Climate Change Long Form Politics and Government

What Public Health Emergencies Can Teach Us About Climate Adaptation

We will be watching videos of life-threatening climate disasters every day on our phones until one day it’s our phone recording the next one.

Major environmental and health emergencies used to be rare, one-off occasions. Now being in a state of emergency is the new normal. Mega-hurricanes, massive floods, heat waves, inferno wildfires, even global pandemics, are now a regular part of our lives every year.

As the environment deteriorates, we will lurch from one emergency to another in a perpetual state of disaster response as the Earth becomes more and more uninhabitable every year. In order to survive humanity will have to both rely on and become our own emergency first responders.

Where we stand now is reason for pessimism. Even if we miraculously reduced all the world’s carbon emissions to zero by tomorrow we still couldn’t stop many of the environmental changes set in motion, only limit their worst effects. This is because more than 93% of the heat humans have generated is trapped in the oceans and atmosphere where it will linger for centuries.

The time for arguing about who is to blame is over. Now it’s time to figure out what happens when it’s our homes that are flooded, AC systems overwhelmed, or an even deadlier pandemic comes along.

For a few years I worked in the world of emergency response at the Centers for Disease Control (CDC). I witnessed the response to the Zika virus in the Americas, the Ebola virus in the Congo, Hurricane Maria in Puerto Rico, and most recently the COVID vaccine distribution.

In each of these emergencies, I’ve learned something new about how these shocks are handled by some of the largest public and private institutions tasked with responding. It’s this same networks of health partners and first responders who will be called upon week after week when the next disaster strikes.

This article/personal reflection is for anyone who is interested in learning more about the world of emergency response and wants tangible solutions to advocate for with their friends, family, and public officials to better prepare for humanity’s fight to survive climate change.

Lessons Learned

1. 2020 COVID – Computers call the shots.
2. 2019 Ebola – Assume people won’t listen to you.
3. 2017 Hurricane Maria – The money is there, if you know where to look.
4. 2016 Zika – Sometimes you have to make it up as you go.

Lesson #1 – Computers call the shots.

In November 2020, the Pfizer and Moderna COVID vaccines neared the finish line for FDA emergency use authorization. In preparation for nationwide distribution, the U.S. Department of Health and Human Services formed a partnership with retail pharmacy chains to administer the vaccine. Drugstores like CVS, Walgreens, and Rite-Aid were to be the frontlines of the largest vaccination campaign in human history.

It was a simple and common-sense partnership. The federal government wanted to get the widest reach possible with the lowest effort. More than a third of Americans get their annual flu shot at a pharmacy and more than 80% of Americans live within 10 miles of a CVS or other community pharmacy.

For the pharmacies, the vaccine was to be provided at no cost to them and to be administered at no cost to the recipients. The pharmacies would benefit from increased traffic in their stores as well as positive PR on their vaccination efforts.

Pharmacies like CVS formed a partnership with the federal government to distribute the COVID vaccines but faced a complex data reporting environment that delayed the roll out. Photo by Anna Tarazevich on

In order to become an approved pharmacy to receive the COVID vaccine they had a few rules they had to follow, namely how they would share data with the CDC on their vaccination efforts.

Every 24 hours, pharmacies had to submit data on things like how many people they vaccinated, the number of doses they ordered, and how many doses they had on hand in their inventory. This information would be fed into a larger system called Tiberius managed by Operation Warp Speed. In Tiberius, the federal government would allocate the scarce doses of the vaccine to each state based on demographics, demand, and availability.

This process working well had a lot riding on it. In December, the U.S. was in the midst of its deadliest month of the pandemic with the alpha variant from the U.K. rampantly hospitalizing and killing thousands of people every day.

Unfortunately, within the first few weeks of the vaccine rollout the wheels started to come off the track. States began complaining that the actual amount of vaccines they were allocated were far less than what they expected, in some cases more than 40% less. As a result, pharmacies and other vaccination sites in those states had to start cancelling thousands of appointments.

Washington State Governor Jay Inslee announcing the unexpected cut to the state’s COVID-19 vaccine allocation.

Our team in the CDC Vaccine Task Force was working with the pharmacies and needed to explain to them what was going on. This led us to wrapping our minds around the messy process that COVID data was coming into and out of the CDC.

The culprit was a faulty data synchronization between the CDC’s vaccine ordering system, VTrcks, and the allocation system Tiberius.

While vaccination providers were planning appointments based on what they ordered, it wasn’t until that information matched up with Tiberius that the right number of doses would arrive at their facility. The issue was diagnosed and fixed, but it held up vaccine distribution at a critical time.

Technology hurdles like this were one of many early missteps that were not only responsible for the U.S. ending 2020 nearly 18 million vaccinations behind schedule, but also resulted in failures to quickly identify hotspots and prevent outbreaks early in the pandemic.

The lesson is despite the best laid plans of mice and men, sometimes it’s the computers that are calling the shots. Literally. More than people agreeing on what needs to be done the harder work is ensuring that the information systems behind the scenes are also in agreement on what needs to be done. Getting the I.T. piece right can be in the biggest determinant on whether life-saving care can be administered in a timely way.

This is the largest and most important vaccine program that we have ever undertaken. We would have liked to have seen it run smoothly and have 20 million doses into people today, which was the projection. Obviously, it didn’t happen.

Dr. Anthony Fauci on the beginning of the COVID-19 vaccine rollout, December 31st, 2020

Things to advocate for:

Investing in standardized application programming interfaces (APIs) across healthcare and emergency response systems.

The two biggest challenges facing interoperability in our healthcare system today are data usability and public health data exchange delays. Health data right now are not readily available in a format that can be easily ingested and incorporated by different healthcare providers and public health systems.

More work and investment is needed in adopting the HHS Standardized application programming interface (API) for patient and population services across hospitals, laboratories, first responders, and meteorological services to make it easier for disparate systems to share information quickly in an emergency.

Development of a standardized “health passport” for individuals to manage, control, and protect their health data.

Do you know what you would do if you lost your paper vaccine card? Depending on where you live the process can be shockingly complicated to get physical or electronic proof of vaccination from your state immunization registry.

Imagine now that an immunocompromised person is brought to a large stadium for shelter after having their basement home flooded. One of more than 150 million people that will become climate refugees in the next 30 years. How will they attest to their exact prescriptions, vitals, and medical history with all their documentation under water?

Equipping individuals to have sovereignty over their own health information has been a challenge for years despite having the technology to do it in a way that protects privacy and ensures portability. Investing in a solution now that leverages advances in distributed data storage and biometrics will vastly improve healthcare in a rapid response setting.

Take Away
There will be no successful response to climate change without relying on technology. When it comes to quickly identifying and triaging an emergency situation our I.T. infrastructure needs to be nimble, portable, and interconnected – COVID has proved that it’s not there yet.

Lesson #2 – Assume people won’t listen to you.

The Ebola virus flared back up in the Congo in 2019 prompting the WHO and CDC to rush medical personnel to contain the outbreak. They feared a repeat of the 2014 outbreak that spread across West Africa, then the largest Ebola outbreak in history.

As medical staff arrived and began treating and isolating patients, they faced a series of attacks by the hardest hit communities. People began throwing stones at doctors and burning down medical facilities. One day, two gunmen barged into a medical staff meeting and opened fire.

At the time, our team at the CDC’s Division of Emergency Operations was developing resource plans for the Ebola response. The deployments of CDC health workers being processed had to be immediately cancelled until the stronger security arrangements could be made. In total, there were 386 attacks against Ebola first responders in the Congo.

When asked why they were hostile to the medical workers, many responded by accusing the health workers of making up Ebola as a ruse to make money off the population. Some declared that it was a hoax perpetrated by the government to drum up foreign aid, cancel local elections and takeaway their rights. Religious officials and politicians stoked these fears.

Ebola doesn’t exist! You’ve invented the disease.

Gunman who fired on Ebola workers in the Congo

The skepticism and misinformation about Ebola bears obvious resemblance to COVID-19. Whether it was downplaying the threat of the virus, politicizing masks, watering down CDC recommendations, or letting unfounded fears of the vaccine abound, there was no shortage of conspiracies that undermined public health messaging.

The misinformation around COVID has similarly led to violence against healthcare workers and government officials. Most famously, the plot to kidnap Michigan governor Gretchen Witmer in retaliation for strict lockdown orders. Globally, hundreds of healthcare workers and contact tracers in the last year have been threatened and attacked.

This underlies a more fundamental issue with health emergencies, including climate change – successfully communicating science remains one of the most pressing challenges to overcome.

Many times, we assume that the compelling nature of scientific assessments – especially ones that are apparent right in front of our eyes – are sufficient to spur action.

