Tough Love

by Susan Rice

  That chart shook up the Principals Committee like nothing I have seen before or since. Up until then, we had been scaling up civilian-led efforts to curb the epidemic as rapidly as possible. CDC and USAID had deployed teams to West Africa. Doctors Without Borders and other NGOs were on the ground. The World Health Organization had botched the initial response but finally seemed to grasp the gravity of the situation. None of it was enough. We had to do more.

  For almost two months, the president had been pressing us hard to get the epidemic under control, to treat this as a national security crisis. If the United States did not lead, no one would. Despite our efforts, the virus was far outpacing our capacity to respond quickly enough. Despairing, late one night, my old friend Gayle Smith called me from Washington. She was leading the NSC’s Ebola response effort, and I was in Wales with Obama at the NATO Summit. We talked through all that we were doing and where the gaps were. There weren’t enough beds for the sick, not enough protective gear for health workers, not enough quality hospitals to treat medical workers who fell ill. It was a race to evade a tsunami, and we were losing.

  I asked her what she thought we could do to try to get ahead of the curve. Gayle reported that our interagency team, led by CDC and USAID, would take one more look at whether they could further scale up the civilian response fast enough, but she doubted it. As we talked, I realized there was one option we hadn’t yet discussed: utilizing the unmatched capacity of the U.S. military. They could bend the curve.

  Recalling the Southern African floods we worked on together in 2000, I said, “What about deploying the U.S. military like we did during the Mozambique catastrophe and for other natural disasters?”

  Gayle paused. “Do you think that’s even an option?”

  “You think it would make a major difference, don’t you?” I asked.

  “Hell, yes. No one can do it better or faster than the U.S. military.”

  “Okay, if you determine that the civilian side can’t cut it, I’ll see what we can do.”

  The president was open to using the military and told me to work it through the Principals Committee. It was a delicate proposition. No one could recall deploying the U.S. military to confront a disease. We would be sending U.S. servicemen and -women into a hot zone an ocean away. How would we handle the risks to them and, later, to Americans when our service members returned to the continental United States?

  DOD swiftly quashed any notion of U.S. medics treating victims, which I understood, and was skeptical about where U.S. troops could add value. Yet, to his great credit, Joint Chiefs chairman General Dempsey decided to find a way to get to yes, rather than marshal a plethora of excuses to avoid action, as the Pentagon is adept at doing when it wants to avoid an unwelcome tasking. Dempsey went to work figuring out how we could bring uniquely American capabilities to bear to serve as a “force multiplier” for a stepped-up international response without the U.S. serving as “the pointy end of the spear.”

  The next day, General Dempsey came back with a proposal. The U.S. could airlift personnel and supplies to West Africa, establish a logistics staging area in Senegal, and stand up a military command center for the region in Monrovia, Liberia. U.S. military personnel could refurbish Robertsfield airport in Monrovia, distribute supplies, set up diagnostic labs, safely medevac Americans who fell ill in West Africa, and build Ebola Treatment Units (ETUs) across Liberia where the ill could be quarantined and safely treated. The military could also build a medical unit at the airport in Liberia, which would be staffed by the U.S. Public Health Service and serve volunteer health care workers from around the world. This facility was key to convincing volunteers to deploy, giving them confidence that they would receive quality medical treatment if they fell ill in the line of duty. In sum, the U.S. could lead the charge and use our commitment to galvanize others to contribute.

  It was a gutsy move by Dempsey, and the president swiftly endorsed DOD’s plan to deploy almost three thousand U.S. servicemen to save lives and help contain the epidemic before it became a global menace. Within three days, the U.S. commander of Operation United Assistance was on the ground in West Africa.

  From there, my responsibility was to ensure we pressured every possible international contributor to do their part. President Obama, many members of the cabinet, and I made scores of calls to incredulous counterparts. “You want us to do what?” was a common refrain. President Obama convened a high-level session at the 2014 General Assembly with U.N. Secretary-General Ban Ki-moon. Few foreign leaders immediately grasped the gravity of the epidemic, the risk it posed beyond West Africa, and the urgency we attached to their contributions. We had to explain the hockey stick and its implications.

