Report of the Independent Panel on the 

U.S. Department of Health and Human 

Services (HHS) Ebola Response

June 2016
Foreword 

The Independent Panel on the U.S. Department of Health and Human Services (HHS) 

Ebola Response is pleased to provide this report. First, we want to commend HHS for its 

extraordinary domestic and international response to the largest and most complex Ebola 

epidemic on record. The performance of thousands of HHS staff members was a 

testament to the public service ethos of the Department.

Our investigation included research into public and internal documents, interviews with 

hundreds of individuals inside and outside of government, careful deliberations, and 

extensive review of our findings and recommendations with government officials and 

other stakeholders. We found notable opportunities for improvement in leadership and 

organization, communication, management, and logistics, as well as in development and 

use of vaccines and treatments. Our report makes recommendations to address each of

these areas.

On behalf of the Panel, I want to thank you for your interest in this work. We strongly 

believe that the actions we recommend will enable HHS to respond even more capably in 

future outbreaks.

Jonathan Fielding

Chair, Independent Panel on the HHS Ebola Response

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ii
Executive Summary

To capture critical lessons from the Ebola epidemic of 2014–2016, the U.S. Department 

of Health and Human Services (HHS) asked CNA to convene an independent panel of 

public health, healthcare, emergency response, and communication experts to review the 

Department’s international and domestic responses. This report summarizes the 

Independent Panel’s assessment of HHS’s challenges—and, where appropriate, 

challenges facing the broader U.S. government—and presents recommendations for 

addressing future urgent public health threats.

The Ebola epidemic that began in West Africa was a seminal event for the global public 

health response community. The epidemic crystalized the importance of national disease 

surveillance capacities and timely multilateral coordination. The World Health 

Organization (WHO) and others acknowledge that investments must be made in the 

ability of countries to detect, report, and respond to urgent public health threats, and that 

reforms are needed to strengthen WHO’s role as the worldwide protector of health [1-2]. 

As part of this global community, HHS made significant contributions to controlling the 

epidemic abroad and safeguarding the United States from the risk of Ebola. Through its

efforts, many lessons emerged. The most salient lessons related to internal government 

coordination, collaboration with international partners, communication with the public and 

key stakeholders, and the need to meet the high demand for public health and medical 

support at home and abroad. 

Lessons from HHS’s response to the Ebola epidemic are relevant to current and future 

outbreaks of infectious diseases, including the current outbreak of the Zika virus. The 

Independent Panel hopes that the Department will carefully consider the findings and 

recommendations presented in this report and—if they have not done so already—

implement the necessary changes in policy, programs, and plans. By taking action to 

address issues that emerged during the Ebola response, HHS will help ensure that it and 

its health response partners around the world are best positioned to address future 

contagions.

The Independent Panel’s findings and key recommendations are summarized below. 

iii
Findings of the Independent Panel 

1. The lack of strong leadership and response coordination from WHO

hindered HHS and international response efforts.

2. The U.S. government was not well prepared to respond to emergent crises

that require a rapid, integrated domestic and international response.

3. The U.S. government did not use all coordination elements of the National

Response Framework during the Ebola response.

4. HHS did not apply existing pandemic plans and coordination mechanisms

during the Ebola response.

5. HHS’s early communications did not demonstrate an appreciation of the

public’s perceptions and fear, or discuss the possibility of isolated U.S.

Ebola cases.

6. In the initial months of the crisis, the U.S. government was not prepared to

deploy response personnel at the scale or rate required for the Ebola

epidemic.

7. Differing perspectives on the most appropriate ways to use and evaluate

investigational vaccines and treatments contributed to incomplete evaluation

of the efficacy of these products.

8. The U.S. government did not anticipate the complications associated with

establishing domestic Ebola Treatment Centers and other domestic

preparedness measures.

9. Screening passengers at selected U.S. airports enabled local authorities to

identify and monitor individuals who might have been exposed to Ebola.

10. The Public Health Emergency Medical Countermeasures Enterprise

collaborated to expedite research, development, manufacturing, and

provision of Ebola vaccines and treatments.

11. HHS initially had difficulty developing credible guidance for, and ensuring an

adequate supply of, personal protective equipment for healthcare workers.

12. Federal, state, and local governments applied different—and, at times,

conflicting—policies and authorities for specific response measures, such as

waste management and quarantine.

13. HHS is not configured or funded to respond to a prolonged public health or

medical emergency overseas or at home.

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Key Recommendations 

HHS should continue to help strengthen the public health and medical care 

infrastructure and response capabilities of other countries. HHS should pursue the 

activities of—and commit funding to—the Global Health Security Agenda to help 

countries implement the 2005 International Health Regulations. HHS can further enhance 

global health security by partnering with nongovernmental organizations that operate in 

developing countries, in order to strengthen their ability to identify, report, and respond to

urgent public health threats. 

HHS should coordinate with the National Security Council and federal partners to 

develop and finalize a U.S. government framework for multi-agency response to 

international incidents. The framework should define a government-wide coordination 

structure for international response, including HHS’s role within this structure. It should 

also identify lead/coordination and support responsibilities for U.S. government agencies 

in different scenarios, including those dealing with serious infectious diseases. HHS 

should further coordinate with the National Security Council and federal partners to more 

clearly define roles for HHS in the management of responses with simultaneous domestic 

and international components. HHS should consider dividing management of the 

response into definable parts, with leads for each part reporting to an overall response 

coordinator.

HHS should coordinate with the National Security Council and federal partners to 

determine how best to use the National Response Framework to respond to urgent 

public health threats. Plans for responding to urgent public health events that are not 

declared emergencies under the Robert T. Stafford Disaster Relief and Emergency 

Assistance Act (Stafford Act) should clarify the roles and responsibilities of HHS and 

other U.S. government agencies and articulate possible funding sources. 

HHS should determine whether it will maintain readily deployable medical 

personnel to treat patients in other countries that request such assistance during 

urgent public health threats. If the Department pursues this option, it should assess the 

roles and missions of its mobile forces, including the U.S. Public Health Service 

Commissioned Corps and the National Disaster Medical System, to determine which 

personnel should be called to deploy. HHS should work administratively—and with 

Congress, if needed—to remove remaining barriers to the deployment of HHS 

responders to other countries. This includes ensuring that pre-identified personnel are 

trained and equipped to deploy internationally.

HHS should clarify its strategy for communicating risk-related information to the 

public, to Congress, and to other key stakeholders during responses to urgent 

public health threats. HHS should develop a public communication framework that 

conveys the critical concepts of public health response and fully integrates crisis and 

emergency risk-communication principles. HHS should also encourage and support state 

v 
and local public health departments that want to build their capacity to communicate riskrelated information in a crisis or an emergency.

The U.S. government should provide sustained funding to HHS for emergency 

preparedness and response activities, and contribute to the readiness of its public 

health partners at the state and local levels. HHS should work with Congress to 

secure a contingency fund to allow the Department, as well as state and local public 

health agencies, to initiate and sustain preparedness and response activities. 

HHS should designate responsibility for coordinating Department-wide response 

efforts to urgent public health threats that have both domestic and international 

components. These assignments should be consistent with the Pandemic and AllHazards Preparedness Act. A career member of the Senior Executive Service who has 

institutional knowledge of HHS’s response capabilities and coordination mechanisms

should support the designated lead(s). HHS should institutionalize a response structure 

that enables the Department to integrate public health and medical services, in 

accordance with incident command system principles.

HHS should designate a lead entity to arbitrate the differing perspectives on 

research and development of vaccines and treatments during an outbreak. The 

National Institutes of Health, the U.S. Food and Drug Administration, the U.S. Centers for 

Disease Control and Prevention, and the Biomedical Advanced Research and 

Development Authority (BARDA) all have specific roles—and perhaps differing 

perspectives—with regard to research, development, and distribution of vaccines and 

treatments. Using a pre-established and rapid decision-making process, the designated 

HHS lead should arbitrate these perspectives if the differences risk causing delays or 

overlaps when responding to an urgent public health threat.

vi
Contents

Foreword.............................................................................................................................i

Executive Summary.........................................................................................................iii

Independent Panel on the HHS Ebola Response: Lessons-Learned Review.............1

Findings .............................................................................................................................3

Recommendations..........................................................................................................15

Glossary...........................................................................................................................25

Appendix A: Overview of the HHS Ebola Response ...................................................27

Appendix B: Organizations Interviewed for this Report.............................................33

Appendix C: Timeline of Key Activities and Milestones during the HHS Response

to the 2014–2016 Ebola Epidemic .................................................................................35

References.......................................................................................................................43

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viii
Independent Panel on the HHS Ebola 

Response: Lessons-Learned Review 

An independent panel of volunteer subject-matter experts led a review of HHS’s

response to the 2014–2016 Ebola epidemic to identify lessons learned. The Panel

included the following experts: 

• Dr. Jonathan Fielding (Panel Chair), Distinguished Professor of Health

Policy and Management, and Pediatrics in the University of California, Los

Angeles, Fielding School of Public Health and Geffen School of Medicine;

former Director of the Los Angeles County Department of Public Health;

former Commissioner of the Massachusetts Department of Public Health

• Admiral Thad Allen, U.S. Coast Guard (Ret.); former Commandant of the

U.S. Coast Guard; former National Incident Commander for the unified

response to the Deepwater Horizon oil spill; former Principal Federal

Official for the U.S. government’s response and recovery operations

following Hurricanes Katrina and Rita throughout the Gulf Coast region

• Dr. Benjamin Chu, President of the Southern California Region, Kaiser

Foundation Health Plan, Inc. and Hospitals; former President of New York

City Health and Hospitals Corporation; former chair of the American

Hospital Association Board of Trustees

• Ms. Julia Galdo, Managing Director, Health Communication and Social

Marketing, American Institutes for Research; co-author of the Centers for

Disease Control and Prevention’s (CDC’s) Crisis and Emergency Risk

Communication

• Dr. Helene Gayle, Chief Executive Officer of the McKinsey Social

Initiative; former President and Chief Executive Officer of CARE; former

Director of the National Center for HIV, STD, and TB Prevention at CDC

and Assistant Surgeon General of the U.S. Public Health Service (USPHS)

Approach and methodology 

The Independent Panel’s review included the following activities to gather and assess 

HHS policies, key decisions, and actions during the 2014–2016 Ebola epidemic: 

• Review of documentation prepared by HHS during the Ebola response,

including situation reports, leadership briefs, and press releases. (See

Appendix A for an overview of HHS activities during the Ebola response.)