It’s smarter to assume that there will always be some countervailing political, social, or economic force which will turn the public against you, even though you are trying to help them. The imperative must be on health authorities to be proactive rather than reactive and drive the message through diverse, independent, and non-partisan channels.

Ideas to advocate for:

Partner with singers, athletes, actors, and social media influencers across the political spectrum in unified messaging campaigns.

Celebrities have a tremendous influence on the information we retain, the attitudes we adopt, and the decisions we make, including those related to our health. This is a known fact, otherwise companies wouldn’t be paying them millions of dollars to be brand ambassadors. There is already evidence that celebrities have influenced our perceptions of climate change and have driven participation in climate activism.

In a health emergency, celebrity messages can be “especially important if trust in government/official sources is quite low,” according to Tracy Epton, a psychologist at the University of Manchester in Britain. Indeed, despite weeks of CDC warnings about the impending arrival of COVID early in 2020, the first real wakeup call for the public was when actor Tom Hanks and his wife Rita Wilson tested positive.

“Public health figures who have credibility must partner with social media influencers who have the reach. Harnessing the wide reach of local, regional and national influencers from a wide swath of sectors both within and outside of the public health community is necessary to counter the large volume of misinformation thrust into the information ecosystem.”

Dr. Amir Bagherpour and Dr. Ali Nouri – Fellow and President of the Federation of American Scientists

Response authorities should set standards on what constitutes false or misleading information in real-time, especially during a declared public health or disaster emergency.

There has been no greater driver of misinformation about scientific information than from social media. What many have called an “infodemic“, a deluge of fake news about the virus circulates on platforms like Facebook, WhatsApp, Twitter and YouTube at a dizzying velocity.

These companies are reactive rather than proactive and slow to flag or remove content before thousands have already seen them. Last April, 59% of posts about COVID rated as false by fact-checkers remained up on Twitter. On YouTube, 27% remained up and on Facebook 24% of false-rated content remained up without warning labels.

There is a strong association between the use of WhatsApp and Facebook and believing COVID misinformation.

September 2020 joint study from Harvard, Northwestern, Rutgers and Northeastern universities on COVID misinformation

Disaster response officials must form stronger partnerships with social media companies to identify common sources of misinformation and enable speedy removal. With the poor track record of tech companies being able to self-regulate, response authorities may need the power to remove content in real-time, especially at the early stages of an emergency.

Learn from the advertising industry on how to identify, engage, and influence the behavior of your target audience.

The ad industry is incredibly powerful because of its ability to understand the preferences of its audience and use them to subtly influence, even manipulate people into taking a desired decision. Credit their innovative use of behavioral economics, marketing analytics, and empowered creative departments.

While public health mass media campaigns have worked successfully on issues like reducing smoking, there is clearly much to be learned in terms of how to change individual behavior in the context of a health emergency. Recruiting from and partnering with the top advertising and public relations firms could provide some fresh thinking and new tools on better ways to win over the audience and nudge the public to prepare more proactively for climate change.

Take Away
Misinformation and conspiracies derail every public health emergency – science can’t be expected to be listened to on its own merits. For scientific guidance to be communicated more effectively there needs to be a re-thinking on the public faces of an emergency, the tactics to remove false information online, and how best to target and influence the average citizen.

Lesson #3 – The money is there, if you know where to look.

On September 20th, 2017, a high-end Category 4 hurricane slammed into Puerto Rico. Hurricane Maria flattened entire neighborhoods causing unprecedented damage to structures, roads, the power grid, and healthcare facilities. The entire population of 3.7 million people was left without electricity overnight.

More than 100,000 Puerto Ricans did not have clean food, water, or reliable electricity for more than 6 months. It is considered the worst natural disaster in history to hit the island.

The response from the U.S. government was haphazard to say the least. Part of the reason was that this was the third consecutive mega-hurricane to hit the U.S. in a stretch of a few weeks: Hurricane Harvey, Irma, and now Maria. This precarious situation left FEMA, CDC, and other emergency response agencies even more strapped for resources.

The Trump administration was not only slow to take the crisis in Puerto Rico as seriously as the recovery efforts in Florida and Texas, but badly bungled the logistics and operations of getting relief to the island. This even prompted a personal feud between Trump himself and the mayor of San Juan.

Ultimately, Puerto Rico received 1/9th of the emergency meals, half the amount of water supplies, and 1/20th of the tarps provided during the responses to Harvey and Irma.

The Department of Homeland Security Office of Inspector General found that FEMA “lost visibility” or failed to fully track nearly 40% of shipments to Puerto Rico with a value of nearly $257 million in meals, water, blankets and other supplies.

ABC News

It was in this environment that our team at the CDC’s Office of Financial Resources was tasked to find money, wherever it may exist within the agency, to help fund the public health emergency response operation in Puerto Rico.

One thing I quickly learned on this fiscal hunting trip is how much government money goes unused every year. When federal agencies don’t spend the funds Congress appropriates to them within a specific timeframe, the funds are “cancelled” and returned to the U.S. Treasury Department General Account (known as the TGA).

Once funds are cancelled, they are legally not allowed to be used for anything else. According to a Government Accountability Office (GAO) study, roughly $24 billion dollars in government-wide budget authority is cancelled every year – enough to pay for an annual universal pre-K program.

The reasons for canceling government appropriations can vary. Sometimes agencies just run out of time to implement a program. Many times, they simply don’t have the capacity to effectively find organizations, projects, or things to buy to use up their appropriated funds.

Before having to cancel appropriated funds, some agencies have authority to redirect this money for other purposes – this is a process known as “re-programming”.

One specific spending mechanism we looked into for the possibility of reprogramming was “unliquidated obligations”. Basically, the government agreed to set aside money to pay for some purpose (obligation) but ended up not incurring any expenses for that purpose.

After diving deeper into the numbers, we uncovered $6 billion in unliquidated obligations on the CDC’s accounting books. Money that could be re-programmed not just for the response in Puerto Rico, but several other public health operations.

Ideas to advocate for:

In a recent GAO study almost 70% of the agency officials interviewed reported that they ended up cancelling unused government funds because they could only be used for very specific purposes and did not have the legal authority to re-direct them to related/adjacent activities.

Rather than returning the money, agency officials need increased acquisition flexibilities, increases to warrant thresholds, new approving authorities, expansion to purchase card flexibilities, and the ability to use Inter-Departmental Delegation Authority (IDDA) and Inter-Agency Agreements (IAAs). These tools will give policymakers enhanced flexibility to respond to health emergencies in a forceful way.

Otherwise, agencies need to go through a process of review and congressional notification to take re-programming actions which can take several months. Because of the “use-it-or-lose-it” nature of these appropriations, a flurry of federal spending happens in the last week of the government fiscal year (last week of September) even if it results in lower quality projects or for issues that are not as urgent.

Federal agencies spend an average of 4.9 times more in the last week of their fiscal year than in a typical week during the rest of the year

National Bureau of Economic Research
Direct the Office of Management and Budget (OMB) to target undisbursed balances by streamlining the project closeout process.

Nearly a fifth of all government spending (~$800B) goes to disbursing grants. The very first work project I worked on was helping manage the Public Health Emergency Preparedness (PHEP) grant throughout all its phases: pre-award, award, implementation, and closeout.

The closeout portion of a grant’s lifecycle is where a lot of the hidden money may lie. Closeout procedures are designed to ensure that the grantee has satisfied the terms of the grant and submitted all required financial and performance reports to the awarding agency. In this process, money that was given to a grantee but was never actually used is often discovered. That’s not always the case though.

In 2011, the GAO identified that the total amount of unused grant money can represent anywhere from 2.7% to a jaw-dropping 34.8% of an agency’s or program’s grant funding. More than $794 million in funding remaining in expired grant accounts for just one agency. Stronger action to improve systems and policies for reconciling payment accounts and monitoring grantee spending can be critical to maximizing available dollars to respond to emergencies.

Take Away
Disasters and emergencies are the last time you want to be getting thrifty. Rather than asking “how are you going to pay for it?” realize that we probably have already paid for it! Millions of dollars are sitting in unused or expired accounts or are being returned to the government because of lack of capacity and poor management. Granting increased flexibility to use government funds and rooting out idling money during a project’s “closeout” phase can refill coffers when responding to multiple, concurrent emergencies.

Lesson #4 – Sometimes you’re going to make it up as you go.

As the Zika virus began to spread across the Western Hemisphere in 2016 there was a scramble for reproductive health experts. Pregnant women infected with Zika were having babies born with deformed brains – a condition so terminal that women in South America were encouraged to postpone pregnancy for almost a year.

The CDC’s National Center of Birth Defects and Developmental Disabilities was called up to lead the emergency response at the agency. Unfortunately, most of the experts from the Center had no previous emergency response experience.

