David Hutchins

David M. Hutchins

Q: This is Sam Robson, here with David Hutchins at the CDC [United States Centers for Disease Control and Prevention] audio recording studio in Atlanta, Georgia. Today is July 5th, 2016. I'm talking with David today about his help in the response for CDC's Ebola--Ebola epidemic response, 2014 to 2016 epidemic. David, thank you so much for being here with me today.

HUTCHINS: It's a pleasure.

Q: Can I start off by asking you, can you pronounce your full name for me?

HUTCHINS: Yes. It's David Martin Hutchins.

Q: And what's your current position with CDC?

HUTCHINS: Currently, I'm on a detail to the Flint water contamination response at the [National] Center for Environmental Health at Chamblee. On the Chamblee campus. My day job actually sits with NCEZID [National Center for Emerging and Zoonotic Infectious Diseases], Division of Preparedness and Emerging Infections. My branch is the response branch for NCEZID. We manage the bioterrorism agents. 00:01:00We work closely with multiple agents across the centers for OID [Office of Infectious Diseases]. And we serve in the responses as needed, on a recurring basis.

Q: Thank you for that. Can I ask you, going back a little bit, where and when you were born?

HUTCHINS: I was born in Florida. My dad was a [United States] Air Force pilot. I was born on an air base, Eglin Air Force Base, just outside of Fort Walton Beach. My dad was actually a POW [prisoner of war] in North Korea when I was born. He later was brought back to the US, and he retired from the Air Force, and we moved back to Atlanta where my parents originally are from. My dad took a job with Lockheed, and so I'm basically an Atlanta native.

Q: Wow.

HUTCHINS: Yeah. So I've been here ever since, off and on. A few places here and 00:02:00there I moved to. But by and large, I'm one of the few in CDC that's an Atlanta native.

Q: So you were born in the fifties sometime?

HUTCHINS: I was born in the middle fifties. Went to school and grew up in East Cobb. East Cobb County, before it was what it is now. When it was still a little farm community of about seventy thousand people total. I think today it's like 970,000 people total, just in the county alone. Went to schools there. Went to UGA [University of Georgia]. Played baseball at UGA. The Bulldogs are my passion. And did some other--went to some other schools along the way.

Q: How old were you when your dad was repatriated?

HUTCHINS: I was six months old.

Q: You were six months old. Does your dad ever talk about that?

HUTCHINS: He passed away ten years ago. Actually ten years ago this Christmas. He never talked about it much at all. He basically just would acknowledge it and 00:03:00move on. He's very patriotic, like most veterans are. Particularly from the Korean conflict and Vietnam conflict. He pretty much--he'd talk about it. He was a pilot. He was shot down over North Korea and survived. He didn't talk about his experiences per se, but he kept up with his friends and people that he served with and flew with. I think that's a small, little continuity group who stayed together. Unfortunately, I think most of them are probably gone now. Rarely do I see any or hear from any of them. Occasionally I'll hear from one or two that are still around.

Q: How did your mom spend her time?

HUTCHINS: I think probably traveling back and forth to her parents. My parents 00:04:00were quite young. My mom was quite young when I was actually born. She had lots of friends, and made good friends there. She volunteered at the hospital, actually, in Eglin where the soldiers would return who had been wounded in conflict, battle, and whatnot. They'd bring them back to the [United] States, and Eglin was one of the bases where wounded folks were brought back. She volunteered a little bit here and there.

Q: What kinds of things caught your interest up through, say, high school?

HUTCHINS: I didn't want to work. [laughs] I didn't enjoy work. Sports was my thing. I played sports all my life, and all through school, whatever was in season is what I played. And I played on the school teams. That transfers into playing some sports in college, and a little afterward. And that's what I still do. That's my outlet, is whatever my body allows me to do, which is not as good 00:05:00as it once was.

Q: Did I hear you mention baseball in college?

