Oct. 23, 2014 -- President Barack Obama has taken heat for picking former White House aide Ronald Klain -- someone without any medical or public health credentials -- to coordinate the federal government's response to Ebola.
But the new Ebola czar has the enthusiastic support of two leading infectious diseases experts. They say the job requires a proven manager able to coordinate agencies ranging from the CDC to the Department of Homeland Security, and not necessarily someone with health care experience.
"I read all of his qualifications and I thought he was close to ideal," says William Schaffner, MD, chairman of the preventive medicine department at Vanderbilt University School of Medicine.
"We've got all the medical talent we need across the spectrum," Schaffner says, naming examples such as CDC Director Tom Frieden, MD, MPH, and Anthony Fauci, MD, director of the National Institute of Allergy and Infectious Diseases. "What Ron Klain brings, I hope, is a vast acquaintance with Washington and how it works.
"He knows how to get things done. He's really the conductor of the Ebola orchestra. The conductor doesn't have to play the violin."
Michael Osterholm, PhD, MPH, director of the Center for Infectious Disease Research and Policy at the University of Minnesota, calls Klain "absolutely the right guy" to be the government's Ebola response coordinator.
Osterholm likens Klain to Leslie Groves Jr., the Army lieutenant general and engineer who directed the Manhattan Project, which developed the atomic bomb during World War II.
"Groves knew nothing about nuclear fission," Osterholm says. "But he could cut through red tape. He got things done. That's why the Manhattan Project remains a widely read case study in project management in business schools."
In terms of the nation's Ebola project, "We need to react in virus time, not bureaucratic time," Osterholm says. "Klain will make that happen."
Those kinds of comments run counter to allegations that Obama erred in choosing an unqualified political crony to prevent the spread of the Ebola virus in this country. "This administration is looking at Ebola as a political problem, not a medical or public health problem," says Steven Bucci, PhD, a foreign policy expert at the conservative Heritage Foundation, on the group's web site.
The President's Man
There's no denying that Klain, a lawyer by training, has the words "political operative" written across his resume in large type. Among other positions, he worked on the 1992 and 1996 presidential campaigns of Bill Clinton, served as chief of staff to vice president Al Gore, and assisted Gore in his 2000 election campaign and in the vote recount in Florida. In 2008, he became chief of staff for Vice President Joe Biden and helped implement the massive stimulus program under the American Recovery and Reinvestment Act (ARRA) of 2009. The Obama administration touts Klain's success in rolling out ARRA as proof of his managerial talent.
In the private sector, Klain has served as a lobbyist for Fannie Mae and other companies, and general counsel for Revolution LLC, an investment firm that has invested in a number of health care-related companies.
The White House has said that Klain's job experience makes him the right person to lead a "whole-of-government" response to Ebola both here and in West Africa. Agencies involved in this effort extend beyond the CDC and the Department of Homeland Security to include the Department of Defense, the FDA, the National Institutes of Health, and the U.S. Agency for International Development.
According to White House Press Secretary Josh Earnest, the Obama administration anticipates Klain acting as its Ebola coordinator for 5 or 6 months. He will receive a salary, the amount of which will be disclosed later in an annual White House report. Klain will report to Lisa Monaco, Obama's homeland security advisor, and National Security Advisor Susan Rice.
But Klain's most important connection will be to Obama.
"He will speak with the president's voice," Schaffner says. "The various federal agencies will take his [telephone] call and do what he says."
Having the president's ear is a more important job qualification than having a public health background, says Amesh Adalja, MD, a member of the public health committee of the Infectious Diseases Society of America as well as the federal National Disaster Medical System. Of course, an Ebola czar needs to "understand the science and the medicine behind what the interventions are," Adalja says in an email.
James Carafano, PhD, a national security and defense policy expert at the Heritage Foundation, says it's an advantage to enjoy "the trust and confidence of the president," but that relationship may not make Klain more effective in his new job. The steep learning curve he faces could make the government's Ebola response less efficient at first, Carafano says.
Like Schaffner and others, Carafano says Klain does not need health care experience for crisis management, which "is a skill unto itself." But he says he can't judge whether Klain is the right choice for Ebola czar because his new job is not well defined. It's not clear whether Klain was appointed merely to ease public fears of Ebola or to actually pull the levers of government machinery, Carafano says. "We really don't know."
Why Not the Surgeon General?
Some analysts and politicians have suggested that the nation's surgeon general could spearhead the war against Ebola, and that the lack of a Senate-confirmed surgeon general is a handicap. Obama's nominee for the position, Vivek Murthy, MD, finds himself blocked by Senate Republicans who criticize his support of gun control. During this limbo, Rear Adm. Boris Lushniak, MD, MPH, serves as acting surgeon general -- a title not considered to carry much weight.
But a surgeon general would not be suited for the role of Ebola czar, Schaffner says. The power of the surgeon general, he says, lies in the bully pulpit that he or she occupies, "not from the administrative structure that the surgeon general runs," Schaffner says. "He has influence, but he really doesn't have any direct power."
"Surgeon generals have no unique expertise in command and control and programmatic response," he says. "I'm very supportive of the surgeon general, but we need somebody who can cut through the red tape. We need somebody who can take one plus one and get three.
"From everything I know about Mr. Klain, that's exactly the kind of person he is."