Early on epidemiologists were being asked to design communications flyers. Clinicians had figure out how to finance a laboratory task force. Unsurprisingly, things were delayed getting out the door to the populations that needed them most.

Staffing during an emergency response requires careful planning and tracking. But more often than not, at the beginning of a crisis an ad-hoc team of subject matter experts and support staff are pulled together, some of whom who may have never been trained for the unique environment of emergencies.

Because of the speed and voluntary nature of recruitment, skill sets are often misaligned or altogether missing for the precise needs of the response. This results in those on the frontline having to learn on the job at a time when inefficiencies and mistakes can have lethal consequences.

Ideas to advocate for:

Predict your needed workforce rather than reacting.

The U.S. has been in enough emergencies to know roughly what to expect whether it’s a domestic natural disaster or international pandemic response. By mining data from previous responses on information like: the number of people deployed, the roles needed, length of deployment, etc. agencies can create a predictive workforce based on specific emergency scenarios. This approach would not only enable more rapid identification of the right people when standing up a response but getting ahead of training those who have not been in a response before but have a frequently needed skillset.

Create a public health reserve – a gig workforce of dedicated emergency responders.

Disaster response agencies could develop a roster of response alumni and on-call workers that can be rapidly deployed without having to pull staff from other departments. This public health reserve would be similar to a “bench” in the management consulting industry but filled with government employees and volunteer citizens whose main role is to be emergency response specialists.

Versions of this exist currently in different cities known as a Medical Reserve Corp (MRC). MRCs were crucial in recruiting citizen volunteers to assist in COVID vaccination efforts. I was able to join the Fulton County MRC in Atlanta and assist in the logistics at Mercedes-Benz stadium (and luckily got my first dose out of it).

Make emergency exercise-based trainings mandatory for all health domains.

Many believe an emergency will not happen to them in their specific field and thus pass up the voluntary trainings on emergency operations. Zika struck reproductive health, COVID came for respiratory health, in which health domain will the next crisis strike? There’s no way to know, which is why these trainings should be mandatory and regularly exercised across health domains with an eye towards high priority scenarios, like:

  • Pandemic influenza
  • Vector-borne diseases (e.g., malaria, bubonic plague)
  • Natural disasters (e.g., hurricanes, wildfires)
  • Environmental hazards (e.g., chemical/oil spills, radiological incidents)

These trainings should be supplemented with YouTube-like clip series of short, discrete, actionable lessons would be designed to provide guidance and reinforce necessary skills in less than 5 minutes (e.g., how to use a test kit or fill out a report, etc.)

Take Away
Public health or medical expertise does not always translate to disaster response expertise. The most critical impact of inadequate training and staffing during an emergency response is that lives are at risk. Response staff needs access to the knowledge and support required to be prepared for their role and be able to deploy the necessary skills as soon as possible.


While the world is still caught up in the COVID-19 pandemic, it’s critical that we do not view this in isolation of the larger ecological crisis at play between nature and humans.

While our imagination may be limited to floods and wildfires, mosquito-borne diseases like malaria and Zika will become more prevalent as the planet’s hot zone around the equator expands by 5.5 feet everyday. Pathogens, dormant for centuries in the Arctic permafrost, are being released as the ice melts.

Regardless of where the threat comes from, the lives of billions of people will be at the whim of how effectively their government can marshal the necessary resources to put out the next fire (in a very real sense).

When it comes to disaster and emergency response, most of us have no idea where to begin. And no, stop-drop-and-roll does not really count. For those on the front lines of responding, there is little time to look back – the next emergency is already upon them. The strain of a constant cycle of emergency activations and deployments have drained our public health and disaster response authorities. They need our help.

Responsible citizens have an opportunity and an obligation to demand action on the longstanding inefficiencies in our emergency response operations. If left unaddressed, they will continue to rear their head when the world can least afford them.

About The Author

Chetan Hebbale is currently a graduate student at the Johns Hopkins School of Advanced International Studies (SAIS) in Washington, D.C. focused on climate and sustainability.

Prior to this, he spent over 4 years at Deloitte Consulting working on technology and strategy projects at the CDC and U.S. Treasury Department.

He is a native of Atlanta, GA and attended the University of Georgia.

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Chetan Hebbale is currently a graduate student at the Johns Hopkins School of Advanced International Studies (SAIS) in Washington, D.C. focused on international economics, climate change, and sustainability.

Prior to this, he spent over 4 years at Deloitte Consulting working on technology and strategy projects at the CDC and U.S. Treasury Department.

He is a native of Atlanta, GA and attended the University of Georgia.

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Chetan Hebbale is currently a graduate student at the Johns Hopkins School of Advanced International Studies (SAIS) in Washington, D.C. focused on international economics, climate change, and sustainability.

Prior to this, he spent over 4 years at Deloitte Consulting working on technology and strategy projects at the CDC and U.S. Treasury Department.

He is a native of Atlanta, GA and attended the University of Georgia.

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Summary of Biden’s COVID-19 National Strategy and Executive Orders

Overview of the COVID-19 National Strategy

The National Strategy outlines an actionable plan across the federal government to address the COVID-19 pandemic, including twelve executive actions issued by President Biden on his first two days in office.

The National Strategy is organized around seven goals:

  1. Goal 1: Restore trust with the American people by establishing a national COVID-19 response structure, conducting regular expert-led public briefings, publicly sharing data around key response indicators, and engaging the public through outreach, townhalls, and roundtables. Immediate actions on this goal include:
    1. Executive Order on Organizing and Mobilizing the United States Government to Provide a Unified and Effective Response to Combat COVID-19 and to Provide United States Leadership on Global Health and Security.
  • Goal 2: Mount a safe, effective, and comprehensive vaccination campaign by boosting supply of vaccines, ramping up vaccination sites and the public health workforce, focusing on high-risk populations and equity of distribution, improving data collection and transparency, and launching a public education campaign to combat vaccine hesitancy. Immediate actions on this goal include:
  • Goal 3:Mitigate spread through expanding masking, testing, data, treatments, health care workforce, and clear public health standards. This will be achieved by implementing mask requirements nationwide, scaling and expanding testing, prioritizing promising therapeutics, hiring more public health workers, and improving data quality. Immediate actions on this goal include:
    • Executive Order on Protecting the Federal Workforce and Requiring Mask-Wearing.
    • Executive Order on Promoting COVID-19 Safety in Domestic and International Travel.
    • Executive Order on Establishing the National Pandemic Testing Board and Ensuring a Sustainable Public Health Workforce for COVID-19 and other Biological Threats.
    • Executive Order on Ensuring a Data-Driven Response to COVID-19 and Future High Consequence Public Health Threats.
    • Executive Order on Improving and Expanding Access to Care and Treatments for COVID-19.
  • Goal 4: Immediately expand emergency relief and exercise the Defense Production Act which can be used to fill vaccine and PPE supply shortfalls, strengthen and secure the supply chain, improve distribution, and pull in FEMA to stand up more vaccination sites. Immediate actions on this goal include:
    • Presidential Memorandum to Extend Federal Support to Governors’ Use of National Guard to Respond to COVID-19 and to Increase Reimbursement and other Assistance Provided to States
    • Executive Order on A Sustainable Public Health Supply Chain
  • Goal 5: Safely reopen schools, businesses, and travel while protecting workers by implementing a national strategy that includes access to FEMA relief funds for PPE, expanded testing, sharing of best practices across schools for an equitable re-opening, enforcement of worker safety laws along with expanding paid leave, and providing consistent technical guidance. Immediate actions on this goal include:
    • Executive Order on Supporting the Reopening and Continuing Operation of Schools and Early Childhood Education Providers
    • Executive Order on Protecting Worker Health and Safety
    • Executive Order on Promoting COVID-19 Safety in Domestic and International Travel
  • Goal 6: Protect those most at risk and advance equity, including across racial, ethnic and rural/urban lines by establishing a Health Equity Task Force, increase data collection and reporting on high-risk communities, provide equitable access to PPE, tests, and vaccines, launch a new community-based Public Health workforce program, and strengthen social safety nets. Immediate actions on this goal include:
  • Goal 7: Restore U.S. leadership globally and build better preparedness for future threats by strengthening the WHO, joining multilateral efforts on R&D and vaccine sharing, build better bio-preparedness through an an international biological response framework and establishing a National Center for Epidemic Forecasting and Outbreak Analytics, and leading on humanitarian support with international financial institutions. Immediate actions on this goal include:
    • National Security Directive on United States Global Leadership to Strengthen the International COVID-19 Response and to Advance Global Health Security and Biological Preparedness

Full Text of National Strategy

Executive Order on Promoting COVID-19 Safety in Domestic and International Travel

Immediate Action to Require Mask-Wearing on Certain Domestic Modes of Transportation.

