Far be it from me to suggest that Kellyanne Conway could not possibly be the opioid czar. When I was named Ebola response coordinator in October 2014, the outrage over a “political operative” taking on such an assignment was widespread. I like to think I had more qualifications than Conway: three stints in two White Houses, chief of staff at a Cabinet agency and leadership of the team implementing a $787 billion federal program — but crucially, like her, I lacked domain expertise in epidemic response. Thus, just as I hoped at that time to be judged by my performance on the job and not my résumé, I take a similar view of Conway’s appointment.
But merely because Conway could be viable coordinating and leading the White House’s opioid effort doesn’t mean that she will be. Four elements vital to her success — elements that I had on my side during the Ebola response — appear to be missing.
First, confronting an epidemic is a full-time occupation. President Barack Obama asked me to come back from the private sector to coordinate the Ebola response because everyone then working at the White House already had a more-than-full-time job. For the five months it took for the global response to reduce the Ebola outbreak from hundreds of cases per week to just a handful, and for our country to deploy our domestic infectious-disease defenses, coordinating the U.S. government’s work on this effort was all I did.
The Trump White House has not announced which, if any, of Conway’s other duties she will give up to lead the opioid response — or how she intends to assemble and coordinate a plan to reverse one of the most vexing public-health threats we face — while also juggling presidential priority-setting, communications strategy, veterans affairs and other assigned duties.
Second, any White House coordinator needs a talented, dedicated staff: “Czaring” is a team sport. I was empowered to assemble a dozen top staffers drawn from various White House offices: experts in emergency response, medical preparedness, international development, biological threats, transborder risks and liaison work with global nongovernmental organizations. These superb, experienced public servants formed the backbone of our Ebola response unit at the White House.
By contrast, there is no sign that any team has been assigned to help Conway. She appears to be a one-woman show at the White House. And it’s not clear that she would take the help even if offered: In the Obama White House, we regarded long-serving government experts as a vital resource in a crisis; in the Trump White House, they appear to be regarded as “deep state” enemies.
Third, you cannot tackle a crisis without resources. I spent my first three weeks on the job working with the Office of Management and Budget and the federal agencies to assemble a $6.2 billion plan to combat Ebola and prepare the United States for imported infectious diseases. Obama then invited the bipartisan congressional leadership to the White House to present this plan — and worked hard on selling it. Four weeks later, a bipartisan majority in both chambers approved $5.4 billion of our request. These emergency funds were critical to our work.
But there’s no sign that the Trump administration is preparing a similar funding plan on opioids. So far, only a new $12 million grant program seems to be on the table. This is a pittance of what is needed to prevent opioid use, combat trafficking, treat those who are addicted and help ravaged communities. To make matters worse, a variety of Trump proposals would actually cut spending on the fight, and, of course, the Senate tax bill would gut health coverage for millions.
Finally, a White House response coordinator is only as good as the engaged, effective president he or she is serving. At the height of the Ebola crisis, I had near-daily meetings with Obama. My principal job was to run policymaking processes that brought top Cabinet and agency leaders in to see the president to resolve the key strategic decisions. And of course, those choices were made by a president steeped in the details and dedicated to the best available science as his guidepost in decision-making.
Today, there seems little evidence that Trump is willing to engage on any problem with that level of rigor: If it can’t be addressed in 280 characters on Twitter, he seems to have little interest. And Trump seems indifferent at best, and outright hostile at times, to scientists and science-based policymaking.
Opioid addiction is one of our worst national problems. A full-time, well-staffed White House coordinator — with a robust budgetary plan and a president engaged to make hard and tough decisions — could make a difference. In this White House, with this president, there’s little reason to believe that’s how Conway’s tenure as czar will work out.