  The whole of the U.S. government shamed, bludgeoned, and begged countries to join us. We got Britain to take charge in Sierra Leone and build ETUs and labs. The French did the same in Guinea. Japan provided protective gear and money. Germany contributed money and treatment expertise. Canada offered money and French-speaking health workers. China provided money and supplies. Above all, ten thousand volunteer health care workers came from across Africa to risk their lives to save others. In this way, we mustered a major global response that would eventually contain the disease to three countries in West Africa, causing the infection curve to flatten and eventually bend downward.

  While we began to gain traction internationally, at home in the U.S. things were getting truly crazy. In late September, a Liberian visitor to Texas fell ill with Ebola, and the hospital in Dallas was unprepared to respond. He died. His contacts in Dallas were placed under quarantine and monitoring. Two nurses at the hospital that treated him contracted the disease, and one traveled by plane with a fever, prompting worry that other passengers might be at risk. Thankfully, both survived.

  But not before Americans started panicking. Ebola is relatively hard to transmit. It’s not like the flu, which you can easily get from airborne particles or a cough. To contract Ebola, you need to exchange bodily fluids with someone infected—blood, vomit, semen, saliva, sweat. In a hospital setting, at home caring for a victim, or burying a body, it is highly transmissible. Otherwise, it is not so easy to contract. Facts aside, Americans’ fear was potent and palpable, if not always rational.

  Domestic hysteria continued to mount in the media and across Washington. Certain governors refused to allow planes from Africa to disembark. Some members of Congress demanded that the Department of Homeland Security seal the border and threatened legislation to prevent anyone (American or African) from entering the country from West Africa. This was a particularly reckless idea, which would have deterred volunteers from helping stamp out the epidemic and effectively imposed an economic embargo on the already reeling region.

  Meanwhile, the Islamic State in Iraq and Syria was beheading Westerners. Russia was chewing huge bites out of its neighbors’ territory. And now this terrifying, hemorrhagic disease had touched down on American soil. We were in the eye of a storm.

  Against this backdrop, President Obama wrestled with how to secure the American people against Ebola, while relying on facts, not fear. The U.S. domestic response started flat-footed. President Obama fumed privately that, “Our shit is not tight” (one of his more common refrains when he felt things were not well under control). For a spell, he seemed to be losing confidence in CDC director Frieden and perhaps others’ ability to communicate with the public and manage the risks that Ebola posed here in the United States. Yet I also sensed the president was reluctant to change generals in the middle of battle.

  Homeland Security Secretary Jeh Johnson and some others were leaning toward recommending that we stop issuing new visas to nationals from the three affected countries and suspend existing visas. In a private discussion in the Oval with the president, Gayle and I argued strenuously against curtailing visas. CDC said it wouldn’t work. Only a third of travelers from these West African countries were visa holders. The majority were Americans or permanent residents whom we could not keep out without r
aising serious legal questions. Curtailing visas would encourage undetected, illegal entry, such as overland from Canada. It would serve as a sop to racially stoked fears. It would stigmatize nationals from Liberia, Guinea, and Sierra Leone already living in the U.S. It would sound the economic death knell for West Africa, as other Western countries would follow suit, and the region would be cut off from the rest of the world. “There are better ways to secure our citizens without using a nuclear weapon against a conventional enemy,” I pointed out, emphatically.

  As the discussion ended, I wasn’t sure where the president was going. I worried that he and I might face a reckoning, if we found we had irreconcilable differences on an issue about which I felt so strongly. For the first and only time in my tenure as NSA, I concluded privately, without ever telling him, that if he decided to effectively close the border I would have to resign. I never said so aloud. I wasn’t interested in threats but the consequences of our actions. I know Obama well enough to know that my saying so would not have helped. Ever rational, the president relied on science and logic. Ultimately, despite the countervailing pressure, he made the tough decision. The right decision.