  • The Secretary of Labor, HHS Secretary, Transportation Secretary and DHS Secretary will immediately take action to require and incentivize masks to be worn in or on: airports, commercial aircraft, trains, public maritime vessels, including ferries, intercity bus services; and all forms of public transportation as defined in section 5302 of title 49, United States Code. They may also provide recommendations on how their agency can impose additional public health measures for domestic travel

International Travel

  • Within 14 days of this order (Friday, February 4th), the Secretary of State, HHS Secretary, CDC Director, Transportation Secretary, and DHS Secretary will:
    • Assess the ability to enforce the requirement of a negative COVID-19 test for airline passengers traveling into the U.S., including the type of proof needed
    • Determine measures to prevent fraud of a negative test
    • Assess the ability to provide alternate measures for those coming from countries with a lack of ability to get tested, including self-quarantine or self-isolation on arrival
    • Submit plans to implement appropriate public health measures at land and sea ports of entry
  • The Secretary of State, HHS Secretary, and DHS Secretary will assess the feasibility of linking COVID-19 vaccination to International Certificates of Vaccination or Prophylaxis (ICVP) and producing electronic versions of ICVPs

Full Text

Executive Order on Improving and Expanding Access to Care and Treatments for COVID-19

Accelerating the Development of Novel Therapies

  • HHS Secretary and NIH Director will develop a plan for supporting studies to identify optimal clinical management strategies and for supporting treatments for COVID-19 that can be easily manufactured, distributed, and administered. These studies will support research in:
    • Rural hospitals and other rural locations
    • The long-term impact of COVID-19
    • Including underrepresented populations in clinical trials  

Improving the Capacity of the Nation’s Healthcare Systems to Address COVID-19

  • Defense Secretary, HHS Secretary, and VA Secretary will:
    • Provide targeted surge assistance to critical care and long-term care facilities, including nursing homes and skilled nursing facilities, assisted living facilities, intermediate care facilities for individuals with disabilities, and residential treatment centers
    • Establish targets for the production, allocation, and distribution of COVID-19 treatments and prioritize investments in therapeutics that can be readily administered and scaled

Improving Access to Quality and Affordable Healthcare

  • HHS Secretary will:
    • Identify barriers to maximizing the effective and equitable use of existing COVID-19 treatments and provide support to State, local, Tribal, and territorial authorities to overcome them
    • Evaluate the COVID-19 Uninsured Program operated by HRSA to promote access to treatments and clinical care for those without adequate coverage
    • Evaluate Medicare, Medicaid, group health plans, and health insurance issuers, and take any available steps to promote insurance coverage for safe and effective COVID-19 treatments and clinical care
    • Issue recommendations on how States and healthcare providers can increase the capacity of their healthcare workforces
    • Work with HRSA and SAMSHA to expand access to programs and services designed to meet the long-term health needs of patients recovering from COVID-19

Full Text

Executive Order on Ensuring a Data-Driven Response to COVID-19 and Future High-Consequence Public Health Threats

Enhancing Data Collection and Collaboration Capabilities for High-Consequence Public Health Threats, Such as the COVID-19 Pandemic

  • Defense Secretary, Attorney General, HHS Secretary, Education Secretary, OMB Director, Director of National Intelligence, Director of White House Office of Science Technology and Policy (OSTP) will designate a senior official to serve as their agency’s lead to work on COVID-19- and pandemic-related data issues
  • OMB, OSTP and U.S. CTO will issue supplemental guidance concerning how to de-identify COVID-19-related data and how to make data open to the public in human and machine-readable formats as rapidly as possible
  • OMB director will review and provide assistance in the ability of agencies to hire personnel expeditiously into roles related to information technology and the collection, provision, analysis, or other use of data to address high-consequence public health threats
  • White House COVID-19 Response Coordinator will coordinate the relevant agencies in their collection, provision, and analysis of data, including key equity indicators, regarding the COVID-19 response, as well as their sharing of such data with State, local, Tribal, and territorial authorities.

Public Health Data Systems

  • HHS Secretary will:
    • Review the effectiveness, interoperability, and connectivity of public health data systems
    • Review the collection of morbidity and mortality data by State, local, Tribal, and territorial governments
    • Issue a report summarizing the findings of the reviews and any recommendations for addressing areas for improvement

Advancing Innovation in Public Health Data and Analytics

  • Director of OSTP, in coordination with the National Science and Technology Council shall develop a plan for advancing innovation in public health data and analytics in the United States

Full Text

Memorandum to Extend Federal Support to Governors’ Use of the National Guard to Respond to COVID-19 and to Increase Reimbursement and Other Assistance Provided to States

By invoking the powers in the Stafford Act and section 502 of title 32, the President orders:

  • The Secretary of Defense to request all State and territorial governors order National Guard forces to perform duty to fulfill mission assignments for the purpose of supporting State, local, Tribal, and territorial emergency assistance efforts
  • FEMA to fund 100% of the cost of activities associated with all mission assignments for the use of the National Guard
  • FEMA will provide assistance for the safe opening and operation of eligible schools, child-care facilities, healthcare facilities, non-congregate shelters, domestic violence shelters, transit systems, and other eligible applicants.
    • This assistance is available at a 100% Federal cost share until September 30, 2021.
    • FEMA will expedite reimbursement for eligible emergency work projects

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Executive Order on a Sustainable Public Health Supply Chain

Immediate Inventory of Response Supplies and Identification of Emergency Needs and Pandemic Supply Chain Resilience Strategy

  • Secretary of State, Defense Secretary, HHS Secretary and DHS Secretary will:
    • Review the availability of critical materials, treatments, and supplies (including PPE and resources to distribute tests and vaccines at scale)
    • Assess whether the U.S. industry can provide such supplies in a timely manner
    • Use the Defense Production Act to fill shortfalls in those supplies by acquiring additional stockpiles, improving distribution systems, building market capacity, or expanding the industrial base
    • Within 180 days of this order (Tuesday, July 20th) – provide to the President a strategy to design, build, and sustain a long-term capability in the United States to manufacture supplies for future pandemics and biological threats

Pricing and Access to Strategic National Stockpile

  • HHS Secretary will:
  • Provide recommendations to the President for how to address the pricing of pandemic response supplies
  • Assess scarce materials or materials the supply of which would be threatened by accumulation for the purpose of hoarding or price gouging
  • Provide a report to the President on the status and inventory of the Strategic National Stockpile
  • Facilitate access to the Strategic National Stockpile for federally recognized Tribal governments, Indian Health Service healthcare providers, Tribal health authorities, and Urban Indian Organizations

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Executive Order on Ensuring an Equitable Pandemic Response and Recovery

COVID-19 Health Equity Task Force

  • Establish a COVID-19 Health Equity Task Force in HHS to provide recommendations to the President on:
    • How agencies and State, local, Tribal, and territorial officials can best allocate COVID-19 resources
    • How to disburse funds in a manner that advances equity
    • Effective, culturally aligned communication, messaging, and outreach to communities of color and other underserved populations
    • Factors that contributed to disparities in COVID-19 outcomes, and recommending actions to combat such disparities
    • Expediting data collection for communities of color and other underserved populations
    • Addressing these data shortfalls and other foundational data challenges, including those relating to data intersectionality

Ensuring an Equitable Pandemic Response

  • Agriculture Secretary, Labor Secretary, HHS Secretary, HUD Secretary, Education Secretary, and EPA Administrator will:
    • Consult with the Health Equity Task Force to strengthen equity data collection, reporting, and use related to COVID-19
    • Assess pandemic response plans and policies to determine whether personal protective equipment, tests, vaccines, therapeutics, and other resources have been or will be allocated equitably
    • Modify pandemic response plans based on policy priorities expressed by communities that have suffered disproportionate rates of illness and death
    • Strengthen enforcement of anti-discrimination requirements pertaining to the availability of, and access to, COVID-19 care and treatment
    • Partner with States, localities, Tribes, and territories to provide greater assistance including expanding access to food, housing, child care, or income support
  • HHS Secretary will:
    • Provide recommendations to State, local, Tribal, and territorial leaders on how to facilitate the placement and recruitment of contact tracers and other workers in the hardest hit communities
    • Conduct an outreach campaign to promote vaccine trust and uptake among communities of color and other underserved populations with higher levels of vaccine mistrust

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Executive Order on Supporting the Reopening and Continuing Operation of Schools and Early Childhood Education Providers