HUTCHINS: I did play. I did play baseball in school. I actually coached in college afterward. That was my career path, was a college coach at one point in time. But like all things, changes come about, and you tend to realize that that's maybe not the career path that you would like. You like what you're doing, but things such as money and circumstances go from there. You end up going in a total different career direction with something you never thought you would do. [laughs] Just like this.

Q: Absolutely. Just like this. Do you remember what your major was in undergrad [undergraduate school]?

HUTCHINS: In undergrad, it was environmental health science. It was a brand new program. EPA [Environmental Protection Agency] was formed in 1970. It was created by the government in 1970. One of the things that they did in order to promote their agenda of environmental restoration--environmental protection--was 00:06:00essentially develop these curriculums in various schools around the country, and the University of Georgia was one of those such few schools. When I was in school, my intent was--I actually enrolled in pharmacy school. Didn't particularly love chemistry, which was kind of a mismatch. Couldn't type. Never took typing. One of the first classes I had was learning to type. I thought, this probably not for me. Environmental health was new. I looked into it and got to know some of the people in it, and it was a curriculum for various colleges throughout, and biological sciences, physical sciences, math. Even engineering. A few engineering courses. Things like that. Government. Law. I was particularly interested in the law piece. I thought, after changing your major three or four times, you've got to settle on something. This sounded like a good, open opportunity. It was interesting to me.

Q: But immediately after college, it was still thinking about the coaching track?

HUTCHINS: I did. I took a job with FDA [US Food and Drug Administration]. A short job with FDA. I didn't enjoy what I did. It was basically paper-pushing at an entry-level. Opportunity came, and I decided I thought grad [graduate] school would be the thing to do. I went up as a GA to Wake Forest [University] and applied--a graduate assistantship with the sports program, and the baseball program--and was selected. So I coached there. Once I graduated, I became a full-time coach at Wake Forest for two, three years.

Q: What happened then?

HUTCHINS: Like all coaches, you either decide that's where you're going, or you realize that you've got to move around quite a bit. Growing up here in Atlanta, 00:08:00growing up here in the South, a lot of my friends were still here. My parents started having some health problems. I'm the oldest of a brother and a sister. I have two siblings. I just thought it was time to come back to Atlanta. I came back here and applied for a position with the state of Georgia. Was able to get that and come back here. I explored some coaching opportunities, but you got to remember, at that point in time, in those days, not a lot of colleges had sports teams. There either were the big universities or--the small schools like you have this day and time didn't exist. No. So, went to work with the state of Georgia. Their Department of Natural Resources. Their Environmental Protection [Division]. I enjoyed it. It was fun. I got to travel the state and play in the rivers and lakes and take water samples, and things like that. It was kind of fun. That's kind of what led me into the environmental world of public health. I 00:09:00actually did use some of my academic training, which is what you go to school for, right?

Q: Absolutely.

HUTCHINS: [laughter] Or are supposed to. Supposed to. It was a natural progression from there to the federal government, which obviously pays--one driving factor. But some opportunities to travel the country and do some things internationally. The lure of a bigger--a larger perspective on interacting in people's lives tends to drive you that way. It was interesting. And it's worked out well.

Q: So basically since joining the Georgia department, and then transitioning to the federal level, it's really been environmental health?

