no plans to medevac non-Americans who become ill with Ebola to the United States. We have discussed allowing other countries to use our medevac capabilities to evacuate their own citizens to their home countries or third countries subject to reimbursement and availability. But we’re not contemplating bringing them back to the United States for treatment.

QUESTION: So the – but essentially, what you’re saying is that one guy somewhere in this building came up with this idea and put it on paper, but it never went anywhere? Is that what you’re saying?

MS. PSAKI: Correct. It’s also weeks old and the memo isn’t current because European – our European partners —

QUESTION: All right. Okay.

MS. PSAKI: — have addressed this matter by providing their own guarantees, but go ahead.

QUESTION: One problem that – I mean, that I see is that a week ago, the Pentagon and the White House was insisting that, no, no, no, there is no overall quarantine order and it’s just this one commander, or these guys who are in Italy. And now all of a sudden, today we have Secretary Hagel saying no, it’s going to be – it’s Pentagon-wide and it’s going to go to all of the troops that are there. What is there to prevent this memo from coming back to life, as it were —

MS. PSAKI: Well, I think with this —

QUESTION: — and becoming policy? Has it been flat out rejected or is it just kind of sitting on a shelf someplace and maybe could be implemented at some point?

MS. PSAKI: It’s sitting on a shelf or on a computer – since we use computers nowadays – by the individual who wrote it, I suppose. I think the important point here is that our European partners, since several weeks ago when that was written, have addressed this by providing a guarantee to international health workers that they would either be flown to Europe or receive high-quality treatment on the spot. So it’s not applicable at this point.

QUESTION: Okay. Well, in general, why was this never approved? I mean, it seems – I mean, you could make the argument that the U.S. has great healthcare facilities, that no one who has contracted the disease in the United States has actually died. So I think there might be some who could make the argument that why not bring people?

MS. PSAKI: Sure, but many countries have decided to make that decision to deal with it themselves, and we’ve certainly been discussing with them how to do that.

QUESTION: So this has been discarded as unnecessary rather that rejected —

MS. PSAKI: It was never discussed at any levels, in any serious level with decision-makers. So I don’t – wouldn’t say it was discarded, but —


QUESTION: Along the lines of what Matt was saying, on page 5 of the memo, it says that it was approved by Nancy Powell, the head of the Ebola Coordination Unit. Doesn’t that suggest it was fairly further along in the process?

MS. PSAKI: I’m happy to look at the approval memo. As I understand, and just so you know, sometimes there are people listed. It doesn’t mean they cleared it. It just means there are people who need to clear a memo. So I will check and see if there was anybody who actually cleared it.

“One guy somewhere in this building came up with this idea and put it on paper, but it never went anywhere?” And the official spokesperson, without blinking said, “correct.”

Don’t you just hate it when they say things like that and throw some midlevel official under the medevac plane?

In fact, the justification for the air ambulance evacuation contract awarded to Phoenix Air on August 18, 2014 appears clear enough as to why this was necessary:

The USG is left with only two options in supporting a CDC scientist that has a high risk exposure to an EVD patient — use the PAG capability to fly the person back to the US for observation and optimum care should disease develop, or leave the person in place where no care is available if the disease develops. The question, then, is not how many EVD patients will be moved, but rather how many contacts and EVD patients will be moved across the entire international response population (as many as three per month). Finally, from a pragmatic stand point, given the limited options for movement of even asymptomatic contacts, it has become clear that an international response to this crisis will not proceed if a reliable mechanism for patient movement cannot be established and centrally managed.

That leaked memo is not saying we’re moving Liberia’s entire infected population for treatment in U.S. hospitals, is it?  An argument can be made that the USG has an obligation to assist in the treatment of those infected in the course of their work fighting the ebola outbreak on behalf of the international community.  The State Department is not/not making that argument, of course.  The only official argument it is making is that — that memo, that never went anywhere beyond the midlevel officer’s desk.

Nothing to do with an election coming up? Sure, okay.

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