Agency Roles and Responsibilities

  • The Secretary of Education will:
    • Provide evidence-based guidance to assist States, elementary and secondary schools and institutes of higher education in deciding whether and how to reopen, and how to remain open. This will be done in consultation with the HHS Secretary.
    • Provide advice on distance and online learning, blended learning, and the promotion of mental health and social-emotional well-being
    • Develop a Safer Schools and Campuses Best Practices Clearinghouse to enable schools and institutions of higher education to share lessons learned and best practices for operating safely during the pandemic
    • Direct the Assistant Secretary for Civil Rights to deliver a report on the on the disparate impacts of COVID-19 on education for underserved populations
    • Coordinate with the Director of the Institute of Education Sciences to collect data necessary to fully understand the impact of the COVID-19 pandemic on students and educators
    • Work with the HHS Secretary to submit a report to the Assistant to the President for Domestic Policy and the COVID-19 Response Coordinator identifying strategies to address the impact of COVID-19 on educational outcomes, especially along racial and socioeconomic lines
  • HHS Secretary will:
    • Facilitate the collection of data needed to inform the safe reopening and continued operation of schools
    • Ensure that COVID-19-related supplies, including testing materials, are equitably allocated to elementary and secondary schools
    • Support the development and operation of contact tracing programs to facilitate school reopenings
    • Provide guidance on cleaning, masking, proper ventilation, and testing,
  • Federal Communications Commission (FCC) is encouraged to increase connectivity options for students lacking reliable home broadband

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Executive Order on Protecting Worker Health and Safety

Protecting Workers from COVID-19 Under the Occupational Safety and Health Act (OSHA)

  • The Labor Secretary will:
    • Within 2 weeks of this order (Friday, February 4th) issue revised guidance to employers on workplace safety during the COVID-19 pandemic
    • Consider whether any emergency temporary standards on COVID-19 (e.g. masks) are necessary and issue them by March 15th, 2021, including for coal, metal or non-metal mines
    • Review enforcement of OSHA and identify changes that could be made to better protect workers and ensure equity in enforcement
    • Launch a national program to focus OSHA enforcement efforts related to COVID-19 on violations that put the largest number of workers at serious risk or are contrary to anti-retaliation principles
    • Work with states and local government and public employee unions to bolster protection from COVID-19 in states that don’t have occupational health and safety plans approved by OSHA
  • Agriculture Secretary, Labor Secretary, HHS Secretary, Transportation Secretary, and Energy Secretary will explore mechanisms to protect workers not protected under OSHA so that they remain healthy and safe on the job during the COVID-19 pandemic

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National Security Directive on United States Global Leadership to Strengthen the International COVID-19 Response and to Advance Global Health Security and Biological Preparedness

Strengthening and Reforming the World Health Organization

  • Within 30 days of this directive (February 21st, 2021), the Assistant to the President for National Security Affairs, Secretary of State and HHS Secretary will provide to the President recommendations on how the U.S. can:
    • Exercise leadership at the WHO and work with partners to lead and reinvigorate the international COVID-19 response
    • Participate in international efforts to advance global health, health security, and the prevention of future biological catastrophes
    • Otherwise strengthen and reform the WHO

United States Leadership in the Global Response to COVID-19

  • Secretary of State and HHS Secretary will:
    • Inform the WHO and Gavi, the Vaccine Alliance, of the United States’ intent to support the Access to COVID-19 Tools (ACT) Accelerator and join the multilateral vaccine distribution facility, known as the COVID-19 Vaccine Global Access (COVAX) Facility 
    • Develop a framework for donating surplus vaccines, once there is sufficient supply in the U.S.
    • Develop a plan for engaging with and strengthening multilateral initiatives focused on the global COVID-19 response, including equitable development and distribution of vaccines, therapeutics, tests, and personal protective equipment
  • Secretary of State, HHS Secretary, USAID Administrator, and CDC Director will:
    • Submit a Government-wide plan to combat the global COVID-19 pandemic, which shall identify principal strategic objectives, corresponding lines of effort, and lead agencies.
    • Review and, as necessary, adjust the United States’ current and planned future deployments of public health, health security, and health diplomacy personnel overseas focused on the COVID-19 response
    • Within 14 days of this directive (Friday, February 4th) and in consultation with the Ambassador to the UN, develop a diplomatic outreach plan for enhancing the United States’ response to the COVID-19 pandemic, with a focus on engaging partner nations, the United Nations, and other multi-lateral stakeholders on:
      • The financing of and capacity for strengthening the global COVID-19 response
      • Assistance to mitigate the secondary impacts of the pandemic such as food insecurity and gender-based violence and supporting vulnerable communities
  • Secretary of State, Treasury Secretary, Commerce Secretary, HHS Secretary, and USAID Administrator will review existing United States and multilateral financial and economic sanctions to evaluate whether they are unduly hindering responses to the COVID-19 pandemic and provide recommendations for any changes

Review of Funding for COVID-19 Response and Global Health Security and Biodefense

  • OMB Director will review the funding allocated for the COVID-19 response, including the secondary impacts of the pandemic, as well as for global health security, global health, pandemic preparedness, and biodefense and provide the President with an assessment if it is enough 

Financing for Global Health Security

  • Secretary of State, Treasury Secretary, HHS Secretary, USAID Administrator, CEO of the United States International Development Finance Corporation, and Assistant to the President for National Security Affairs will promptly provide to the President recommendations for creating an enduring international catalytic financing mechanism for advancing and improving existing bilateral and multilateral approaches to global health security
    • Treasury Secretary will separately provide a strategy to the President for how the U.S. can promote financing, relief, and other policies that are aligned with and support the goals of combating COVID-19 and strengthening global health security in international financial institutions, including the World Bank Group and International Monetary Fund

Advancing Global Health Security and Epidemic and Pandemic Preparedness

  • Assistant to the President for National Security Affairs will
    • Coordinate the Federal Government’s efforts to prepare for, prevent, detect, respond to, and recover from biological events
    • Elevate United States leadership and assistance in support of, the Global Health Security Agenda
    • Develop recommendations for how the Federal Government will update existing health security policies and strategies, including:
      • Developing stronger global institutions focused on harmonizing crisis response for emerging biological events and public health emergencies
      • Taking steps to strengthen the global pandemic supply chain and address any barriers to the timely delivery of supplies in response to a pandemic
      • Working with partner countries and international organizations to strengthen and implement the International Health Regulations
      • Reducing racial and ethnic disparities in the COVID-19 global response and disproportionate impacts on marginalized and indigenous communities, women and girls, and other groups
      • Reviewing and developing priorities for multilateral fora aimed at reducing the risk of deliberate or accidental biological events
      • Combating antimicrobial resistance
      • Fighting climate change as a driver of health threats
    • Coordinate with the Secretary of State, HHS Secretary, USAID Administrator, and CDC Director to develop  protocols for coordinating and deploying a global response to emerging high-consequence infectious disease threats, including establishing standard operating procedures for how USAID and the CDC coordinate their response efforts.
    • Coordinate with the COVID-19 Response Coordinator and Assistant for the President for Domestic Policy to develop a plan for establishing an interagency National Center for Epidemic Forecasting and Outbreak Analytics and modernizing global early warning and trigger systems for scaling action to prevent, detect, respond to, and recover from emerging biological threats
    • Coordinate with the Secretary of State and UN Ambassador to support the establishment of a new position in the office of the United Nations Secretary-General of a facilitator for high-consequence biological threats
  • The Director of National Intelligence will:
    • Develop a plan for how the intel community may strengthen and prioritize collection and reporting capabilities of pandemics, including through organizational changes or the creation of National Intelligence Manager and National Intelligence Officer positions focused on biological threats, global public health, and biotechnology
    • Submit to the president a  National Intelligence Estimate on the impact of COVID-19 on national and economic security; and current, emerging, reemerging, potential, and future biological risks to national and economic security
    • Coordinate with the HHS Secretary, Defense Secretary, CDC Director, USAID Administrator, and OSTP Director to develop an analysis of the security implications of biological threats that can be incorporated into modeling, simulation, course of action analysis, and other analyses

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Executive Order on Establishing the COVID-19 Pandemic Testing Board and Ensuring a Sustainable Public Health Workforce for COVID-19 and Other Biological Threats

COVID-19 Pandemic Testing Board

  • By invoking section 301 of title 3, United States Code, the President orders the establishment of a COVID-19 Pandemic Testing Board chaired by the COVID-19 Response Coordinator which shall:
  • Coordinate efforts to promote COVID-19 diagnostic, screening, and surveillance testing
  • Make recommendations to expand testing, genomic sequencing, and reduce disparities in access to testing for priority populations, communities with shortages in testing, at-risk settings, and high-risk groups
  • Maximize testing capacity of commercial labs and academic labs