HUTCHINS: It started out that way. My first agency was EPA, here in Atlanta, in 00:10:00the regional office. In the Office of Water, which is my passion. Drinking water, per se. I did a couple year stint in [Washington], DC, in headquarters, like a lot of people do. DC's not really a place I wanted to live, but I did enjoy the work environment. I did enjoy the opportunities to learn and grow and things like that. But I came back to Atlanta to the regional office here in Atlanta. Afterward, I'm there for about seven years, and things open up for you. You begin to interact with other colleagues from other agencies. In 1986, EPA created a superfund--what's essentially called superfund amendments. Along with that was an Agency for Toxic Substances and Disease Registry, ATSDR, which still exists today. It was created in order to essentially guide EPA in the health 00:11:00components of superfund cleanup. CERCLA [Comprehensive Environmental Response, Compensation, and Liability Act] cleanup, it's called. They were recruiting numbers of people, and numbers of EPA colleagues left and went to that agency. I followed with them. That's how the door opens up into CDC for a lot of people from the environmental health world. It comes through that organization. Today, they're actually part of NCEH [National Center for Environmental Health]. ATSDR is kind of one and the same now. It's HHS an [US Department of Health and Human Services] subsidy. That's how we've progressed into CDC, and into the Center for Environmental Health, through ATSDR after numbers of years. And explored some other programs. Even though my background--academic training--is in environmental health, you tend to explore other things. I went to chronic disease for a while, and then back to NCEH with a new program called the Climate Change [Program], which was quite different. And then progressed over to EZID 00:12:00[National Center for Emerging and Zoonotic Infectious Diseases]. The infectious world is a whole different world for me, but it's been fun. It's been quite an opening learning experience for me. It's been enjoyable. I enjoy it.

Q: What time did you come into the infectious world?

HUTCHINS: I came over in 2010, 2011. So it's been about, what? Four or five years now. It's changed quite a bit. Obviously, I'm nowhere near--I'm not an infectious disease person, per se, but we basically help manage the responses to any of these infectious outbreaks that have been going on. We've had numbers of them. Obviously we've had Ebola. Now Zika, and SARS [severe acute respiratory syndrome] in the past, and [influenza A virus subtype] H1N1, and things of that sort. The response part has always been an interest of mine. Even from the very beginning with the state and with EPA. I was in the response piece as an 00:13:00on-scene coordinator, and respond to breakouts and emergencies and things of that sort. It's kind of what piques my interest, personally.

Q: Do you remember what you were working on immediately before the Ebola epidemic?

HUTCHINS: I do. I was actually in the EOC [Emergency Operations Center]. There was a short, two, three-month response that was activated called "Unaccompanied Children." I was in that response with the folks from EZID, from Division of [Global Migration and] Quarantine, which was the lead for the agency. So I was there. What happened was when Ebola was activated--because that's what my program does, and I was there--they asked me if I would stay and help the new incident manager set it up. Get it going, get it running, along with OPHPR 00:14:00[Office of Public Health Preparedness and Response]. Kind of coordinate with them. And it's basically what I did. I just never left and went back to my desk. I stayed through the Ebola response.

Q: Was that back when the incident manager was Inger [K. Damon], or before Inger?

HUTCHINS: It was before Inger. Stuart [T.] Nichol was the first manager. Incident manager. Stuart is the branch chief for the VSPB [Viral Special Pathogens Branch] in Inger's division. I did not actually know Stuart that well. I'd only talked with him in official correspondence on email and by phone. But I got to know Stuart real well. And Ray [R.] Arthur was the deputy. Ray is the branch director for the Global Disease Detection program. I got to know him a little bit and worked with him. Helped him set up his immediate office and the command staff, and things of that sort. Helped operationalize some of the things 00:15:00that take place whenever an activation is first begun.

Q: Was it pretty routine at this point, or were there some things that were different off the bat?

HUTCHINS: As far as Ebola, you mean, or--

Q: Yeah.

HUTCHINS: Well, the agency's fairly new at responding. Responses are different depending on the agent. This was quite different because this is the first time that an international event had happened. Up to that point, our primary concern was focusing on domestic issues. This took place across the water, basically. West Africa. Now, Ebola--there have been Ebola outbreaks and responses since the seventies. Stuart's program--it's where the SMEs [subject matter experts] 00:16:00reside. But nothing of this magnitude. Trying to coordinate and operationalize efforts here in the US for countries across--another continent, it was quite challenging, actually. A lot of the language--not the language that the countries speak, but the infectious disease lingo versus--and bringing people in who not necessarily are from EZID and other centers. You have to start with the very basics of learning the lingo and learning the language of infectious disease. Learning the ideology of the agent, which is well known to Stuart's branch, but it's not so well known to others who don't work with it on a daily basis. It's a little bit challenging at times. And you've got to remember, 00:17:00you're doing this without money, initially, until Congress acts. You're providing resources, and the agency's--CDC's providing resources and trying to find the money from other programs. Our OD [Office of the Director] did a great job--an excellent job. They get criticized often for various things, but they did a great job at funding and making sure that money wasn't the issue.