• Surveys of HHS staff involved in the Ebola response.

1 
• Interviews with more than 200 individuals involved in the response.

1

 (See

Appendix B for a list of the organizations interviewed.)

• Reconstruction of a timeline outlining key activities and milestones during

the HHS Ebola response. (See Appendix C for the pictorial timeline.)

• Review of after-action reports from the Ebola response that were provided

by HHS or by other government agencies or organizations.

• Review of open-source literature regarding the global Ebola response.

• Careful deliberation.

A contractor (CNA) and an HHS Program Manager in the Office of the Assistant 

Secretary for Preparedness Response (ASPR) supported the Independent Panel’s work.

The Independent Panel engaged major HHS components and partners—both inside and 

outside of the federal government—to identify and investigate issues from the HHS Ebola 

response. HHS senior leadership and the HHS Ebola Lessons Learned Steering 

Committee reviewed several drafts of this report and provided comments. However, this 

report from the Independent Panel was not subject to HHS approval. 

Commendations for HHS 

As the lead U.S. government health agency, HHS has a responsibility to prevent and 

respond to adverse health events that affect or could affect Americans—even when doing 

so involves supporting the public health response in other countries. During the 2014–

2016 Ebola epidemic, HHS responded both globally and domestically, mobilized more 

than 4,000 personnel [3], played a central role in controlling the epidemic in West Africa, 

and worked to ensure that the United States remained as safe as possible from Ebola.

The Independent Panel acknowledges the expertise and contributions of the thousands 

of HHS staff members—including individual responders; those serving on task forces and 

other response groups; commanders; and operations center personnel—who collectively 

contributed to the success of HHS’s response. Their bravery, sacrifices, and personal 

commitment to public health service were truly exceptional.

The large deployment also put additional strain on many HHS personnel who were not 

deployed. While not covered in this report, the Panel acknowledges the importance of 

minimizing the stress and preventing burn-out of these non-deployed personnel, who 

deserve credit for maintaining essential core HHS functions during the Ebola response.

1 The Independent Panel interviewed Ebola responders from many HHS components between June and 

November 2015, and had follow-up conversations through February 2016. They also interviewed 

individuals from other federal agencies, and from organizations outside of the U.S. government, to 

discuss their coordination with HHS. Accordingly, this report focuses on HHS’s response efforts and its 

coordination with other agencies and organizations.

2 
Findings

The Independent Panel produced this report to summarize HHS’s involvement in 

combatting both the international Ebola epidemic and domestic cases of the disease, and 

to present recommendations for addressing future urgent public health threats that may 

arise from Ebola or other causes. The Independent Panel focused on strategic, policylevel, and major operational issues from the HHS Ebola response, and identified 13 key 

findings in its review (described below). While the Independent Panel interviewed Ebola 

responders from across the U.S. government and from other organizations, this report 

focuses on the Panel’s assessment of HHS’s challenges. 

Finding #1: The lack of strong leadership and response coordination 

from the World Health Organization (WHO) hindered HHS and 

international response efforts. 

In March 2014, within days of reports of Ebola cases in Guinea, CDC deployed personnel 

to investigate [3]. Reportedly, the WHO Africa Regional and Country Offices discouraged 

CDC from establishing a larger presence in the region during the early stage of the 

epidemic [4]. 

Later, the disease spread rapidly, fueled by the mobility of the affected populations, the 

proximity of more densely populated urban areas, and the region’s poor public health and 

medical infrastructure. The affected countries lacked the adequate epidemiological 

surveillance, laboratory, and investigative capabilities to track and report cases. They 

also had disincentives to report cases quickly, because news of possible Ebola cases 

could prompt other countries to impose travel restrictions [1]. 

Even though the epidemic continued to expand, WHO did not issue a Public Health 

Emergency of International Concern until August 8, 2014, after the virus had claimed 

more than 900 lives and spread to Liberia, Sierra Leone, and Nigeria [5]. Leaders from 

CDC and the U.S. Agency for International Development (USAID) traveled to West Africa 

in late August 2014, to get firsthand knowledge of the situation. Based on these 

assessments, they argued for mobilizing a stronger U.S. government response to the 

Ebola epidemic.

WHO’s reluctance to challenge the affected countries’ positions on the severity of the 

situation and to declare the epidemic an emergency, alongside its difficulties with 

coordinating responding agencies, delayed and hampered both HHS’s and the 

international community’s efforts to contain the spread of the disease [6]. 

3 
Finding #2: The U.S. government was not well prepared to respond 

to emergent crises that require a rapid integrated domestic and 

international response. 

The National Security Council initially deferred to USAID and HHS for coordination of the 

Ebola response. In May 2014, the White House asked the HHS Office of Global Affairs to 

coordinate the U.S. government response to the Ebola epidemic in West Africa. In 

August, as the epidemic worsened, the USAID’s Office of U.S. Foreign Disaster 

Assistance (OFDA) served as the lead operational platform for the U.S. government 

response in West Africa. CDC was designated as the OFDA Disaster Assistance 

Response Team lead for all technical, public health, and healthcare issues. Reportedly, 

this arrangement between CDC and OFDA worked well [7]. 

However, the OFDA Disaster Assistance Response Team did not include the U.S. 

government research activities being conducted in West Africa under their operational 

umbrella. This left the National Institutes of Health—the HHS component leading 

research on investigational Ebola vaccines and treatments—unable to leverage other 

U.S. government assets that were deployed [8]. Overall, there is no clear policy on how 

HHS should coordinate with USAID to provide leadership on public health, medical 

issues, and clinical research during an international response. 

As Ebola cases arose in the United States, there was no clear guidance for 

simultaneously coordinating the overall U.S. government efforts for both the international 

and the domestic responses. For example, USAID had the lead for communications 

regarding U.S. response operations in West Africa, while the U.S. Department of State 

had the lead for communications regarding medical evacuation of U.S. citizens. HHS 

(including CDC) and the National Security Council handled communications about 

domestic Ebola cases.

The National Security Council’s initial reliance on USAID and HHS for overall 

coordination of the U.S. government response ultimately created challenges for unity of 

effort among U.S. federal agencies. In October 2014, in order to integrate and 

synchronize the U.S. government’s international and domestic response efforts, the 

White House appointed an overall Ebola Response Coordinator. This appointment 

ensured that HHS’s—and other agencies’—efforts were coordinated with those of the rest

of the U.S. government, and enabled the White House to maintain policy leadership on 

important developments. 

Finding #3: The U.S. government did not use all coordination 

elements of the National Response Framework during the Ebola 

response. 

The National Response Framework describes the principles, roles, responsibilities, and 

coordinating structures for delivering the core capabilities required to respond to a 

disaster or emergency. The framework is always in effect, and elements can be 

implemented at any time, whether an event is declared an emergency under the Robert 

T. Stafford Disaster Relief and Emergency Assistance Act (Stafford Act) or by another 

authority. Although the National Response Framework applies to urgent public health 

4 
threats, the U.S. government has never fully implemented the framework to respond to a 

public health event resulting from an infectious disease. 

Lack of experience using the National Response Framework for response to public health 

events, along with the absence of a formal declaration of emergency for Ebola in the 

United States, may account for the failure to fully implement the coordination structures 

described in the National Response Framework. For example, the U.S. government did 

not fully activate Emergency Support Function #8, the Public Health and Medical 

Services Annex to the National Response Framework, to coordinate federal government 

assistance to local, state, territorial, and tribal areas in response to Ebola [9]. This 

hampered HHS’s and the U.S. government’s ability to lead federal response efforts. 

Finding #4: HHS did not apply existing pandemic plans and 

coordination mechanisms during the Ebola response. 

When the Ebola cases emerged in West Africa, CDC deployed staff to the affected 

countries and became the de facto response lead within HHS. As the situation in West 

Africa worsened, other HHS components (such as Staff Divisions at HHS Headquarters) 

played larger roles and took on unexpected responsibilities. For example, the HHS Office 

of Global Affairs was asked by the White House to be the U.S.-based coordinator for the 

U.S. government’s response efforts in West Africa [10], and it had this role from 

March through August 2014. When the Ebola response escalated to a combined 

domestic and international event, more HHS components assumed key roles. 

HHS is the Lead Federal Agency for coordinating the U.S. government’s public health 

and medical response for emergencies and incidents covered under the National 

Response Framework and Public Health Service Act authorities, including infectious 

disease outbreaks [11]. However, HHS did not make full use of the U.S. Government 

Ebola Virus Disease Plan [11]2 or applicable parts of the Interagency Pandemic 

Operations Plan [12]3 during the Ebola response. Furthermore, although HHS ASPR has 

legislative authority to coordinate domestic incidents on behalf of HHS, HHS did not fully 

utilize the assets of that office; nor did it clearly designate another HHS office or agency 

to fulfill that overall coordination role [13]. 