Actions to Address the Cost of COVID-19 Testing

  • Treasury Secretary, HHS Secretary, Labor Secretary, and COVID-19 Response Coordinator will:
    • Facilitate the provision of COVID-19 testing free of charge to those who lack comprehensive health insurance
    • Clarify group health plans’ and health insurance issuers’ obligations to provide coverage for COVID-19 testing
  • HHS Secretary, Education Secretary, DHS Secretary, including FEMA will:
    • Provide support for surveillance tests for settings such as schools
    • Expand equitable access to COVID-19 testing

Establishing a Public Health Workforce Program

  • HHS Secretary and Labor Secretary will:
    • Consult provide technical support to State, local, Tribal, and territorial leaders in their challenges for pandemic response efforts, including challenges recruiting and training sufficient personnel for testing, contact tracing, and mass vaccinations and combating opioid use
    • Develop a plan for how HHS would deploy personnel in response to future public health threats
    • Establish five-year targets and budget requirements for achieving a sustainable public health workforce, including expanding the U.S. Public Health Service Commissioned Corps and Epidemic Intelligence Service
  • HHS Secretary, DHS Secretary, Labor Secretary, Education Secretary, and Chief Executive Officer of the Corporation for National and Community Service will establish a U.S. Public Health Job Corps modeled on the FEMA Corps program which will:
    • Train individuals in contact tracing and testing related to the COVID-19 pandemic;
    • Assist in outreach for vaccination efforts, including by administering vaccination clinics

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Executive Order on Organizing and Mobilizing the United States Government to Provide a Unified and Effective Response to Combat COVID-19 and to Provide United States Leadership on Global Health and Security

Organizing the White House to Combat COVID-19

  • Established within the Executive Office of the President the position of Coordinator of the COVID-19 Response and Counselor to the President (COVID-19 Response Coordinator) and a Deputy who will be responsible for coordinating the government-wide effort to curb the pandemic including:
    • Reducing disparities in the response, care, and treatment of COVID-19, including racial and ethnic disparities;
    • Coordinating efforts to produce, supply, and distribute personal protective equipment, vaccines, tests, and other supplies including through the use of the Defense Production Act
    • Expanding COVID-19 testing and the use of testing as an effective public health response
    • Supporting the timely, safe, and effective delivery of COVID-19 vaccines to the United States population;
    • Supporting the safe reopening and operation of schools, child care providers, and Head Start programs

United States Leadership on Global Health and Security and the Global COVID-19 Response

  • Assistant to the President for National Security Affairs will convene the National Security Council Principals Committee to address and advise on matters regarding:
    • The intersection of the COVID-19 response and other national security equities
    • Global health security
    • Engaging with and strengthening the World Health Organization
    • Public health, access to healthcare, and the secondary impacts of COVID-19;
    • Emerging biological risks and threats
  • Within 180 days of this order (Monday, July 19th), this group will  complete a review of and recommend actions to the President concerning emerging domestic and global biological risks and national biopreparedness policies
  • Re-Establish the NSC Directorate on Global Health Security and Biodefense for monitoring current and emerging biological threats

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Executive Order on Protecting the Federal Workforce and Requiring Mask-Wearing

Immediate Action Regarding Federal Employees, Contractors, Buildings, and Lands

  • The heads of executive departments and agencies shall immediately take action to require compliance with CDC guidelines with respect to wearing masks, maintaining physical distance for all persons in Federal buildings or on Federal lands.

Encouraging Masking Across America

  • HHS Secretary and CDC Director will engage with State, local, Tribal, and territorial officials, as well as business, union, academic, and other community leaders with the goal of maximizing public compliance with, and addressing any obstacles to, mask-wearing

Safer Federal Workforce Task Force

  • Establish the Safer Federal Workforce Task Force which shall provide ongoing guidance to heads of agencies on the latest CDC guidance regarding:
    • Testing methodologies, case investigation and contact tracing;
    • Requirements of and limitations on physical distancing, including recommended occupancy and density standards;
    • Equipment needs and requirements, including personal protective equipment
    • Air filtration
    • Enhanced environmental disinfection and cleaning;
    • Safe commuting and telework options
    • Enhanced technological infrastructure to support telework
    • Vaccine prioritization, distribution, and administration;
    • Approaches for coordinating with State, local, Tribal, and territorial health officials
    • Management infrastructure needed to implement public health guidance

Federal Employee Testing

  • CDC Director and HHS Secretary will develop a testing plan for the Federal workforce

Research and Development

  • Director of OSTP, HHS Secretary, OMB Director, CDC Director, NIH Director, and NSF Director will assess the availability of Federal research grants to study best practices for implementing, and innovations to better implement, effective mask-wearing and physical distancing policies, with respect to both the Federal workforce and the general public

Full Text

About The Author

Chetan Hebbale is currently a graduate student at the Johns Hopkins School of Advanced International Studies (SAIS) in Washington, D.C. focused on international economics, climate change, and sustainability.

Prior to this, he spent over 4 years at Deloitte Consulting working on technology and strategy projects at the CDC and U.S. Treasury Department.

He is a native of Atlanta, GA and attended the University of Georgia.

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Politics and Government Short Form

Ecosystem Integrators And The Future of Work In Government

The rise of the digital age has brought a new mindset that requires leaders who are committed to being agile and taking intelligent risks. As government agencies look to develop high potential individuals that can lead in this environment, a critical role to prepare for is one of an Ecosystem Integrator.

Today, the “ecosystem” of government is a dynamic, interconnected network that connects our public institutions, private corporations, and everyday communities.  An Ecosystem Integrator’s primary role is to build connections and create the space for aligned action by others. In this role connecting the people and technology platforms in this ecosystem and giving room for decisionmakers to work in an integrated fashion will ultimately transform how government interacts with its stakeholders and improve business outcomes.

From a technology stand point, the way people and organizations interact with information has changed drastically, and likely permanently. The government has an imperative to respond accordingly by creating a “smarter” government that can harness the power of emerging technology to collect and integrate disparate sources of data to reinvent and overhaul core government services.

From a people stand point, innovative thinking will be required to navigate the divide between career officials and political appointees in today’s highly charged political environment. Bridging the gaps in trust and breaking down siloes in decision-making will be a necessary cornerstone to produce a well-functioning government.

To tackle these problems, Ecosystem Integrators will need to develop these core competencies:

  • Aligning for a Common Purpose: Establish early on what strategic goals are important to all stakeholders and build the organization around that core vision. This includes ensuring technology modernization or enhancement efforts are aligned to a common goal as well as dialoguing, and sometimes negotiating, with political appointees without a career government background as to what are appropriate risks to take for the organization.
  • Interpersonal Relationship Building: Cultivate and facilitate relationships internally and between public and private sector entities. Create a positive culture by encouraging and empowering others to form meaningful connections, and train career government officials ahead of a transition of how to communicate with new political appointees. Establishing these bonds will allow for greater trust, transparency, and consensus around roles and responsibilities across the organization. 
  • Systems Thinking:  Lead or advise others in understanding the full scope of the organization’s work, including governing laws, policies and regulations as well as understanding the patterns, dependencies, and governance structure of multiple, interrelated complex IT systems. These insights should be used to articulate to leadership what areas of the organization are working well and which have gaps that need to be closed.

As an example of successful ecosystem integration, tackling prescription opioid abuse presented an opportunity for public sector officials to step up and facilitate the type of collaboration needed to combat this public health epidemic.

Case Study: Ecosystem Integrators in the Opioid Response

State governors and their administrations are increasingly serving as Ecosystem Integrators in the anti-opioid ecosystem. State commissions, such as the Commonwealth of Virginia Governor’s Task Force on Prescription Drug and Heroin Abuse, the Commonwealth of Massachusetts Governor’s Opioid Working Group, and New York’s Heroin and Opioid Task Force, are helping to drive real action.

They achieve this through improved coordination and alignment of strategies focused on opioid abuse and heroin use prevention, intervention, treatment, recovery, and enforcement. Given the attention these commissions have received, and the resources their work has attracted, state leaders are orienting their bodies to drive ongoing implementation and innovation after they deliver their final reports. Through working sessions, implementation groups, and coordinated action plans at the governor’s level, various state governments are integrating the activities of executive agencies, community organizations, and health care providers, thus making the overall effort more effective.

This case study demonstrates the importance of Ecosystem Integrators in connecting the public and private sectors to improve the lives of everyday citizens. Given the wide-scale impact of the opioid crisis, Ecosystem Integrators must be able to bring private sector organizations like foundations or companies that focus on public health, economic development, or the welfare of children and families to the table. Once government brings these parties together it can more easily provide resources and create the space for these local organizations to better tailor efforts to the unique needs of a community or region.

Ultimately, government cannot address today’s complex challenges with outdated systems or legacy organizational roles. The way government operates through its work, its workforce, and its workplace is changing, and we need fresh thinking to address the issue of how the public sector delivers value. Ecosystem Integrators stand at the front line of this fresh thinking by aligning people and technology to common goals, bridging trust within the workforce and with private industry, and utilizing systems thinking to create a holistic understanding of how the organization’s infrastructure ties together. Ecosystem Integrators will play a critical role in creating a more unified and smarter government of the future. 