Q: What's ROD?

HUTCHINS: Our OD. The CDC OD. The Office of the Director.

Q: Oh! Our OD.

HUTCHINS: Yeah, sorry. CDC OD. Yeah.

Q: [laughs] Sorry about that.

HUTCHINS: There were lots of things to set up. And too, you've got to remember that most subject matter experts, they're scientists. They're doctors. They're scientists. They're not well-versed in the organizational structure of responses. It's a whole new language to them. It's a whole new nomenclature. It's a whole new way to operationalize their daily work. Because their daily 00:18:00work becomes the response, not what they're doing back in Building 24, in their office. Or in their laboratory in Building 19. I guess what happens is that some folks take to that really well, and some do not. Some tend to maybe continue to work in their day world, and that doesn't always work in a response, when you're trying to really mitigate the exposure and eliminate the source of disease outbreak.

Q: Do you remember any incidents--and I'm not asking you to name names or anything like that--but any incidents in particular that would illustrate maybe some of the difficulty in someone who's very knowledgeable about the science, trying to find their way in this new--they would probably see it as a bureaucracy? I don't know.

HUTCHINS: Well, just small things such as there is an operation structure. There's an, what's called, "incident command structure," that was created years ago by FEMA [Federal Emergency Management Agency]. It's used by the military. 00:19:00It's used by the US government. It's adopted by the government. CDC has adopted its version of the ICS [incident command system] structure. What that tries to do is it allows the incident manager to direct the various task forces. Task forces are created based on the need there might be, such as epi [epidemiology], or such as finance, or such as communication, and things of that sort. It helps with the span of control. It helps to be able to adapt those resources to a quick, and for lack of a better word, quick and dirty action. Not being familiar with that structure, there's a lot of loose, miscommunication--or non-communication--is typically what happens, that comes out of that. What you find is that the left hand doesn't talk to the right hand, and it's not 00:20:00intentional, it's just that there's not that direct line of communication that's needed that you would find in a more seasoned or more veteran organization that's accustomed to--such as the military. That's what they do. They have to act--they have to operate that way. That's what you find. I think in every response that CDC's ever been involved with, there's been some of those issues. But they're much--we're lightyears ahead of what we were a few years ago. There's a lot of learning that goes with it, and consequently you have more and more seasoned--what I call seasoned veterans--who are becoming more responsive response agents for CDC and are able to--Zika's finding that now, even though I know they're struggling at times for staffing because of burnout, which is a whole different issue. But they have people who have been in responses now and 00:21:00have a quick understanding. I just saw two new ones today that I've not seen in quite a while. They jumped right in, and they're moving on--they move quickly. That's what you need.

Q: Is it a matter of getting the people more seasoned, and getting the right people in those positions? Or is there some sort of infrastructure that you can help build to try and bridge that communication?

HUTCHINS: OPHPR, I think, was created to provide that infrastructure and to provide that training. It's a combination of hands-on response, because you can be trained until the day is dark, but there's nothing like hands-on experience for anything. Anything in life. It's essentially combinations of the trainings. Becoming familiar. Being introduced to concepts and then coming on board and being able to essentially operationalize those concepts. Combinations of that help the agency move along on a response basis. And that's not necessarily CDC's 00:22:00mandate in the past. It's just not. So we're learning. Other HHS agencies--ASPR [Office of the Assistant Secretary for Preparedness and Response] was created a few years back to help direct that. I don't know how successful. Some would argue that they've been not as successful as what the intent was, but that's neither here nor there. Our agency has to address it, which benefits us the most. That's what we have to do. Dr. [Thomas R.] Frieden's done a good job of helping direct it, and I think with Ebola, it was probably a lot of the issues and pitfalls were maybe brought to light between Stuart, Inger, Oliver [W. Morgan], Cyndy [Cynthia G.] Whitney, Dan [Daniel B.] Jernigan, all of the incident managers. Some had had experience. Dan obviously had on H1N1. But Oliver, Inger, Stuart had never been incident managers, and they really brought 00:23:00the agency lightyears ahead by being able to lead them. They're good leaders. They are. Those five in particular are good leaders.