Instead, the high-profile and large-scale effort of the Ebola response, which involved

many parts of HHS and other U.S government agencies, led HHS Headquarters to 

centralize responsibility within the Immediate Office of the Secretary. The Secretary had 

daily meetings with senior leaders from across the Department and coordinated directly 

with leadership from other U.S. government agencies, such as USAID. 

Meanwhile, HHS components tried to maintain the relationships established in their 

response plans, but the new, centralized coordination within HHS Headquarters did not 

2 The U.S. Government Ebola Virus Disease Plan was developed during the 2014–2016 Ebola response. 

It was not finalized when the first Ebola cases in the United States occurred.

3 The Interagency Pandemic Operations Plan was finalized in 2013.

5 
consistently recognize those relationships. Because some HHS components followed 

their existing response plans and others did not, response partners had to coordinate 

with multiple HHS offices. This hampered HHS’s coordination among different levels of 

the Department and, in turn, affected coordination for the public health and medical 

response between HHS and its interagency partners. 

Finding #5: HHS’s early communications did not demonstrate an 

appreciation of the public’s perceptions and fear, or discuss the 

possibility of isolated U.S. Ebola cases. 

HHS staff worked diligently to deal with complex communication challenges during the 

Ebola response, such as the constant need to communicate new information in a rapidly 

changing environment. HHS needed to reach a wide range of domestic and international 

audiences—both those who were affected by Ebola and those who were not—and had to 

do so via traditional and new media channels. HHS did not use a Department-wide riskcommunication strategy to coordinate messaging [6]. 

Early public messages from CDC expressed the need for a stronger U.S. government

response in West Africa and, at the same time, confidence that Ebola cases were unlikely 

to spread widely in the United States. Early public statements from CDC indicated that 

any “advanced hospital” (i.e., a hospital with an intensive care unit) could safely care for 

Ebola patients in the United States [14]. After Ebola was transmitted at a hospital in 

Dallas, TX, many Americans questioned the readiness of the U.S. healthcare system—

and HHS’s capabilities—to manage the disease. Unlike during the H1N1 influenza 

outbreak, HHS did not always use crisis and emergency risk-communication principles to 

emphasize what was unknown or to acknowledge the public’s fear. 

Because state and local governments hold much of the responsibility for the nation’s 

public health, elected officials at all levels of government spoke publicly about the Ebola 

response. Some state officials implemented (and made related statements about) their 

quarantine procedures that did not align with CDC’s public health guidelines [15]. Thus, 

HHS faced the challenge of communicating with an anxious public who was hearing 

sometimes inconsistent messages from different jurisdictions and levels of government.

In addition, messages were often edited for brevity and clarity during the 

intergovernmental clearance process. However, this process was time-consuming and 

made it difficult to effect rapid changes to the messages as new events unfolded [6]. As a 

result, the messages were, at times, more reassuring than the situation warranted and 

did not fully address media inquiries and public concerns as the situation continued to 

develop. This contributed to an environment in which much of the public, as well as many 

state and local government officials, questioned the readiness of U.S. hospitals and the 

credibility of HHS information. 

6 
Finding #6: In the initial months of the crisis, the U.S. government was 

not prepared to deploy response personnel at the scale or rate 

required for the Ebola epidemic. 

The Ebola epidemic in West Africa demonstrated that protecting the health and wellbeing 

of Americans at home may require the U.S. government to provide healthcare, public 

health, social, and technical services in other countries. Despite the unprecedented scale 

of deployment by CDC and the USPHS Commissioned Corps, HHS was not prepared to 

meet the high demand for public health support and clinical care. 

HHS does not typically provide direct clinical care on a large scale internationally, 

because such care is usually available through contracts with nongovernmental 

organizations (NGOs). However, due to the large scale of the Ebola epidemic, NGOs 

such as Médecins Sans Frontières (Doctors Without Borders) could not meet the demand 

for qualified medical staff and called for additional resources [16]. Although HHS 

capabilities for providing clinical care in a domestic emergency exist in the USPHS 

Commissioned Corps and the National Disaster Medical System, only a limited number of 

response teams are trained and equipped for international deployments, and there were 

other statutory limitations to deploying the National Disaster Medical System. In addition, 

these teams, as currently structured, have short-duration deployment timelines that are 

inadequate for prolonged infectious disease responses.

Additional HHS staffing and deployment challenges during the Ebola response included 

the following:

• Nearly 4,000 retired officers in the USPHS Reserve Corps were

unavailable to provide surge capacity during the Ebola response, based on

an earlier HHS interpretation of authorities in the Affordable Care Act [17].

• Some agencies within HHS would not release their active-duty USPHS

Commissioned Corps personnel to volunteer for deployment to West

Africa because they felt it would be too difficult to continue the agencies’

work without these staff members [17]. This highlighted the balancing act

within some HHS agencies, as they had to meet the mandates of the

agency while also allowing for active-duty USPHS Commissioned Corps

personnel to be available for deployment.

• The USPHS Commissioned Corps has no fiscal appropriations to train and

prepare its officers for deployment. For the Ebola response, officers

received just-in-time training that did not include instruction on all of the

necessary equipment or procedures for working in the Monrovia Medical

Unit [17].

• Host nation officials initially refused to recognize the U.S. health

professional licenses of HHS clinicians deployed to staff the Monrovia

Medical Unit [10, 17].

• HHS responders needed to complete “Preparing for Work Overseas”

training offered by the U.S. Department of State before they could deploy

7 
to West Africa for longer than 30 days [7]. This training course had limited 

availability, and could not accommodate the numbers of HHS personnel 

who needed to deploy quickly. As a result, in the initial phase of 

deployment, CDC personnel had 30-day limits on their deployments to 

West Africa (this limit was later waived) [7]. This increased the need for 

training and the rate of staff turnover in the affected countries. 

• Confusion regarding the U.S. government’s capacity and funding to

provide nonfederal employees with medical evacuation assurances limited

HHS’s ability to recruit personnel from the private sector (such as

universities) for deployment to West Africa.

Furthermore, HHS and other U.S. government agencies do not have sufficient staff or 

training to rapidly deploy a large number of individual responders with expertise in other 

disciplines, such as health communications experts, treatment unit managers, and social 

scientists. These subject-matter experts often have important roles in disease outbreak 

control.4

 

Finding #7: Differing perspectives on the most appropriate ways to 

use and evaluate investigational vaccines and treatments 

contributed to incomplete evaluation of the efficacy of these 

products. 

The global community expressed varying perspectives on the most appropriate ways to 

test and distribute investigational vaccines and treatments for Ebola. Generally, the U.S. 

government supports evaluating investigational vaccines and medications in rigorously 

designed clinical trials to determine their safety and efficacy. In contrast, given the 

emergent nature of the Ebola epidemic, some international entities believed that the 

investigational vaccines and treatments should be used primarily for mass vaccination 

campaigns or to treat Ebola patients, despite the limited scientific evidence regarding 

potential risks and benefits.5

Despite HHS’s successful collaboration with other federal agencies and private-sector 

partners to expedite research, development, and manufacturing, the Department was 

unable to forge consensus among its own components regarding the optimal clinical trial 

designs for investigational vaccines or treatments. The inability to do so was the result of 

4 For example, social scientists are vital to helping responders understand cultural characteristics of the 

impacted community and to facilitating effective implementation of response activities. 

5

 Before clinical trials were established, HHS supported compassionate use of investigational treatments 

for Ebola patients through approval of Emergency Investigational New Drug (EIND) applications via the 

U.S. Food and Drug Administration; in fact, these EIND applications were processed and approved in 

record time. Although there was some perception of unfair distribution of the investigational treatments, 

the U.S. Food and Drug Administration followed appropriate protocols for their distribution. Once clinical 

trials for the investigational treatments are established, HHS protocol requires that patients receive those 

treatments through enrollment in clinical trials rather than through EINDs, as little to no information about 

the investigational treatments can be learned through EINDs. 

8 
differing perspectives, largely reflective of each organization’s primary responsibility (e.g.,

controlling the epidemic, or establishing the safety and efficacy of the products). 

The differing perspectives among international partners and HHS components led to 

three vaccine trials with different designs and to many treatment trials.6 In addition, due 

to a decrease in the number of Ebola cases, these investigational vaccines and 

treatments could not be fully evaluated. Some of the clinical trials did not yield sufficient 

interpretable results, and data from the investigational Ebola vaccine trials have not been 

submitted to the U.S. Food and Drug Administration at the time of this writing. 

Finding #8: The U.S. government did not anticipate the 

complications associated with establishing domestic Ebola 

Treatment Centers and other domestic preparedness measures. 

Concerns about contagion and costs associated with treatment of suspected or 

confirmed Ebola cases discouraged hospitals from volunteering to be Ebola Treatment 

Centers early in the domestic response. Although hospitals do have the duty to evaluate 

and treat all patients presenting to their Emergency Departments for treatment, some 

were concerned about the potential loss of revenue if prospective patients had concerns 

about receiving care in the same facility as Ebola patients. The hospitals would lose 

revenue if non-Ebola patients sought care in other healthcare facilities. 

During the Ebola response, the HHS Hospital Preparedness Program—along with other 

HHS components—requested supplemental funding from Congress to address such 

potential shortfalls. However, by the time the supplemental funding was available to state 

and local public health agencies, the peak in the number of global Ebola cases and U.S. 

response activities had already passed. 

