In November, state and federal authorities were having trouble tracking individuals who had entered the United States from Ebola-stricken countries in West Africa and may have been exposed to the deadly virus. The travelers’ cellphones often didn’t work in this country, so officials from the Centers for Disease Control and Prevention proposed giving them cellphones with 30-day plans so local authorities could call them daily during the 21 days of required monitoring.
There was just one problem: A year earlier, conservatives had criticized the administration for providing cellphones to the poor, saying the “Obama phones” were designed to encourage dependence on the government. Those subsidized phones had been part of a three-decade-old program to help low-income families afford phone service, but the controversy made White House officials skittish.
In a White House senior staff meeting, Ron Klain, the lead coordinator for the U.S. response to the Ebola epidemic, argued that the urgent need to keep track of anyone who could spread the disease far outweighed any political risks. He prevailed, and the phones were distributed, helping health officials monitor almost all of the targeted travelers, about 70 a day.
When President Obama tapped Klain to coordinate the Ebola response just over three months ago, conservative pundits and lawmakers mocked the choice as craven, saying the nation needed a doctor or statesman to lead the effort, not a well-known lawyer and political fixer who had served as chief of staff to Vice President Biden and former vice president Al Gore.
Radio talk-show host Rush Limbaugh called Klain’s selection “pure 100 percent politics” while the hashtag #BetterEbolaCzars — featuring images of Dr. Quinn, Medicine Woman and topless models — took off. Such criticism disappeared months ago, along with fears that Ebola would ravage the United States. And Klain, who is set to leave the administration Feb. 15, is getting high marks from public-health experts and others for overseeing critical aspects of the response — from the system for evacuating infected Americans from West Africa to the disposal of Ebola-related hospital waste.
“Ron Klain was brought into the U.S. government response at a time when the level of domestic anxiety and concern, and disorganization nationally, had reached a frenzied peak,” said Sen. Christopher A. Coons (D-Del.), who was chairman of the Senate Foreign Relations subcommittee on African affairs in the past Congress. “To be able to ignore the press and partisan tumult howling outside is a special skill.”
The day after Klain started work in October, Craig Spencer, a New York physician who treated patients in Guinea, tested positive for Ebola and was admitted to Bellevue Hospital in New York within days after going jogging, riding the subway and going bowling. Klain briefed Obama as they huddled in the Diplomatic Room with White House Chief of Staff Denis McDonough and the president’s homeland security adviser, Lisa Monaco. Klain had already called New York Gov. Andrew M. Cuomo (D), whom he knew from his time in the Clinton administration, and New York First Deputy Mayor Anthony Shorris, who had just been introduced to him by a mutual friend via e-mail.
The next day, New Jersey state officials quarantined nurse Kaci Hickox, who was returning from Sierra Leone but had no symptoms of Ebola. Her case prompted an uproar over the lack of consistency in monitoring guidelines for returning travelers. Klain brought officials together to work through the weekend on devising a stricter monitoring system, and on Monday, the CDC announced the new guidelines.
It fell to Klain to figure out how to manage the disposal of waste from Spencer, an effort that required coordination from federal agencies and state authorities. Large volumes of material had to be trucked to a facility in Texas, the only place in the country with the required permits and licenses. Although the waste had been treated and was no longer infectious, Klain called nervous state political leaders on several occasions to assuage concerns while the truck was en route, according to a senior administration official. Even some dumps that had disposed of destroyed Syrian chemical weapons would not take the Ebola waste. Eventually, the trips were completed.
For Klain, the key to his assignment has been bringing together officials at all levels of government and pressing for blunt assessments.
“You’ve got to convince people to come to the table and be honest,” he said during an interview in a sparsely decorated office in the Eisenhower Executive Office Building.
The turnaround in the government’s Ebola effort speaks to a broader strategy used by the administration in recent years. With a constrained staff but an unlimited set of challenges, the White House sometimes turns to an outsider — albeit in Klain’s case, one with deep ties to the administration — to mobilize the federal bureaucracy.
“Appointing a czar can be a catalyst, making things happen faster than the conventional response to a crisis,” said U.S. Ambassador to NATO Douglas E. Lute, who helped coordinate the nation’s strategy in Iraq and Afghanistan as the “war czar” in the George W. Bush and Obama administrations. “The bureaucracies, day to day, are not designed to take on these crises.”
Typically, under a presidential directive adopted under Bush, the Department of Homeland Security would serve as the lead agency in the case of a domestic threat, major disaster or emergency. But the White House decided to take a different route because staffers were already coping with the rise of the Islamic State and the conflict in Ukraine, said White House communications director Jennifer Palmieri.
Sen. Lamar Alexander (R-Tenn.), who had called on the president to install a Cabinet member, physician or high-ranking general as czar a few weeks before Klain’s appointment, said in a recent statement that there was no way to assess Klain’s performance “because I’ve heard and seen nothing about him since he was appointed. That’s the problem with White House staff ‘czars’ not accountable to Congress.”
Klain benefited from some positive developments, including a decline in infections in Liberia that began shortly after he was appointed, even before the first U.S. military-built Ebola treatment center became operational.
To keep track of the U.S. effort at home and in West Africa, Klain relies on extensive data — an approach similar to the one used by Jeffrey D. Zients in the fall of 2013 to salvage the troubled launch of HealthCare.gov. Zients is now Obama’s top economic adviser.
Two reports on Ebola are delivered to Klain by 7:15 a.m. every day. One uses yellow dots to show all the travelers in the United States from countries hit hard by Ebola, and the distance between them and the nearest hospital capable of treating the disease. (When hospitals across the country expressed reluctance about getting certified to treat Ebola patients, Klain persuaded several to sign up, and now 49 are certified to handle the disease.)
The other report details the status of the U.S. military effort headquartered in the Liberian capital, Monrovia — Operation United Assistance — as well as the government’s civilian aid to the region.
Klain also helped in the push to get Congress to approve $5.4 billion in emergency Ebola funding late last year. Some conservative Republicans say that money represents an example of Obama’s willingness to spend taxpayer dollars on foreign aid rather than on U.S. military efforts to take on those threatening the United States.
“Ebola’s an easier thing for the president to do,” said Jim DeMint, president of the Heritage Foundation. “It’s all magnanimous. It’s creating a government program and spending money, where there’s no need to hold your ground against the opposition.”
Global health experts said they welcomed the White House efforts on Ebola.
“Given the potential for cases to land anywhere around this country, this was a form of crisis that we had not had before,” said Tom Inglesby, director of the Center for Health Security at the University of Pittsburgh Medical Center. He added that it was wise to designate one person at the White House to coordinate the agencies given “the very complicated domestic and international ramifications happening concurrently.”
There are about 10,000 civilians in West Africa — working on safe burials, disease detection and the training of medical personnel — “funded in whole or in part by the United States government,” McDonough said. By comparison, there were about 1,000 U.S. civilians in West Africa in early September.
When Klain leaves, he will return to his private-sector job as president of Case Holdings. McDonough said he and the president will “continue to lean on” Klain for advice after his departure. It is unclear whether there will be another Ebola czar, although McDonough said there is enough “muscle memory” in the federal government to manage in his absence.
A remaining question, however, is whether the government could respond quickly to a different crisis without turning again to a fixer from the outside.
“Can you institutionalize non-institutional ways of doing things?” Klain asked. “I don’t know.”
Correction: An earlier version incorrectly identified 10,000 civilians as Americans. This version has been corrected.