Q: When you look back--and I'm guessing it's maybe July when you're starting to get really involved in Ebola, because that's when the EOC--

HUTCHINS: It was activated on the ninth of July, yes. By September, the case counts were just out of proportion. Were blowing up. September, October, beginning to really swell. Things were moving quickly. There still weren't monies available. Congress had not yet allocated monies. Along with that was, of course, the fear of what happens if the disease comes to the Americas. And it did. There was the patient in Dallas who passed away. So there were a lot of 00:24:00fears about the domestic, because no one really--the subject matter experts, this is the Pierre Rollins and Stuart Nichols and so forth--they understand how the transmission and how deadly it is, but I don't think the general public does. The media, of course, sensationalizes it to no end. So fears grow. There was a lot of--around that time, around the late summer, early fall--quite a bit of angst and anxiety about how to address it, both domestically and internationally at the same time. Because it was spreading from country to country, and if you go to those countries, you realize that it's not the US. The borders are open. There's a lot of cultural issues. There's a lot of ignorance about the disease itself and about how it's transmitted and how it's controlled. It's not anything to be critical. It's just--it's the way it is.

Q: So in July and August, the first couple months when you're involved. When you think back, are there any particular moments that stand out to you? Any particular memories that float to the surface?

HUTCHINS: Just the urgency to put together guidelines about how we're going to deal with it. How the US is going to address it. There's a lot of discussion, a lot of research that's going on. Quite a bit of interaction, of course, as you imagine, with Washington and the White House. And the media. I guess it was--there wasn't a day passed where you didn't have two to three media groups coming through. Trying to work in the--you've been to the EOC, on the third floor--trying to work in there, and at the same time, conduct your business. And keep things that the media shouldn't see private and quiet. That's a little bit challenging. But the press folks at the CDC did--Jason [Campbell] and Tom 00:26:00[Thomas W. Skinner] and the guys--they did a great job at keeping that very separated. They did a good job at that.

I guess the biggest thing was trying to get staff. Trying to fill the needs for--and trying to define what the needs were. That's always the toughest thing in a response. Because your epidemiologists and your physicians are automatic, and you know you need those. But what else do you need? Do you need communicators? Well, those are pretty well--the JIC [Joint Information Center] exists for that reason. But the rest of it, you're not--I guess one of the things that shows is how sometimes, even though we're one agency, silence still exists in centers, even though that's been--our current group is trying to break those down. They still exist. Trying to draw staff into the response was tough, 00:27:00and apparently still is. [laughs] Apparently, that doesn't change. Because people do have their day jobs. They're paid to do something. They're hired to do a specific job. Because we're volunteer, we're not a mandated response agency--all of our responders are volunteers--it proves challenging to fill many positions quickly. And the word is "quick." I don't need it tomorrow. I don't need it next week. I need it today. That becomes tough to do sometimes. So, yeah. That's in the first two, three months.

Our first big challenge from Dr. Frieden was to put fifty people--fifty contact tracers--on the ground in West Africa within thirty days. First, you've got to find them. Secondly, you've got to get them there. You've got to get them 00:28:00prepared, because it's not--you're not going on a joyride. It's not going to the ocean, on the beach. You are going to a third world country where running water doesn't always exist. Where cell towers--you might have one to two hours at best in a twenty-four-hour period for communication with the outside world. Vehicles. Roads are poor. Some roads don't exist. It's kind of like camping out. Primitive camping. Trying to get fifty people that--thank goodness for EIS [Epidemic Intelligence Service] officers that are willing to go. However, EIS officers are young. Most have never been through this--it's a training program. Thank goodness for them, but you have to be careful with where you send them, and where you send most anyone that's not seasoned. There's only one Pierre, so you can only send Pierre to one place. That was the first big challenge in the first two months was getting people there. The incident management structure managed 00:29:00to do that and get them there. That was a tough challenge. They worked a lot of hours and did a lot of behind-the-scenes work to get people there and get them ready to go, and get there in time to begin their tasks.