Many state and local public health departments also felt that they were not adequately 

prepared to advise hospitals or conduct active surveillance if Ebola cases presented in 

their jurisdictions. Furthermore, nurses and other staff caring for patients expressed 

concerns about whether their healthcare facility was providing them with sufficient 

training and personal protective equipment (PPE) for treating Ebola patients [6]. 

Finding #9: Screening passengers at selected U.S. airports enabled 

local authorities to identify and monitor individuals who might have 

been exposed to Ebola. 

Enhanced entry screening at U.S. airports alleviated intense public and political pressure 

for stricter containment measures, such as travel bans and border closures. Enhanced 

entry screening provided a means to identify potential Ebola cases quickly, and allowed 

state and local governments to rapidly learn the Ebola risk profile of people in their 

6 HHS leads two of the three clinical trials for Ebola vaccines in West Africa: the Sierra Leone Trial to 

Introduce a Vaccine against Ebola (“STRIVE”), and the Partnership for Research on Ebola Vaccines in 

Liberia (“PREVAIL”). The third vaccine trial is led by WHO in Guinea.

9 
jurisdictions. However, it was also a large resource burden (requiring both time and 

money) for the U.S. government and state and local health departments. 

CDC and the CDC Foundation developed novel solutions for monitoring some travelers 

after their arrival in the United States. By providing free and dedicated cell phones to the 

travelers, public health officials could contact them quickly and consistently. In addition, 

some public health officials used video capabilities (such as Apple® FaceTime) to check 

in with individual travelers when visual contact was needed. These solutions were more 

cost-effective and efficient than repeatedly conducting in-person visits.

Active screening of these travelers at selected U.S. airports—and plans for their 

subsequent monitoring by state and local health departments, if appropriate—was an 

important strategic public health action, but also acknowledged and addressed public 

concerns about the spread of Ebola in the United States [6]. 

Finding #10: The Public Health Emergency Medical 

Countermeasures Enterprise (PHEMCE) collaborated to expedite 

research, development, manufacturing, and provision of Ebola 

vaccines and treatments. 

Early during the Ebola outbreak, the PHEMCE7 leveraged assets across the U.S. 

government to accelerate development and appropriate use of investigational Ebola 

vaccines and treatments. It accomplished this by using both existing and new 

partnerships with government, academia, and industry stakeholders. 

The PHEMCE partners also used novel contracting methods and moved funding quickly 

to support development and evaluation of candidate vaccines and treatments. HHS 

conducted vaccine trials in Liberia and Sierra Leone, and developed and implemented a 

novel clinical trial design in West Africa to test ZMapp (an experimental drug for Ebola 

treatment [18]) and other medications that may have applicability in future outbreaks. 

While some trials are still ongoing, the current (and fortunate) lack of cases has created 

scientific challenges in assessing product efficacy.

Finding #11: HHS had difficulty developing credible guidance for, 

and ensuring an adequate supply of, personal protective

equipment for healthcare workers. 

Early in the response, individual healthcare centers independently stockpiled PPE 

regardless of their specific risk [19]. Although such stockpiling was not always 

appropriate, the impulse for centers to do so was understandable, especially since supply 

7 The ASPR-led PHEMCE coordinates U.S. government efforts to enhance medical countermeasure 

preparedness for chemical, biological, radiological, and nuclear (CBRN) threats and emerging infectious 

diseases (such as Ebola). The PHEMCE includes HHS internal agency partners and several interagency 

partners.

10
of PPE was not coordinated, and neither CDC nor any other authority provided guidance 

on how much PPE a facility should stockpile, based on the facility’s level of risk. 

The first incidence of Ebola transmission in the United States led CDC to recommend 

more stringent PPE guidelines. HHS adjusted its PPE guidance to reflect the more 

invasive and comprehensive treatment of Ebola patients in U.S. hospitals. This tacit 

acknowledgment that the original guidelines did not afford sufficient protection 

undermined CDC’s credibility with its stakeholders [6]. This development, along with the 

absence of guidance for PPE stockpiling based on a facility’s level of risk, contributed to 

nationwide shortages of some recommended PPE items, such as powered air purifying 

respirators [20-21]. 

PPE manufacturers maximized their production capacities using their existing resources 

and infrastructure. To increase production, they would have had to invest in new 

infrastructure. Reportedly, the manufacturers were reluctant to do so without a guarantee 

that there would be a future market for their products.

In addition, both the USPHS Commissioned Corps and NGOs cited difficulties finding 

standard PPE in West Africa, which hindered their training and treatment efforts and their 

compliance with CDC’s guidance [6, 19]. 

Finding #12: Federal, state, and local governments applied 

different—and, at times, conflicting—policies and authorities for 

response measures, such as waste management and quarantine. 

The application of federal, state, and local legal authorities differed throughout the 

domestic response. For example, nationally inconsistent transportation procedures and 

the public’s fear hampered the movement of Ebola medical waste across state borders, 

as well as acceptance at final disposal sites [22]. 

U.S. Department of Transportation regulations classify Ebola waste as a Category A 

infectious agent, meaning that transporting Ebola waste requires more complicated 

packaging than regular medical waste [23]. Clarifying the packaging and transport 

requirements took time and created backlogs of Ebola waste. Furthermore, many wastemanagement contractors felt that they could not legally transport Ebola waste, which 

temporarily left hospitals without means of disposal [23]. 

The U.S. Department of Transportation eventually issued special permits for waste 

transportation, but several states remained reluctant to accept the waste. In some 

instances, state governments required that Ebola waste transported through their states 

be accompanied by armed escorts [23]. Nearly all states were also reluctant to accept 

Ebola waste for incineration. Throughout the response, there were only two sites (one in 

Florida, and one in Texas) that would accept Ebola waste [22]. As a result, Ebola waste 

from treatment of U.S. patients was transported across many states for incineration.

In addition, quarantine policies were inconsistent across levels of government and did not 

adequately address the complex and extensive requirements associated with 

implementation [24]. Several states (New York, New Jersey, and Maine) implemented

quarantine policies that were more restrictive than the CDC’s recommendations [6].

11
Differences in quarantine procedures also created confusion among the public and 

concerns that mandatory quarantine for returning healthcare workers would keep them 

from volunteering to help fight the outbreak overseas [25]. 

Another challenge was the logistics of providing assistance, such as food and social 

services, to isolated and quarantined individuals [26]. The Ebola response revealed

quarantine and isolation issues that are often overlooked within the emergency 

management community, and thus often not included in training exercises. 

The rapid evolution of national-level guidelines for Ebola response, as well as differences 

in guidelines and perspectives within state and local authorities, resulted in a lack of 

coordinated implementation and enforcement across levels of government, and confused 

responders’ understanding of existing policies and authorities. Recommendations to 

address this need for policy coordination should acknowledge that states have primary 

responsibility for public health preparedness.

Finding #13: HHS is not configured or funded to rapidly respond to a 

prolonged public health or medical emergency overseas or at 

home. 

As the Ebola outbreak rapidly expanded, HHS slowly mounted a robust response. 

Because the outbreak was not declared an emergency under the Stafford Act and HHS 

does not have ready access to a response contingency fund, the Department had 

difficulty funding its initial efforts to contain the outbreak in West Africa. Congress did not 

grant supplemental appropriations to fund the international effort until the response was 

well underway. The U.S. Office of Personnel Management did not waive authority for 

direct hire, despite multiple requests from HHS and support from the White House [27-

28]. Many aspects of the response were delayed by the lack of readily available, flexible, 

unobligated funds. Consequently, HHS relied on private organizations, such as the CDC 

Foundation, to fund critical response activities and supplies [29]. In turn, other private 

organizations and other nations provided donations to the CDC Foundation [30-31]. 

Within the United States, the HHS Hospital Preparedness Program and the Public Health 

Emergency Program provide grants to support state and local preparedness activities. 

This funding is obligated for preparedness projects and is not intended for response 

operations. State and local public health agencies must wait for additional emergency 

funding to cover their immediate response to an urgent public health threat. Also, 

significant declines in funding in recent years have made it difficult to sustain investments

in preparedness—such as maintenance of PPE stockpiles and staff training—that state 

and local public health agencies made years ago. As a consequence, some state and 

local partners lacked the capabilities and capacities necessary to respond appropriately 

to Ebola. 

Unfortunately, HHS does not have a reserve, emergency response fund as some other 

departments do. Delays in supplemental appropriations hampered HHS’s ability to 

support state and local response efforts. In addition, congressional appropriations often 

included rules and conditions that limited what expenses could be reimbursed to privatesector medical services. 

12
Overall, HHS lacks both a source and a flexible mechanism to distribute financial 

assistance rapidly to state, local, and private-sector entities responding to urgent public 

health threats. Finally, U.S. healthcare organizations had to make significant financial and 

other resource investments—without guarantee of reimbursement—to prepare for a 

confirmed or suspected Ebola patient. 

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14
Recommendations

Based on the findings presented above, the Independent Panel developed 

recommendations to further enhance U.S. government coordination and HHS’s public 

health preparedness and response capabilities. The recommendations aim to: 

• Help strengthen public health and medical care capabilities through

implementation of the Global Health Security Agenda.

• Improve coordination with U.S. government response partners.

• Improve collaboration with state, local, and private-sector partners.

• Improve internal coordination for preparedness and response.

• Ensure that the Department communicates effectively with the public.

• Ensure that the Department has sufficient and readily accessible

resources.

The Panel further recommends that HHS develop an improvement plan for response to 

urgent public health threats. 

Specific recommendations are provided below. The Panel recognizes that HHS has 

taken steps to address many issues that arose during the 2014–2016 Ebola response. As 

a result, some of the actions recommended below may have already been taken or be 

underway. 