  Still, the challenge was: how best to protect Americans? In mid-October, President Obama appointed Ron Klain—former chief of staff to Vice Presidents Gore and Biden and an experienced Washington fixer—as Ebola Czar. Ron drew staff from the NSC and elsewhere to establish a White House–based Ebola Task Force. Gayle remained a key player, as did Lisa Monaco, Denis McDonough, and I, but Ron took on day-to-day leadership of the crisis and did a phenomenal job. His arrival enabled us to go back to juggling multiple global crises simultaneously, rather than being consumed by this enormous challenge.

  To ensure Americans’ safety without upending transatlantic travel, we continued having health care workers screen airport passengers for fever before all departures from West Africa. If those flying showed any symptoms, they could not travel abroad. In addition, inside the U.S., the CDC and Homeland Security officials devised a system where we funneled all passengers from the three Ebola-affected countries through five designated U.S. airports. Arrivals were medically screened before being admitted into the U.S. and then monitored daily by CDC for twenty-one days (the incubation period for Ebola). Hospitals across the country were trained and equipped to detect, test, safely isolate Ebola patients, and transfer them, if infected, to three specialized treatment centers across the country. As CDC and other agencies tightened up their “shit,” Obama’s ire abated.

  It worked. Fear diminished.

  In West Africa, the disease ultimately killed over 11,300 people and infected more than 28,500—too many, but far fewer than could have been the case. Over many months, new infections eventually fell to zero. Congress appropriated $5.4 billion in emergency funds to bolster our domestic and international health infrastructure. The U.S. border remained open. No U.S. troops fell gravely ill. CDC, USAID, and the U.S. Public Health Service Corps saved tens of thousands of lives. The National Institutes of Health invested in finding effective vaccines for Ebola (one of which demonstrated its efficacy in Congo in 2018). We revolutionized the readiness of our domestic health system to treat Ebola safely.

  U.S. private donors, NGOs, and philanthropies made critical contributions. Our allies pulled their weight. (With the unusual exception of Australia, which tried to screen out any arriving passenger who had traveled recently to any of fifty-four African countries. When the U.S. delegation headed by President Obama landed in Australia in November for the G20 Summit, we refused to fill out their entry questionnaire, because it was so stupid and offensive.)

  Over eleven thousand lives is a lot to lose. The death toll would have been exponentially higher had the U.S. not rallied the world once it became clear that this was no isolated Ebola hot spot but a fast-moving, potentially global epidemic that the World Health Organization and United Nations were unprepared to confront. By galvanizing the world to confront and contain a threat to us all, as only America can, we avoided the hockey stick scenario and demonstrated the power of U.S. global leadership at its best.

  Months earlier, in February 2014, the Obama administration had launched the Global Health Security Agenda to encourage wealthier countries to help developing countries build their capacity to prevent, detect, contain, and treat deadly infectious diseases. Now this critically important initiative had real money from Congress and international impetus behind it. With air travel, deforestation, climate change, and humans’ increased proximity to wildlife due to population growth, disease today can spread far more rapidly than at any time in human history. Experts agree that the resurgence of some form of global pandemic disease, whether Zika, Ebola, avian flu, or SARS, is all but inevitable. As national security advisor, this was (and remains) among my biggest fears. The loss of life, economic devastation, and the potential to spark armed conflict that would accompany a global pandemic—even one on half the (population-adjusted) scale of the 1918 Spanish Flu, which killed 3 to 5 percent of the world’s population—overshadows many of the worst-case scenarios I was compelled to contemplate short of nuclear war.

  It makes no sense that we have been stuck in the same situation all of my life. We have gotten nowhere. It’s time for a change.

  This was a snippet of private conversation, in which President Obama lamented the failure of U.S. policy toward Cuba over the last fifty-plus years. As we talked during a car ride late in his first term, I wholeheartedly agreed. Implied, but not stated, however, was that there would be no testing of the potential for change unless Obama won a second term.

