No Surgeon General but an Ebola Czar

The deadly Ebola virus has arrived in the continental United States months after the initial outbreak in West Africa, heightening panic and prompting uncertainty because of a lack of leadership from the American government. In previous public health crises the surgeon general has provided that leadership, however that post is currently vacant.

Under President Reagan, Surgeon General C. Everett Koop exerted unprecedented influence, essentially using his position as a bully pulpit to broadcast his anti-smoking message. Koop’s legacy goes beyond the “Surgeon General’s Warning” continuing to appear on cigarettes. His successors are generally thought responsible for relaying health facts and information to the American public in an efficient manner. Beyond his or her duties as the public face of the government’s public health policy on matters including smoking and obesity, the surgeon general can serve a purpose during acute public health crises like communicable disease outbreaks. The most recent example of the positive impact a surgeon general can have in the midst of a public health crisis occurred during the H1N1 outbreak, when the Surgeon General’s office wrote press releases and recorded podcasts to increase awareness of the disease and help the public protect themselves. The position of “America’s Doctor,” however, has been vacant for the past year, since Dr. Regina Benjamin retired in 2013 after a four-year term .

Initially, President Obama worked to appoint Dr. Vivek Murthy, a 36-year-old Yale graduate and the former head of Doctors for Obama, which after the 2008 election became Doctors for America. Having only finished his residency in 2006, Murthy did seem to be a rather inexperienced choice for the nation’s top physician. But age was the least of Murthy’s problems when it came to his nomination.

Murthy's nomination met strong resistance from Congressional Republicans, who challenged him on his political views. Murthy was also targeted by the NRA, a formidable political force, for his support for gun control measures. Perhaps fearful of incurring the NRA’s wrath, Republicans succeeded in blocking Murthy's nomination.  It is absurd that any self-respecting politician would block a viable candidate for this position because it might upset a financial donor.

With Murthy out of the running, the surgeon general position has been filled for the past fifteen months by Deputy Surgeon General Boris Lushniak, an experienced bureaucrat. Excepting March, when Murthy’s blocked nomination made national news, no one has missed surgeon general. As a new public health crises emerges, however, the surgeon general’s absence is becoming ever more noticeable.

Dramatic and exaggerated media stories have fostered public panic since Ebola arrived in Dallas, Texas. It has historically been the responsibility of the surgeon general to act as a voice of reason, speak for the White House, and assure the public that their leaders are handling the issue. In the absence of the surgeon general as a public face, the White House has appointed Ron Klain, former Chief-of-Staff to Vice Presidents Al Gore and Joe Biden, as a separate “Ebola Czar” to coordinate the government’s response to the crisis.

It is disappointing that, because of the ineffectiveness of the Congressional nomination process, the president has been forced to create a new position to perform duties that a surgeon general would normally perform. Though the president has the power to bypass the inefficiencies of Congress by appointing advisors, some feel that the move sets a bad precedent for sidestepping legislative checks and balances.

While some see Klain’s appointment as a positive step towards controlling the spread of Ebola in the United States, the creation of an “Ebola Czar” does not sit well with others. For starters, Klain has absolutely no experience in public health or infectious diseases; he is an experienced political operative who was a staffer in the Obama White House before leaving for the private sector.

Before the appointment of Klain, the chief official responsible for the handling of the Ebola outbreak was the CDC director Thomas Frieden. Frieden oversaw the treatment in the US of aid workers who contracted the disease in Africa, some of whom have been successfully treated with experimental drugs. Concerns about the CDC’s performance began when the first patient diagnosed with Ebola in the United States died in the Dallas hospital where he was being treated. Since then, two nurses from the hospital have contracted the virus because of protocol breaches. While it does seem that the Dallas hospital was underprepared, the government protocols--more lax than the protocols used for decades by Doctors Without Borders to combat Ebola outbreaks in Africa--seem to be at fault as well.

Congress called a hearing to attack Frieden for his poor handling of the situation thus far, which is irresponsible given the circumstances. If the threat of Ebola is as serious as Frieden’s detractors in Congress believe, then criticizing the country’s top official at this moment in time is neither reassuring to a panicking public nor helpful to Frieden’s productivity as a leader. Rather, Congress should let Frieden deal with the crisis as best he and the CDC can. Additionally, Congress should focus its energy on supporting the nomination of a new surgeon general who can realistically assist with the Ebola response. While Klain may be a competent bureaucrat, he has no medical expertise to offer.

The Congressional hearing accomplished only one thing: the further politicization of a public health crisis, just in time for the midterms. In the week following the hearing, Democrats have lined up in support of the White House, insisting that banning all flights from West Africa will make the problem worse, while Republicans have argued that some drastic action must be taken.

It is reprehensible that the White House and Congress have allowed the position of surgeon general to remain vacant, leaving the country without a face for public health. Americans are panicked and unsure of their safety; they are in desperate need of a competent and knowledgeable leader, which can hopefully come in the form of a surgeon general.