Addressing these findings and recommendations should be a near-term priority for HHS 

and its partners in order to improve their preparedness for, and response to, urgent public 

health threats. HHS should particularly work to address those findings and 

recommendations that emerged from other recent public health and medical responses—

such as the H1N1 influenza outbreak or the earthquake in Haiti—but were not 

implemented prior to the Ebola epidemic.

Strengthen public health and medical care capabilities through 

implementation of the Global Health Security Agenda. 

HHS should continue to help strengthen the public health and medical care 

infrastructure and response capabilities of other countries. 

• HHS should pursue the activities of—and commit funding for—the Global

Health Security Agenda to help countries implement the 2005 International

Health Regulations. This initiative includes enhancing global disease

surveillance by strengthening the ability of national governments to detect,

report, and respond to urgent public health threats. (Finding #1)

15
• To better integrate research response into international public health

response, HHS should consider creating a corollary to the GHSA for

clinical research. (Finding #1)

• HHS can further enhance global health security by partnering with NGOs

that operate in developing countries, in order to strengthen their ability to

identify, report, and respond to urgent public health threats. (Finding #1)

• HHS should expand its financial, technical, and logistical support to WHO,

in order to enhance its multilateral response capabilities, such as the

Global Outbreak Alert and Response Network. (Finding #1)

HHS should build upon existing international response networks to strengthen

multilateral alliances for public health response. 

• Member countries of the multilateral alliances should coordinate to rapidly

provide assistance to other countries for responding to urgent public health

threats. The alliances may also provide a means to broadly source

responders who have in-demand, specialized expertise. (Finding #6)

• HHS should lead this effort by hosting an international conference to

develop the basis for requesting, providing, and accepting assistance.

(Finding #6)

HHS should share the U.S. government’s perspectives with—and seek consensus 

among—U.S. and international partners regarding the evaluation of investigational 

vaccines and treatments during an outbreak.

8

 

• HHS should rapidly resolve disagreements among HHS components

regarding evaluation protocols for vaccines and treatments that are under

development when an urgent public health threat emerges. (Finding #7)

Improve HHS’s coordination with U.S. government response partners. 

HHS should coordinate with the National Security Council and federal partners to 

develop and finalize a U.S. government framework for multi-agency response to 

international incidents.

• The framework should define a government-wide coordination structure for

international response and the HHS role within this structure. It should also

identify lead/coordination and support responsibilities for U.S. government

agencies in different scenarios, including those dealing with serious

infectious diseases. (Finding #2)

8 See the “Improve HHS’s internal coordination for preparedness and response” section for discussion of 

HHS arbitration of differing perspectives on research and development of vaccines and treatments during 

an outbreak.

16
• HHS should further coordinate with the National Security Council and

federal partners to more clearly define roles for HHS in the management of

responses with simultaneous domestic and international components.

HHS should consider dividing management of the response into definable

parts, with leads for each part reporting to an overall response coordinator.

(Finding #2)

• HHS should work with the National Security Council, the Federal

Emergency Management Agency, and USAID to explore whether prescripted mission assignments could be used for international deployment

of public health and medical personnel to support U.S. government

response efforts. (Finding #2)

The U.S. government should determine how best to use the National Response 

Framework to respond to urgent public health threats. 

• Plans for responding to urgent public health events that are not declared

emergencies under the Stafford Act should clarify the roles and

responsibilities of HHS and other U.S. government agencies and articulate

possible funding sources. The plans should be tested in interagency

exercises that include representatives from state and local agencies.

(Finding #3)

• HHS should clarify the decision points for activating each Emergency

Support Function in the National Response Framework, and,

correspondingly, the roles and responsibilities of HHS and other U.S.

government agencies for responding to non-Stafford Act events. (Findings

#2 and #3)

HHS should work with interagency partners to codify the policies associated with 

enhanced entry screening, clarify the rationale for implementing these procedures, 

and further build the relationships and infrastructure needed to support such 

screenings.

• Policies for enhanced entry screening should include planning criteria that

identify situations when airport screening is appropriate and feasible—and

when it is not. HHS should work with the U.S. Department of Homeland

Security’s Customs and Border Protection to determine whether there are

policies and authorities that can facilitate more effective and efficient entry

screening and monitoring. (Finding #9)

• HHS and the U.S. Department of Homeland Security should further

develop plans for innovative solutions that were used during the Ebola

response (such as providing dedicated cell phones to individuals who were

being monitored for Ebola symptoms) so that these solutions can be used

if enhanced entry screening is implemented again in the United States.

(Finding #9)

• HHS should develop clear public messages for implementing screening

procedures. (Finding #9)

17
Improve HHS’s collaboration with state, local, and private-sector 

partners. 

HHS should develop and implement an outreach plan that leverages HHS’s 

regional offices, Operating Division field staff, and relationships with public health 

agencies and organizations to coordinate and communicate among federal, state, 

and local governments. 

• HHS should work with the National Association of County and City Health

Officials, the Association of State and Territorial Health Officials, and the

National Public Health Information Coalition to develop the outreach plan.

The plan should delineate the role for each level of government, as well as

the roles of public health agencies and organizations, in establishing and

implementing policies and regulatory authorities for public health and

medical emergencies. HHS can use national-level exercises with both

elected leaders and public health leaders to discuss and resolve the most

difficult policy issues. (Findings #5 and #11)

• HHS should engage its regional offices to develop the outreach plan,

including using its Regional Emergency Coordinators, in order to better

connect public health agencies with emergency response agencies within

each region. (Findings #5 and #11)

In coordination with the hospital community and state and local public health 

departments, HHS should maintain a national network of identified treatment 

centers.

• Leveraging efforts from the domestic Ebola response, HHS can extend the

network of tiered hospitals for Ebola case management to enhance the

identification and treatment of other urgent public health threats. (Finding

#8)

• HHS should develop clear standards for each treatment center. These

standards should include requirements for size, staff training, equipment,

and protocols to triage patients to different levels of care. In addition, HHS

should develop long-term funding streams to support these treatment

centers and to support the care of individual patients. (Finding #8)

Improve HHS’s internal coordination for preparedness and response. 

HHS should designate responsibility for coordinating Department-wide response 

efforts to urgent public health threats that have both domestic and international 

components. 

• A career member of the Senior Executive Service who has institutional

knowledge of HHS’s response capabilities and coordination mechanisms

should support the designated lead(s) throughout the response. (Finding

#4)

18
• HHS should define and institutionalize a response structure that integrates

public health and medical services throughout the Department, in

accordance with incident command system principles. The HHS response

structure should build on the authorities of the Pandemic and All-Hazards

Preparedness Act and the Pandemic and All-Hazards Preparedness

Reauthorization Act [13, 32]. It should be clear on and broadly

acknowledge the issue of whether and how the structure should change if

the Secretary of HHS declares a Public Health Emergency. (Finding #4)

• If HHS Headquarters decides to use new plans and procedures for

response to an urgent public health threat, the Department should clearly

communicate the new coordination structure to its internal and external

response partners. (Finding #4)

• HHS should ensure full distribution across the Department of applicable

U.S. government response plans, such as the Interagency Pandemic

Operations Plan and the U.S. Government Ebola Virus Disease Plan.

(Finding #4)

• The HHS Office of the ASPR should conduct briefings and exercises with

incoming HHS leadership and all relevant HHS components to ensure

ongoing, shared understanding of existing coordination mechanisms and

available resources for response to urgent public health threats. Results of

these exercises should be reviewed and incorporated (as appropriate) into

HHS response plans, policies, and executive orders. (Finding #4)

• HHS should pursue acquiring Direct-Hire Authority when the Department

has a severe shortage of personnel to respond to urgent public health

threats. The Office of Personnel Management’s waiver process may need

to be evaluated and revised in order to do so. (Finding #6)

• HHS should better integrate research response into its domestic and

international public health response. This should include clinical research

as well as studies to support actions in the areas of communications and

health services. (Finding #1)

HHS should designate a lead entity to arbitrate the differing perspectives on 

research and development of vaccines and treatments during an outbreak. 

• The National Institutes of Health, the U.S. Food and Drug Administration,

CDC, and Biomedical Advanced Research and Development Authority

(BARDA) all have specific roles—and perhaps differing perspectives—

with regard to research, development, and distribution of vaccines and

treatments. Using a pre-established and rapid decision-making process,

the designated HHS lead should arbitrate these perspectives if the

differences risk causing delays or overlaps when responding to an urgent

public health threat. Arbitration is critical to rapidly resolving

disagreements over evaluation protocols for vaccines and treatments that

are under development when an urgent public health threat emerges.

(Finding #7)

19
HHS should document the new processes that were used for expediting 

development and testing of Ebola vaccines and treatments. 

• These new processes should be institutionalized and applied during future

urgent public health threats. (Finding #10)

• The PHEMCE should develop a U.S. government position statement

regarding preferred study designs for testing investigational vaccines and

treatments during an epidemic. (Finding #7)

HHS should continue supporting the interagency and stakeholder working groups 

that were established to develop national-level policies for addressing PPE and 

medical waste management.

• Lessons from the 2014–2016 Ebola epidemic regarding PPE and medical

waste management should be incorporated into training and exercises.

(Finding #11)

• HHS should work with domestic and international partners to identify

financial incentives, or legal and regulatory means, for quickly marshaling

the full resources and capacities of the PPE manufacturing sector and

distribution supply chain to support future response to urgent public health

threats. (Finding #11)

• HHS should continue to leverage existing collaborative relationships, such

as ASPR’s ongoing partnership with the Association for Healthcare

Resources and Materials Management, to examine the applicability of

various public-private partnership frameworks for a potentially diverse

range of urgent public health threats. (Finding #11)

Ensure that HHS communicates effectively with the public. 