  Having tucked this insight away, after I became his second-term national security advisor, I hoped that we would get a chance to revisit America’s bankrupt Cuba policy. Decades of diplomatic deep freeze with no formal relations and a legislatively mandated economic embargo had not ousted the Castros or meaningfully improved the human rights and living conditions of the Cuban people. Rather, the U.S. was reviled by much of Latin America as a Goliath trying in vain to squeeze the life out of a Davidian Cuba. Our dated Cuba policy was a ball and chain dragging down our broader efforts to strengthen U.S. ties to Latin America and the Caribbean and to bolster the wave of democratic progress that had washed over large swaths of the region.

  Trying to change Cuba policy was a third rail of American politics. Even as the influence of Florida’s aging, hard-line Cuban American community was starting to wane, and farm state representatives were eager to open the Cuban market to U.S. agriculture, many in Congress remained powerful and intimidating protectors of the status quo. Going against old-school Miami and the State Department’s Western Hemisphere Bureau, which historically was a minefield of Cuba hard-liners, was a huge risk. If we failed, we’d look like fools. If we were exposed before negotiations were complete, the backlash in Congress would undermine the president’s legislative agenda on multiple fronts. As a result, if we were going to explore the potential for any opening with Cuba, it would have to be done in absolute secrecy.

  Early in 2013, President Obama assigned Ben Rhodes the task of negotiating with Cuba. It was a stealth pick—someone close to the president within the White House, who could move around with lower visibility than others, and whose communications role did not arouse suspicion of him serving as a special envoy. When I arrived midyear as national security advisor, Ben and Ricardo Zuniga, our extremely talented NSC senior director for the Western Hemisphere, had already held a preliminary meeting with the Cuban side. Cuban president Raúl Castro, who had taken over power from his ailing brother Fidel, assigned his son Alejandro, a military officer and trusted emissary, and Fidel’s prized translator, Juana Vera, as their Cuban counterparts. The Canadian government agreed to facilitate quiet meetings in discreet locations near Ottawa and Toronto to enable the two delegations to come and go without detection.

  Initially, apart from Ben and Ricardo, only a small handful of us at the White House knew this secret channel existed: Obama, Biden, Chief of Staff Denis McDonoug
h, Deputy NSA Tony Blinken, the vice president’s NSA Jake Sullivan, and me. It was highly unusual to operate so surreptitiously, but we could not risk leaks. The U.S. Interests Section in Cuba, members of Congress, and U.S. government agencies were not involved.

  At first, the discussions focused mainly on the U.S. demand that Cuba free American Alan Gross, a USAID subcontractor unjustly imprisoned since December 2009. As a moral and practical matter, without Gross’s release, there was no latitude for progress on any other front. For its part, Cuba wanted to be removed from the State Sponsor of Terrorism list, the release of some of its nationals from U.S. custody, and (of course) sanctions lifted. The two sides circled each other warily for months, stalled on these issues.

  When I arrived at the NSC, I assured Ben that I would strongly support his efforts every step of the way. From the outset, we worked closely together on the strategy and tactics of his negotiation. In our early meetings, I was struck by the team’s emphasis on getting Gross released as a predicate for negotiations on other matters. I believed that once it became known that we had negotiated directly with the Cubans on anything (even returning Gross), Congress would shut down the potential for further meaningful contacts. Moreover, it wasn’t clear that we could even get Gross without cutting a larger deal. In my view, we shouldn’t settle for one bite, if there was the potential for getting the whole enchilada.

  Invoking one of the vice president’s Bidenisms, “Don’t die on a small cross,” I proposed that we instead pursue a “Big Bang.” The idea was to negotiate and announce the entirety of the agreed changes to U.S.-Cuban relations: Gross’s release, Cuban prisoners’ return, the terrorist list, sanctions easing, normalized diplomatic relations, talks between our leaders—all at once. The shock would be so great that our opponents would be paralyzed (at least temporarily) by the blast effects. By the time the dust settled, the deeds would have been done, and the silent majority of Americans and members of Congress who favored change would be free to support it at no political cost to them.