About The Author

Chetan Hebbale is currently a graduate student at the Johns Hopkins School of Advanced International Studies (SAIS) in Washington, D.C. focused on international economics, climate change, and sustainability.

Prior to this, he spent over 4 years at Deloitte Consulting working on technology and strategy projects at the CDC and U.S. Treasury Department.

He is a native of Atlanta, GA and attended the University of Georgia.

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Investigative Report Long Form Politics and Government

But Her Emails: A Deeper Look At The Legal Issues Behind Classified Information

Upon assuming the role of Secretary of State in 2009, Hillary Clinton and her aides struggled with how to separate her work and business related communications in an increasingly digital and mobile age. The result was the set up of a private email server forgoing the use of an official email address altogether. Thus, the Hillary Clinton email scandal was born.

Even though this scandal has been going on for over a year, a vast majority of Americans are still unsure of what exactly she did wrong. Many in the Democratic Party believe this whole controversy has simply been a partisan, Republican attack to damage her Presidential campaign. That view has been reinforced by Sen. Bernie Sanders who has refused to raise the issue in the 2016 Democratic primary thus far – something both potential Republican nominees have promised to do in the general election. So what is going on here?

In August 2015, the FBI officially launched an investigation into Clinton’s use of a private e-mail server while she was Secretary of State. The primary issue that FBI investigators are looking at is whether or not Clinton knowingly retained, transmitted, or deleted classified information from her private server. Communicating this type of information through unsecure means could put highly classified government secrets at risk by making them susceptible to hackers and spies. 

FBI Director James Comey to date has not spoken publicly about the investigation into Hillary Clinton’s private e-mail server

As of January 2016, the State Department has withheld 22 emails from Clinton’s server as “top secret” and too classified to release to the public.  Two of these emails surround the movement of North Korean missiles, and the specifics of a drone operation.

There are several laws surrounding the mishandling of classified information which are spelled out under Title 18 US Criminal Codes and Procedures. The two statutes federal investigators are most interested in are Title 18 U.S. Code § 1924 and Title 18 U.S. Code § 793.

Title 18 U.S. Code § 1924 : Unauthorized removal and retention of classified documents or material

(a) Whoever, being an officer, employee, contractor, or consultant of the United States, and, by virtue of his office, employment, position, or contract, becomes possessed of documents or materials containing classified information of the United States, knowingly removes such documents or materials without authority and with the intent to retain such documents or materials at an unauthorized location shall be fined under this title or imprisoned for not more than one year, or both.

Title 18 U.S. Code § 793 –  Gathering, transmitting or losing defense information

(f) Whoever, being entrusted with or having lawful possession or control of any document, writing, code book, signal book, sketch, photograph, photographic negative, blueprint, plan, map, model, instrument, appliance, note, or information, relating to the national defense, (1) through gross negligence permits the same to be removed from its proper place of custody or delivered to anyone in violation of his trust, or to be lost, stolen, abstracted, or destroyed, or (2) having knowledge that the same has been illegally removed from its proper place of custody or delivered to anyone in violation of its trust, or lost, or stolen, abstracted, or destroyed, and fails to make prompt report of such loss, theft, abstraction, or destruction to his superior officer

Section 1924 and 793 establishes that anyone that possesses classified information and knowingly, or through “gross negligence” removes it without authority or retains it in an unauthorized location shall face punishment.

Clinton Defense:

  • Clinton has denied wrongdoing by saying these emails have all been retroactively classified, and she neither sent nor received information “marked classified” while Secretary of State. More importantly, as the head of the agency she was the ultimate arbiter of what information would or wouldn’t be considered classified at the time.
  • There is no law that prevents federal employees from having a non-government, personal email as long as relevant work-related documents are preserved. She points to several other public officials who used private emails while in office, including former Secretaries of State Condoleezza Rice and Colin Powell and that the current Secretary of State John Kerry is the first to primarily use a email account.
  • The campaign has argued that her work-related emails were captured on government systems because she was emailing with folks with government email addresses, and as far as deleting or destroying relevant records, she says the emails that were destroyed on her server were personal correspondence that she has the legal right to decide what to do with.

What the FBI has to decide:

  • Did Clinton knowingly remove classified information when she wiped her server?
  • Did Clinton know that the emails being sent from her private email address through her private email server contained classified information?

Below are 3 scenarios where the FBI and DOJ will have to make an assessment on these questions.

Will Hillary Clinton’s e-mails with Clinton Foundation employee Sidney Blumenthal meet the threshold that she knowingly retained “classified information” on her private server and also communicated information of “the national defense” with someone “not entitled to receive it.”?

Clinton’s use of a private server was unveiled as a result of the Congressional investigation into the 2012 terrorist attacks which killed 4 Americans at the US consulate in Benghazi, Libya. In December 2014, Clinton turned over all the emails deemed “work-related” to the State Department and the Benghazi investigation. During the review of these emails it was revealed that she had extensively corresponded with someone by the name Sidney Blumenthal while Secretary of State.

Sidney “Sid” Blumenthal was a former journalist at the New Yorker who became one of the Clinton’s closest aides and confidants during Bill Clinton’s administration. At the time of the Benghazi attacks, Blumenthal was not a State Department employee, despite having tried, he worked at the Clinton’s large non-profit organization, The Clinton Foundation.

Once his correspondence with Hillary Clinton came to light, Blumenthal was summoned to testify before the Congressional Benghazi committee in June 2015. In a closed door meeting with the committee members, Blumenthal turned over 60 emails that he had exchanged with Hillary Clinton. Once the committee crosschecked the emails that Blumenthal had turned over with the ones Clinton had handed over to the State Department, they found that she had not turned over nine emails and portions of six others – 15 emails in all were unaccounted for.  After accusations that she deleted these emails, the State Department released a new 1,500 pages of Clinton’s emails in September 2015 that were previously undisclosed to the Benghazi committee.

Clinton advisor Sidney Blumenthal subpoenaed by Congress in May 2015

The additional tranche of emails revealed at least 84 containing classified information, including ones she sent. Several email between her and Blumenthal have had select paragraphs and even entire pages redacted.  This June 2012 memo has been completely redacted, and this September 2012 memo even has the subject line hidden.  

Blumenthal in fact prefaced many of his intelligence memos to Clinton by saying they came from “an extremely sensitive source” and the information “should be handled with care”.  This throws into doubt Clinton’s argument that she could not know information was classified because it was not “marked classified”. Clinton repeatedly forwarded these emails to her aides, thanked Blumenthal and encouraged him to continue sending her information.

The most incriminating email from Blumenthal to Clinton is a memo where he reveals the name of a CIA intelligence operative in Libya.  In a March 2011 memo, Blumenthal wrote “Tyler spoke to a colleague currently at the CIA, who told him the agency had been dependent for intelligence from [redacted due to sources and methods].” Despite the email not being “marked classified”, information about a current CIA asset which was illegally obtained would likely fall under the purview of a 2009 Non-Disclosure Agreement Clinton signed which stipulates that “classified information is marked or unmarked classified information.”

John Rizzo, a former general counsel at the CIA, said of the memo “it’s the most sensitive kind of classified information — the true identity of a human source.

J. William Leonard, a former director of the U.S. government’s Information Security Oversight Office (ISOO) who worked for both the Bill Clinton and George W. Bush administrations said of the information “It’s born classified”…for the State Department to say otherwise was “blowing smoke.”

Clinton, by law, was supposed to report this improper disclosure of classified information to Department of State Inspector General. But interestingly during her tenure, there was no Inspector General for the State Department, the longest there had been an absence in that position since 1957. Clinton is one of ten members of the US government which determines what is classified information, yet still forwarded this email to one of her aides – debunking her claim that she never sent classified information through her private server.

“This is a serious breach of national security and a clear violation of the law”, said Army Col. Larry Mrozinski, who served almost four years as a ­senior military adviser in the State Department under both Clinton and Condoleezza Rice.  “It’s hard to imagine that in her position she would fail to recognize the obvious…anybody else would have already lost their security clearance and be subjected to an espionage investigation,” Mrozinski added.

If the FBI concludes that the identity and location of this CIA operative was authentic then this could be considered a violation of Section 1924 for possessing “documents containing classified information” (even if it was not marked classified) at an “unauthorized location” (on her private server). Furthermore, this would prove that Clinton was corresponding about information “of the national defense” with an employee of The Clinton Foundation, even though Blumenthal was never given a security clearance to deal with such sensitive information in the first place. 