HHS should clarify its strategy for communicating risk-related information to the 

public, to Congress, and to other stakeholders during responses to urgent public 

health threats.

• HHS should develop a public communication framework that conveys the

critical concepts of public health response and that fully integrates crisis

and emergency risk-communication principles. (Finding #5)

• HHS should develop basic messaging for specific issues and actions that

are likely to occur in serious public health crises (e.g., disease

transmission, treatment decisions, triage, waste management, radiation

exposure). These messages can be leveraged to develop communications

during emergencies. The messages should be cleared in advance; HHS

should consider coordinating the development of messages with the U.S.

Department of Homeland Security, the American Red Cross, and other

relevant agencies to encourage consistency in messaging to the public.

HHS should also prepare to repeatedly communicate these concepts to

20
the public using traditional media and social networking/digital messaging 

platforms. (Finding #5)

• HHS should identify and train a cadre of personnel from across HHS to be

potential spokespersons during public health and medical emergencies.

These personnel should have public health expertise and a thorough

understanding of health crisis/risk communication. They should receive

training in these concepts annually, at a minimum. (Finding #5)

• HHS should establish a clear, systematic, and rapid way for messages to

be reviewed and cleared that enables timely and relevant communication

with the public. The Department must also exchange and verify

information with internal and external response partners, and be prepared

to supplement or correct information if the facts are misconstrued or

conveyed improperly. (Finding #5)

• HHS should set clear expectations for what good risk communication can

and cannot accomplish (e.g., it cannot compensate for poor operational

response). (Finding #5)

HHS should encourage and support state and local public health departments that 

want to build their capacity to communicate risk-related information in a crisis or 

emergency. 

• The HHS public communication framework should extend beyond

individuals and administrations to form the basis for a common information

system for public health at all levels. At a minimum, HHS should provide

annual training on the framework to decision-makers and potential

spokespersons for domestic and international responses to ensure that it

is understood and adopted. (Finding #5)

• HHS should support state-level communications networks to extend this

capacity. (Finding #5)

• HHS should consider developing the capacity to convene outside advisory

expertise in risk communication, as needed, to provide additional support

and perspectives, both for preparedness and for response. (Finding #5)

Ensure that HHS has sufficient and readily accessible resources. 

HHS should determine whether it will maintain readily deployable medical 

personnel to treat patients in other countries that request such assistance for 

responding to urgent public health threats. 

• If the Department pursues this option, it should assess the roles and

missions of its mobile forces, including the USPHS Commissioned Corps

and the National Disaster Medical System, to determine which personnel

should be called upon to deploy. (Finding #6)

• HHS should work administratively—and with Congress, if needed—to

remove remaining barriers to the deployment of HHS responders to other

21
countries. This includes ensuring that pre-identified personnel are trained 

and equipped to deploy internationally. (Finding #6)

• HHS should explore ways to expand and support use of the USPHS

Ready Reserve Corps to provide surge capabilities for urgent public health

threats. (Finding #6)

• HHS should ensure that the USPHS Commissioned Corps is ready to

deploy—as required by statutory authorities—by providing funding and

resources to train and prepare its officers. (Finding #6)

• HHS should consider establishing multidisciplinary assessment teams,

with personnel from appropriate HHS components, that could be deployed

early and internationally to respond to an urgent public health threat.

These assessment teams could rapidly assess what public health and

medical resources are needed, and make recommendations about the

scope and extent of an appropriate HHS response. (Finding #4)

HHS should ensure that it has the necessary and appropriate policies and plans to 

support quarantine and isolation.

• Specific guidance and planning considerations should ensure that policies

and actions are appropriate, safe, and effective. It is important to balance

concerns of individual autonomy with the needs and safety of the

surrounding population. The plans should also include guidance on

messaging for affected populations and the general public, and be

incorporated into exercises to prepare for future urgent public health

threats. (Findings #11 and #12)

The U.S. government should provide sustained funding to HHS for emergency 

preparedness and response activities, and contribute to the readiness of its public 

health partners at the state and local levels. 

• HHS should work with Congress to secure a contingency fund to allow the

Department, as well as state and local public health agencies, to initiate

and sustain preparedness and response activities. (Finding #13)

• HHS should explore how to flexibly use its existing budget authority to

support rapid response to urgent public health threats. (Findings #8 and

#13

22
Develop an improvement plan for an HHS response to urgent public 

health threats. 

HHS and the U.S. government can build upon existing plans and coordination 

mechanisms to better prepare for and respond to a range of infectious disease outbreaks 

and other urgent public health threats. As a result, the Independent Panel’s findings and 

recommendations can apply to other adverse public health events beyond the Ebola 

epidemic. HHS has identified a number of authorities and operational opportunities that 

would enable a stronger and more flexible response in the future. The Independent Panel 

anticipates that HHS leadership will carefully consider the findings and recommendations 

presented in this report when developing an improvement plan to strengthen HHS’s 

public health preparedness and response capabilities. 

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24
Glossary 

ASPR Office of the Assistant Secretary for Preparedness and Response

BARDA Biomedical Advanced Research and Development Authority

cAd3-EBOZ chimpanzee adenovirus type 3-Zaire Ebola virus vaccine

CBP Customs and Border Protection

CBRN chemical, biological, radiological, and nuclear

CDC Centers for Disease Control and Prevention

DHS U.S. Department of Homeland Security

DOD U.S. Department of Defense

EIND Emergency Investigational New Drug

EOC Emergency Operations Center

FDA U.S. Food and Drug Administration

FEMA Federal Emergency Management Agency

HHS U.S. Department of Health and Human Services

HPP Hospital Preparedness Program

IO International organization

LRN Laboratory Response Network

MSF Médecins Sans Frontières (Doctors Without Borders)

MMU Monrovia Medical Unit

NGO nongovernmental organization

NIH National Institutes of Health

OFDA Office of U.S. Foreign Disaster Assistance 

OGA Office of Global Affairs

OS Office of the Secretary 

PHEMCE Public Health Emergency Medical Countermeasures Enterprise

PPE personal protective equipment

PREP Act Public Readiness and Emergency Preparedness Act

PREVAIL Partnership for Research on Ebola Vaccines in Liberia

rVSV-ZEBOV recombinant vesicular stomatitis virus-Zaire Ebola virus vaccine

STRIVE Sierra Leone Trial to Introduce a Vaccine against Ebola

UN United Nations

25
UNMEER United Nations Mission for Ebola Emergency Response

USAID U.S. Agency for International Development

USG U.S. government

USPHS U.S. Public Health Service

WHO World Health Organization

26
Appendix A: Overview of the HHS 

Ebola Response

The most widespread Ebola epidemic to date began in December 2013 in a small town in 

Guinea [33]. The virus spread quickly and easily, passing through rural communities and 

porous borders to reach crowded cities [16]. 

Inadequate public health infrastructure in Guinea, Liberia, and Sierra Leone—the three 

countries most severely affected by Ebola—greatly contributed to the spread of disease

[16].

9 Moreover, Ebola’s nature of transmission posed a threat to healthcare workers and 

other front-line workers (e.g., burial workers), creating a dangerous environment for those 

tasked with treating patients, as well as those investigating and containing the outbreak 

[34]. 

From December 2013 to November 2015, the virus claimed more than 11,000 lives and 

infected more than 28,000 people [35]. In late 2015, sporadic cases continued to emerge

in Guinea and Liberia [36]. 

International response 

The U.S. government began its international response to the Ebola epidemic in early 

2014 (see Table 1). In March 2014, the Centers for Disease Control and Prevention 

(CDC) deployed personnel to investigate Ebola cases in Guinea [37]. In May, the White 

House asked the HHS Office of Global Affairs to coordinate the U.S. government’s 

response efforts in West Africa. As the epidemic worsened, in early August, the Office of 

U.S. Foreign Disaster Assistance (OFDA) within the U.S. Agency for International 

Development served as the lead operational platform for the growing U.S. government 

response effort in West Africa, and OFDA deployed a Disaster Assistance Response 

Team to West Africa to help coordinate the U.S. government response [37]. 

The Disaster Assistance Response Team responders worked closely with the cadre of 

nongovernmental organizations (NGOs) in West Africa and helped coordinate a 

combined public-private response. In particular, the Disaster Assistance Response Team 

helped coordinate the U.S. government’s response with Médecins Sans Frontières 

(Doctors Without Borders), the NGO providing most of the clinical care to Ebola patients 

in West Africa [38]. 

9 Nigeria, Senegal, and Mali also had Ebola cases, the first of which were confirmed in July, August, and 

October 2014, respectively. These countries were able to respond more quickly to the Ebola epidemic, 

due to increased vigilance and stronger public health response capabilities [16]. 

27
In late August 2014, the Director of CDC and the Director of USAID/OFDA traveled to 

Liberia [39]. After they returned to the United States, CDC warned that the epidemic was 

spiraling out of control and that prompt action by the international community was 

necessary to contain the epidemic [40]. 

Table 1. Major U.S. government international response activities during the 2014–

2016 Ebola epidemic 

Date Event

March 14, 2014 Médecins Sans Frontières receives a report from the Ministry of 

Health in Guinea about a “mysterious disease” [16]. 

March 31, 2014 CDC deploys its first team to Guinea to investigate the disease 

outbreak [41]. 

May 2014 The White House asks the HHS Office of Global Affairs to serve 

as the U.S.-based coordinator for the government’s response 

efforts in West Africa. [10]. 