Q: What's the next thing in your part of the response that really stands out to you?

HUTCHINS: Well, it was--I guess over the--the thing went on for twenty months, about. I was a part of it until February, so I was a part of it for about seventeen to eighteen months of it. The next piece--

Q: You're talking about February of 2016? Of this year?

HUTCHINS: Yes. In February, I actually drafted over to be the chief of staff for the Flint response. I left the Ebola piece of it. By that time, it was downsized considerably. The optimal outbreak had essentially ended, for all intents and purposes. But over the course of the next twelve, fourteen months, really was 00:30:00maintaining--was building the infrastructure in-country to be able to avert future outbreaks such as this. That was challenging to itself. That basically fell upon CGH, the Center for Global Health, with assistance from other centers and the incident management structure. Being able to drive that and maintain that consistent push to put people in place, to put career--people had to make career changes in order to take positions in those countries. To be able to back-fill here. To be able to hire temporary hires. To be able to fill positions so people could volunteer to go over. Because you still have flares over the 00:31:00next course of a year. It was always the "hold your breath" each week about, is there another outbreak? And there were many of them. There were flares where they would spike. Called "spikes." Where they would spike up. You would have people crossing the border. You would have numbers of--whatever cause. Whatever the causative agent was, the causative reason was. I guess over the next few months, it was really pushing these structures to be built in-country, and trying to ensure that the outbreak limits were eliminated. Trying to stop that piece of it. The contacts. A lot of contact-tracing took place. And dealing, too, with the Washington piece of it. The constant information-sharing with the 00:32:00HHS and the White House becomes--it can become burdensome. Tends to slow you down at times. But that's why they exist. They have the right to know, and they need to know. Because decisions are made at that level. There's a lot of that that really became, for the next few months, became a bit--and I'll say, it's a bit of a burden. But it is. But it's necessary. It's a necessary burden.

Q: Do you remember some specific memories of that that you were involved in?

HUTCHINS: One of the things that happened was that the NSC--the [National] Security Council--wanted to be able to get to any CDC leader at a moment's notice. They had to invent something such as a phone system. Now, we have our EOC system, our emergency operations system, that anyone can call quickly, and they can triage quickly. But that wasn't always quick enough. Sometimes the right connection couldn't be found, for whatever reason. Our EOC watch officers 00:33:00are some of the best around, and they're seasoned. They're good at what they do. But if I call you, and you don't pick up--I can't find Sam sometimes. So they invented a system where each leader, in a twenty-four-hour period, had to carry a special cell phone with them that had a strict number that was a direct line to the White House. To the NSC. And that became a bit of a challenge because we had to identify groups of leaders, and they were typically the incident manager and the deputy; the center directors, like Dr. [Beth] Bell; and Dr. [Thomas] Kenyon at the time, before he left; Jordan [W.] Tappero. People like that. People who were some of the senior leaders of the agency. There was a small group of them that rotated on a twenty-four-hour basis. They had to physically hand it off with each other. You have to be here, in Atlanta--you have to be at 00:34:00Clifton [Road campus] to be able to hand it off. Things like that had to take place. A whole process had to be outlined, and a standard operation procedure for that. We had numbers of little things like that that had to take place.

The briefing reports were another. The constant briefing. And the timeline of constant briefing reports, both to our OD, to HHS and ASPR. To the NSC. Everyone wants it in a little different format, and they want it in a little different way. Of course, that's part of the bureaucracy that you call it, that you tend to cause burnout, probably, a little more than maybe it should. There's some of that. So that basically took up your days in the next six, eight, ten months. Because it's every day. It's that. Including weekends. A lot of that goes on.