Clinton forwarding his email to others and encouraging additional information be sent could be considered a violation of Section 793, Section 798, and the 2009 Non-Disclosure Agreement for “knowingly and willfully” communicating sensitive information with someone who was not “properly authorized by the United States Government to receive it“. However, the case to prosecute Clinton under Section 793, “The Espionage Act,” is far weaker than the other statutes. It is easy to piece together certain behavior and claim that she has violated the law, but intent is important when deciding to prosecute. 

There is an argument to be made based off of a 1941 Supreme Court case that in order to be prosecuted under The Espionage Act, the disclosure of this information would have had to be done in “bad faith” and with “intent” to injure the United States. It is not currently possible to say Clinton intended to injure anyone by forwarding the e-mail, and that likely would not be true anyway. The FBI will have to assess what additional information her deleted emails may contain with regards to her “intent” when using her private email to discuss classified information.

Does Hillary Clinton’s failure to encrypt her private server for the first two months as Secretary, along with other security lapses, constitute “gross negligence” while possessing information of “the national defense”?

Once Clinton turned over her server to the FBI in August 2015, reports began to emerge that it was extremely vulnerable to hacking attempts because the server permitted remote-access connections directly over the Internet. Not only that, Clinton did not encrypt any of her emails for the first two months as Secretary of State.

Before becoming Secretary of State in 2009, Clinton purchased a private email server to be installed in her home in New York. On this server she used the email address for all work and personal correspondence throughout her 4-year tenure as Secretary. She did not use, or activate, an official State Department “” email account throughout this time. Hillary Clinton’s email server and address ( were not sanctioned by the State Department as one of the agency’s authorized electronic recordkeeping systems under the National Archives and Records Administration‘s (NARA) regulations.

This separates her case from former Secretaries of State Colin Powell and Condoleezza Rice who had a private email address, but primarily used their work email. They did not go as far as to have all their communications flow through a private server which only they controlled, nor were they sending highly classified information through their private email. Colin Powell had only two of his e-mails retroactively classified, that too at the lowest level.

One of Clinton’s primary defenses has been that her predecessors Rice and Powell also used private email addresses

After scanning the “clintonemail” domain, a private cybersecurity firm found that from January 2009 to March 2009 the domain had no digital certificate issued by an authority. Without what’s called an “SSL” certificate, data flows through in the form of plain text. This means all of Clinton’s web browser, smartphone and tablet communications would not have been “encrypted,”  which allows any hacker to read that information.

Marc Maiffret, who has founded two cybersecurity companies, called her set up total amateur hour” and that “real enterprise-class security, with teams dedicated to these things, would not do this.” “An attacker with a low skill-level would be able to exploit this vulnerability,” said a Homeland Security Department’s U.S. Computer Emergency Readiness team.

Clinton has so far refused to answer questions about how well her system was secured, the types of safeguards on her server and whether, or how frequently, security updates were applied. Clinton’s first email sent from the server was on January 28th, 2009, but the Clinton’s server wasn’t issued an SSL certificate until March 29th, 2009 – contradicting her claim that this system wasn’t used till after March 2009. During those two months, Clinton’s travel logs show that she visited China, Indonesia, Egypt, Israel, Japan and South Korea and discussed issues about North Korea, Mexico, Afghanistan, military advisers, CIA operations and a briefing for Obama.

There are now reports that, Asian governments may have been reading Clinton’s information during the 3 month window when her server did not have an SSL certificate. While Clinton has claimed there is no evidence that her private server was successfully hacked, there have been two confirmed hacking attempts into Clinton’s email server:  one in 2011 from Russia and a second one in 2012 from Serbia. There are now reports of dozens more hacking attempts into her server, some even originating from allies like China, South Korea and Germany.

While the specific safeguards for her email server are still unknown, we know these two things for sure. First, the State Department was aware of these lapses, warned Clinton and attempted to provide her with a secure “” email account, but she chose not to use it. Second and more damningly, Clinton tried to modify existing State Department security protocols so she would be able to use her unsecured Blackberry in a secure facility (called a SCIF) to view classified information. The NSA said no.

Does the lax security for her private server and attempted circumvention of security protocols while there were confirmed hacking attempts into her server demonstrate “gross negligence” while retaining information of the national defense? The FBI will have to make the call.

Does Hillary Clinton transferring the data from her private server to Platte River Networks and then wiping the server constitute retaining “classified information” at an “unauthorized location”, having information of the “national defense” be “lost, stolen, abstracted, or destroyed“, and an obstruction of justice?

Whether or not Clinton’s private email server itself violated The Federal Records Act, The National Archives Regulations or the Freedom of Information Act remains the subject of legal debate. But what she chose to do with her data after leaving office has not received as much attention.

After Hillary stepped down as Secretary of State in February 2013, she chose to upgrade her private email server. In June 2013, a small IT company in Denver called Platte River Networks won a contract to provide information technology services to Bill and Hillary Clinton, which included taking possession of Hillary’s email server while she was Secretary of State. The role of Platte River Networks was to “upgrade, secure and manage the e-mail server for both the Clintons and their staff beginning June 2013.”

This was a huge contract for a company that had actually never held a federal contract before, had no prior relationship with the Clintons, and who’s most notable accomplishment at the time was winning the 2012 Denver Metro Chamber of Commerce’s Small Business of the Year award. In June 2013, the company took Clinton’s server from her home in New York and transferred it to a secure facility in New Jersey. It was here the data from her original server was “migrated” to a new server for the purpose of making the transition to Platte River Networks.

After leaving office, Clinton had the data from her private server transferred to a private, not well known, IT company in Denver called Platte River Networks

Platte River Networks did not have clearance to handle classified government information. Cindy McGovern, a spokeswoman for an agency within the Defense Department that vets companies for security clearances, said her office had not extended one to Platte River Networks. The company has admitted that as far as it knows, their employees never held formal government-issued security clearances.

Given the existence of classified information on her private server, Clinton’s decision to transfer this information to a private IT company with no security clearance could be violation of Section 1924 for housing sensitive information at an “unauthorized location,” but could even fall under Section 793 for “gross negligence” in handling information of “the national defense.”

Then there is the question of the wiping of the email server. Clinton claims the emails she deleted were personal and not work related, and its up to her if she wanted to get rid of them, even if she decided to do so 2 years after leaving the State Department. Because all of her correspondence is in her control and not the government’s, it is difficult to verify the claim.

However the FBI has attempted to do so by approaching Platte River Networks to retrieve Clinton’s original server. There are reports that employees at the company began to fear a cover-up as they received a letter from Clinton Executive Service Corp instructing them to “cut the back up”.

The employees did not do so and the FBI has now recovered deleted emails which they considered to contain work-related information. This debunks her claim, which she made under the penalty of perjury, that she turned over all her work-related emails to the State Department.

In addition, if they find find highly classified emails then she could be considered attempting to obstruct justice and be in violation of Section 793 for having information of the “national defense” be “lost, stolen, abstracted, or destroyed”.

What will happen next?

Bryan Pagliano, Clinton’s IT staff member who managed the private server, has been granted immunity – likely signaling that he will be providing testimony to a grand jury.

Last month the Justice Department granted immunity to Clinton’s IT staff member who managed her e-mail server, Bryan Pagliano.  A witness is usually granted immunity if he/she will be giving testimony to a grand jury about evidence that relates to an investigation, and usually implicates themselves in a crime. Until now, Pagliano has been pleading the 5th Amendment and has refused to cooperate with the investigation surrounding how the e-mail server was set up and the safeguards put in place. There are even suspicions of fraud involving his hiring and payment, which were all done by the Clintons, and not reported to the State Department.

Many have said a granting of immunity is not evidence of guilt, rather a competent lawyer who is seeking protections for their client before cooperating with an investigation. Pagliano receiving immunity may ultimately be inconsequential, but one former FBI official said, “you don’t start granting people close to Clinton immunity unless you are seriously looking at charges against your target.

The FBI is expected to officially announce the findings from the investigation around May or June. The Democratic National Convention will choose the party’s nominee for President at the end of July. If Clinton is found guilty of any charges she must either withdraw her name from the Democratic primary, or continue to deny/downplay wrongdoing and hope that she will still collect enough delegates in the remaining primary states to secure the nomination. If a heavy charge is brought down and she chooses to withdraw from the race, Bernie Sanders would likely become the nominee. However, there are rumors there could still be a contested convention because of the party’s high number of super delegates.

About The Author

Chetan Hebbale is currently a graduate student at the Johns Hopkins School of Advanced International Studies (SAIS) in Washington, D.C. focused on international economics, climate change, and sustainability.

Prior to this, he spent over 4 years at Deloitte Consulting working on technology and strategy projects at the CDC and U.S. Treasury Department.

He is a native of Atlanta, GA and attended the University of Georgia.

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