July 2014 By the end of the month, CDC has 100 personnel in West Africa 

to support Ebola response efforts [4]. 

August 4, 2014 OFDA deploys a Disaster Assistance Response Team to West 

Africa [37]. 

August 24, 2014 CDC and USAID leaders travel to West Africa to personally 

observe the outbreak [39]. 

September 16, 

2014

President Obama declares that the U.S. will send 3,000 troops to 

Liberia to support the Ebola response [42]. 

October 2, 2014 U.S. Public Health Service (USPHS) Commissioned Corps sends 

an Advance Team to establish partnerships in Liberia [17]. 

October 19, 2014 USPHS Commissioned Corps officers deploy to staff the 

Monrovia Medical Unit in Liberia [43]. 

February 2015 PREVAIL, a Liberia-U.S. clinical research partnership led by the 

HHS’s National Institutes of Health, launches a randomized, 

placebo-controlled Phase II/III clinical trial of two candidate Ebola 

vaccines in Liberia [44]. 

April 14, 2015 CDC helps the Sierra Leone Ministry of Health and Sanitation 

launch an Ebola vaccine clinical trial in that country [45]. 

July 31, 2015 The World Health Organization (WHO) reports that the rVSVZEBOV10 vaccine is highly effective against Ebola, according to 

Phase III trials in Guinea [47]. 

10 The rVSV-ZEBOV vaccine uses genetically engineered recombinant vesicular stomatitis virus (rVSV) 

to carry a Zaire Ebola virus (ZEBOV) gene. VSV is an animal virus that primarily affects cattle. It has 

been successfully tested as an experimental vaccine platform against several other viruses [46]. 

28
The U.S. government responded quickly and, on September 16, 2014, President Obama 

traveled to CDC headquarters in Atlanta, GA, to announce the deployment of 3,000 U.S. 

troops to Liberia [48]. U.S. Department of Defense forces in Liberia constructed hundreds 

of new beds and treatment centers for Ebola patients, including the Monrovia Medical 

Unit (MMU), an Ebola treatment unit created to treat healthcare workers in Liberia [49]. 

The USPHS Commissioned Corps sent an Advanced Echelon Team to Liberia in early 

October to establish partnerships for operating the MMU. The USPHS treated patients at 

the MMU from November 2014 through April 2015 [50]. 

Domestic response 

While the U.S. government supported efforts to contain the disease overseas, several 

cases of Ebola in the United States tested HHS’s ability to respond domestically (see 

Table 2). In July 2014, two American aid workers were diagnosed with Ebola while 

working in Liberia. In early August, they were medically evacuated to the United States 

and admitted to Emory University Hospital for treatment [51]. 

In September 2014, the first U.S. case of Ebola was diagnosed in Dallas, TX [52]. A 

Liberian traveler visiting the United States was admitted to Texas Health Presbyterian 

Hospital and diagnosed with Ebola [53]. Despite receiving treatment, the patient died. 

Two nurses who cared for him contracted Ebola, marking the first known incidents of 

domestic transmission of Ebola [53]. 

The Ebola cases in Texas raised a number of issues regarding domestic public health 

preparedness and response, including roles and responsibilities among local, state, and 

federal health authorities; hospital preparedness; waste management; public 

communications; civil liberties; travel restrictions; and quarantine considerations. They 

also perpetuated media interest and led to an increase in the public’s fear about Ebola 

risks [53]. 

HHS also worked with the U.S. Department of Homeland Security to screen people 

traveling from Guinea, Liberia, and Sierra Leone and arriving at any of five major U.S. 

airports [54]. This process was called “enhanced entry screening” and involved taking 

each traveler’s temperature; asking questions about possible exposure to Ebola; and 

collecting contact information for subsequent follow-up with the traveler, if needed [55]. 

From October 2014 through August 2015, more than 30,000 airline passengers were 

screened [56]. CDC conducted additional medical screening on some (less than 10 

percent) of the travelers. None of the travelers tested positive for Ebola. 

In October 2014, a returning traveler—an NGO physician who had been caring for Ebola 

patients in Guinea—was diagnosed with Ebola in New York City. Because the city is a 

major international travel hub, the New York City Department of Health and Mental 

Hygiene had begun planning for the possibility of Ebola cases months before the single 

confirmed case arrived in the city. Their planning focused on developing processes for 

active monitoring; developing public messages and outreach campaigns; conducting 

exercises and no-notice drills; and implementing travel history and fever screening at all 

New York City hospitals [26]. The NGO physician was monitored and later showed signs 

29
of Ebola [26, 57]. He was admitted and treated at Bellevue Hospital in New York City, 

and did not transmit the disease [26]. 

Table 2. Major U.S. Ebola response activities during the 2014–2016 Ebola epidemic 

Date Event

July 9, 2014 CDC activates its Emergency Operations Center to coordinate 

technical assistance and activities with Ebola response partners 

[58]. 

August 2–5, 2014 Two American healthcare workers are airlifted to the United 

States after contracting Ebola while conducting missionary work 

in Liberia; they are the first Ebola patients treated in the United 

States [59-60]. 

August 5, 2014 CDC elevates its Emergency Operations Center to Level 1 [61]. 

September 2, 

2014

Biomedical Advanced Research and Development Authority 

(BARDA) funds development and manufacturing of ZMapp, a 

medication to treat Ebola. 

September 22, 

2014

CDC launches a training course at the FEMA Center for 

Domestic Preparedness to prepare healthcare workers who 

intend to work in Ebola Treatment Units in West Africa [62]. 

September 26, 

2014

CDC modeling estimates there could be 1.4 million Ebola cases 

in West Africa by January 2015, if no further intervention occurs

[63]. 

September 30, 

2014

CDC confirms that a Liberian who traveled to Dallas, TX, has 

Ebola, marking the first case of Ebola diagnosed in the United 

States [52]. 

October 11, 2014 The U.S. Department of Homeland Security’s Customs and 

Border Protection and CDC begin enhanced entry screening at 

U.S. airports for travelers arriving in the United States from 

Guinea, Liberia, and Sierra Leone [56]. 

October 12, 2014 Two nurses who treated the Liberian traveler in Dallas, TX, are 

diagnosed with Ebola, marking the first known transmission of the 

virus in the United States [59]. 

October 20, 2014 CDC releases new guidance for U.S. healthcare workers on 

personal protective equipment for Ebola [64]. 

October 23, 2014 The New York Department of Health and Mental Hygiene reports 

that a physician returning to New York City from volunteering in 

West Africa has tested positive for Ebola [52]. 

December 2, 

2014

HHS designates 35 U.S. hospitals as Ebola Treatment Centers 

[65]. 

February 6, 2015 ASPR and CDC identify 697 Assessment Hospitals and 55 Ebola 

Treatment Centers in the United States [66]

July 1, 2015 HHS launches the National Ebola Training and Education Center 

[67]. 

30
To prepare for the possibility of emergent Ebola cases, HHS worked with local health 

authorities and hospital administrators to identify hospitals in different parts of the United 

States that were equipped to care for Ebola patients. These hospitals were designated as 

Ebola Treatment Centers [68]. HHS provided training and equipment to those hospitals 

[65]. For example, CDC assembled personal protective equipment kits that could be 

deployed to them [69]. The Office of the HHS Assistant Secretary for Preparedness and 

Response awarded approximately $20 million through its Hospital Preparedness 

Program to enhance the Ebola Treatment Centers’ capabilities [70]. 

Through its Laboratory Response Network, HHS approved more than 50 laboratories 

across the United States to test for Ebola virus [71]. As early as April 2014, the Public 

Health Emergency Medical Countermeasures Enterprise (PHEMCE) was activated to 

review potential Ebola vaccine and treatment candidates, and to put steps in place to 

accelerate the development of the most promising candidates. In addition, the PHEMCE 

and BARDA supported the late-stage development and manufacturing of candidate 

vaccine and treatments for Ebola. The U.S. Food and Drug Administration rapidly 

reviewed and approved Emergency Investigational New Drug applications for using these 

medications to treat Ebola patients. The PHEMCE partners worked together to support 

the vaccine and treatment trials led by the National Institutes of Health and CDC.

31
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32
Appendix B: Organizations 

Interviewed for this Report 

HHS / Immediate Office of the Secretary

HHS / Office of the Assistant Secretary for Preparedness and Response 

Biomedical Advanced Research and Development Authority

Office of Emergency Management

Office of Policy and Planning

HHS / Office of Global Affairs

HHS / Office of the Assistant Secretary for Public Affairs

HHS / Office of the Assistant Secretary for Health

Division of Commissioned Corps Personnel and Readiness

Monrovia Medical Unit

Readiness and Deployment Operations Group

HHS / Centers for Disease Control and Prevention

Center for Global Health

Division of Global Migration and Quarantine

Domestic Task Force

Ebola Policy Unit

Emergency Operations Center

Global Migration Task Force

International Task Force

Joint Information Center

National Center for Emerging Zoonotic and Infectious Diseases

National Center for Immunization and Respiratory Diseases

Office for State, Tribal, Local, and Territorial Support

Office of Public Health Preparedness and Response

Office of Public Health Scientific Services

Office of the Associate Director for Communication

STRIVE Vaccine Task Force

HHS / U.S. Food and Drug Administration

Office of the Chief Scientist

HHS / National Institutes of Health

National Institute of Allergy and Infectious Diseases

U.S. Department of State

Office of Medical Services

U.S. Department of Homeland Security

Federal Emergency Management Agency

U.S. Agency for International Development

Office of U.S. Foreign Disaster Assistance

33
U.S. Department of Agriculture

One Health Coordination Center

U.S. Department of Defense

Defense Threat Reduction Agency

Office of the Under Secretary of Defense for Policy

National Security Council

American Hospital Association

Texas Department of State Health Services

City of Dallas

Fire-Rescue Department

Office of Emergency Management

Police Department

Public Information Office

New York City

Department of Mental Health and Hygiene

Fire Department

Office of Emergency Management

Office of the Chief Medical Examiner

Greater New York Hospital Association

Bellevue Hospital Center

Emory University

Emory University Hospital

School of Medicine

University of Nebraska Medical Center

Constituency for Africa

Mercy Corps

Partners in Health

Global Communities

34
Appendix C: Timeline of Key 

Activities and Milestones during the 

HHS Response to the 2014–2016 

Ebola Epidemic

The following pages summarize key activities and milestones for the HHS Ebola 

response, from March 2014 through August 2015. (Note that HHS Ebola response 

activities (e.g., vaccine trials) have continued into 2016.) A pictorial timeline of activities 

and milestones is on page 37. An epidemic curve showing the number of new Ebola 

cases per month in Guinea, Liberia, and Sierra Leone is overlaid on the timeline. Data for 

the case counts are from CDC [72]. Table 3, on pages 39-42, displays the same 

information as the timeline. 

Acronyms used in the timeline and in the table are defined in the glossary on pages 

25-26 of this report. 

35
This page is intentionally blank.

36
37

This is a pictorial timeline of key activities and milestones during the HHS response to the 2014–2016 Ebola epidemic. There are

six columns to represent the actor or category for each activity or milestone: HHS OS, CDC, FDA and NIH, U.S. interagency, U.S. 

cases, and WHO and NGOs. An epidemic curve showing the number of new Ebola cases per month in Guinea, Liberia, and 

Sierra Leone is overlaid on the timeline. Table 3, on pages 39-42, displays the same information as the timeline.
This page is intentionally left blank.

38
Table 3. Key activities and milestones during the HHS response to the 2014–2016 

Ebola epidemic11

Month Key activity or milestone (actor or category)

March 2014 • There are 120 new Ebola cases in Guinea, Liberia, and Sierra

Leone

• Ebola cases reported in Guinea and Liberia (WHO and NGOs)

• CDC personnel deploy to Guinea (CDC)

• MSF warns about magnitude of potential epidemic (WHO and

NGOs)

April 2014 • There are 114 new Ebola cases in Guinea, Liberia, and Sierra

Leone

• PHEMCE meets to discuss countermeasures (HHS OS)

• CDC personnel deploy to Liberia (CDC)

• ASPR/HPP provides preparedness guidance to U.S. hospitals

(HHS OS)

May 2014 • There are 75 new Ebola cases in Guinea, Liberia, and Sierra

Leone

• Ebola cases reported in Sierra Leone (WHO and NGOs)

• OGA designated as U.S.-based coordinator for Ebola response in

West Africa (HHS OS)

June 2014 • There are 290 new Ebola cases in Guinea, Liberia, and Sierra

Leone

• CDC personnel deploy to Sierra Leone (CDC)

July 2014 • There are 723 new Ebola cases in Guinea, Liberia, and Sierra

Leone

• American aid workers in Liberia diagnosed with Ebola (WHO and

NGOs)

• CDC activates its Emergency Operations Center (CDC)

• CDC sends 50 additional personnel to West Africa (CDC)

11 Ebola case counts are from CDC [72]. 

39
Month Key activity or milestone (actor or category)

August 2014 • There are 1,730 new Ebola cases in Guinea, Liberia, and Sierra 

Leone

• American aid workers admitted to Emory University Hospital (U.S. 

cases)

• FDA authorizes use of diagnostic test for Ebola (FDA and NIH)

• CDC elevates its EOC to Level 1 (highest level) (CDC)

• DOD establishes Task Force for Ebola response (U.S. 

interagency)

• WHO declares Ebola epidemic is a Public Health Emergency of 

International Concern (WHO and NGOs)

• WHO requests that Ebola-affected countries conduct exit 

screenings at international airports (WHO and NGOs)

• HHS issues interim guidance for monitoring and movement of 

persons exposed to Ebola (HHS OS)

• American aid workers discharged from Emory University Hospital 

(U.S. cases)

• USAID/OFDA Director and CDC Director visit West Africa (U.S. 

interagency)

• NIH begins Phase I human safety trial of cAd3-EBOZ Ebola 

vaccine (FDA and NIH)

September 2014 • There are 3,501 new Ebola cases in Guinea, Liberia, and Sierra 

Leone

• CDC Director warns that Ebola epidemic in Africa is spiraling out 

of control (CDC)

• President Obama announces DOD Joint Force Command in 

Liberia (U.S. interagency)

• UN Security Council declares that Ebola epidemic threatens 

international peace and security and forms UNMEER (WHO and 

NGOs)

• Liberian national seeks care in Dallas, TX, for fever and 

abdominal pain (U.S. cases)

• CDC launches Ebola Treatment Unit training course at FEMA 

Center for Domestic Preparedness (CDC) 

• CDC modeling estimates 1.4 million cases of Ebola by January 

2015, if no intervention (CDC)

• ASPSR and CDC issue hospital checklist for Ebola preparedness 

(HHS OS)

• CDC confirms first case of Ebola diagnosed in United States 

(Dallas, TX) (CDC)

40
Month Key activity or milestone (actor or category)

October 2014 • There are 6,987 new Ebola cases in Guinea, Liberia, and Sierra

Leone

• USPHS Commissioned Corps Advanced Team deploys to Liberia

(HHS OS)

• Liberian national diagnosed with EVD in Dallas, TX, dies (U.S.

cases)

• CDC and DHS CBP begin enhanced entry screening at 5 U.S.

airports (U.S. interagency)

• FDA authorizes additional diagnostic test for Ebola (FDA and

NIH)

• Nurses in Dallas, TX, test positive for Ebola (U.S. cases)

• UN Secretary General calls for 20-fold surge in assistance to fight

Ebola (WHO and NGOs)

• CDC announces new teams to be dispatched for U.S. Ebola

cases (CDC)

• President Obama designates “Ebola Czar” to coordinate U.S.

response (U.S. interagency)

• CDC issues new guidance for use of PPE with Ebola patients

(CDC)

• MSF physician who returned to NYC tests positive for Ebola (U.S.

cases)

• NIH begins Phase I human safety trial of rVSV-ZEBOV Ebola

vaccine (FDA and NIH)

• CDC issues revised guidance for monitoring and movement of

persons exposed to Ebola (CDC)

• Nurses from Dallas, TX, recover and released from hospitals

(U.S. cases)

• OGA begins preparing USG Senior Leadership Briefs (HHS OS)

November 2014 • There are 3,359 new Ebola cases in Guinea, Liberia, and Sierra 

Leone

• President Obama proposes $6.18 billion for Ebola response (U.S.

interagency)

• Monrovia Medical Unit (staffed by USPHS) opens (HHS OS)

• CDC assembles PPE kits that can be deployed to U.S. hospitals

(CDC)

December 2014 • There are 3,272 new Ebola cases in Guinea, Liberia, and Sierra 

Leone

• 35 U.S. hospitals designated as Ebola Treatment Centers (U.S.

cases)

• Congress appropriates supplemental funding for Ebola response

(U.S. interagency)

• HHS Secretary issues declaration under PREP Act to facilitate

development of Ebola vaccines (HHS OS)

41
Month Key activity or milestone (actor or category)

January 2015 • There are 1,886 new Ebola cases in Guinea, Liberia, and Sierra

Leone

• More than 50 LRN laboratories approved to test for Ebola (CDC)

February 2015 • There are 1,637 new Ebola cases in Guinea, Liberia, and Sierra

Leone

• President Obama announces withdrawal of most DOD personnel

from Ebola response in West Africa (U.S. interagency)

• ASPR announces $194.5 million to support Ebola response

activities (HHS OS)

• NIH helps launch PREVAIL study trials in Liberia (FDA and NIH)

March 2015 • There are 1,178 new Ebola cases in Guinea, Liberia, and Sierra

Leone

• CDC introduces Ebola Training Toolkit (CDC)

• HHS announces $12 million to support National Ebola Training

and Education Center (HHS OS)

• rVSV-ZEBOV Ebola vaccine trial begins in Guinea (WHO and

NGOs)

April 2015 • There are 1,405 new Ebola cases in Guinea, Liberia, and Sierra

Leone

• CDC helps launch STRIVE vaccine trial in Sierra Leone (CDC)

• Ebola Innovation Summit held in San Francisco with USG, NGOs,

IOs, and private sector (U.S. interagency)

• Monrovia Medical Unit closes (HHS OS)

May 2015 • There are 736 new Ebola cases in Guinea, Liberia, and Sierra

Leone

• WHO declares Liberia free of Ebola transmission (WHO and

NGOs)

June 2015 • There are 430 new Ebola cases in Guinea, Liberia, and Sierra

Leone

• HHS selects nine regional Ebola Treatment Centers (HHS OS)

• New Ebola cases confirmed in Liberia (WHO and NGOs)

July 2015 • There are 305 new Ebola cases in Guinea, Liberia, and Sierra

Leone

• HHS launches National Ebola Training and Education Center

(HHS OS)

• WHO announces lowest weekly total for new Ebola cases in over

a year (WHO and NGOs)

• Early results from rVSV-ZEBOV vaccine trial suggest vaccine is

100% effective (WHO and NGOs)

August 2015 • There are 257 new Ebola cases in Guinea, Liberia, and Sierra

Leone

42
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