Q: Can I ask--did the phone issue, did that resolve itself somehow? Or did it 00:35:00just continue to be this thing, you have to hand off the phone?

HUTCHINS: It went on for quite a while. Eventually, once the operating procedures were put in place for the domestic about what the US would do and how the US would respond to a case--and once the Dallas patient came and went--over time, like many other things, it begins to--I won't say the interest dissipates, but the urgency tends to subside. Because you either move onto new things, or you become accustomed. The realization is that we have it under control. Over time, that tends to happen. It came to a point where it was mutually agreed by both CDC and HHS and the NSC that we would no longer need to do this. That we could go back to our operating way of calling the watch desk, or the watch 00:36:00officers. That happens. And that happens with most any--you don't like to call it "knee-jerk," but sometimes it could be. But there's a need for information. When the president needs the information, he doesn't need it tomorrow. He needs it today. That's how it works.

Q: As far as the briefing reports go, what was your role as far the briefing reports? Were you putting them together, or giving them, or--

HUTCHINS: No, I would typically approve them. Ensure that they were on time. The chief of staff office, which is what I was part of, would always either review them or ensure that the incident manager reviewed them, and that they contained the content that needed to be shared with other organizations. With HHS and ASPR and NSC. If in fact the incident manager was out-of-pocket, or the deputy was out of pocket, then we would review them and approve them. But by and large, we had just ensured that that took place.

Q: Can I ask, were there some counterparts that you worked with at NSC or the 00:37:00White House who really stand out to you as, I remember that individual, and I remember doing this with them? I don't know.

HUTCHINS: Well, our EOC works directly, of course, with the--HHS has their own--the Secretary's Operations Center for HHS. The SOC. There are a couple folks there that you begin to know and you begin to work with directly. I think at HHS, Karen [B.] DeSalvo was a big player, and Nicki [Nicole] Lurie, were both big players, of course, as they are with all responses. They lead ASPR. But I think Karen had a lot of interaction with Dr. Frieden and with our leadership. With Inger and Stuart and Oliver and others that followed, on direction and on needs. By and large, up in that level--that's obviously above my level, but 00:38:00that's who you tend to work with, is those folks. Rick [Richard] Hunt from the NSC was one who was the primary contact at the NSC between CDC. He's the one typically that shared the information flow, oftentimes. We'd provide information to him, and for his colleagues.

Then on the recruiting--I mentioned earlier about the recruiting. About the challenge of recruiting staff on a constant basis. A number of HHS staff, particularly the Commissioned Corps office [US Public Health Service Deployment Office], was, on a constant basis, in constant communication with them. Help us find officers. Help us find Public Health Service officers from other agencies. Help us find staff. We ended up--actually, I don't know, I'm sure someone's 00:39:00mentioned this. But we ended up doing contracts with FEMA. We had two stints of FEMA staff who we paid for to come and help us fill positions in OPHPR. We had two different tours of FEMA staff, and ironically, some of them have stayed here. Took positions here, or temporary positions here. This was one of the first--one of the second--this was really probably the second time that our HR [human resources] office became involved with responses. Typically, that's not what they do. They have their own methods and their own operations. They were fairly helpful at developing quick and dirty ways to bring new staff in, whether it be temporary hires, or new hires, or contracts. A lot of contracts in this 00:40:00response. Probably more than we've ever had before. They were pretty helpful at getting those through the system a bit faster than your normal, day-to-day hiring process.

Q: I didn't know about the FEMA contracts and how they had come through. Do you remember when in the response that was?

HUTCHINS: Gosh, let me think here back. It was in the fall. The first batch was in the fall. I think they were ninety-day increments. We paid something like five million for--there were about thirty of them. Thirty to forty of them. OPHPR was instrumental in bringing them on board. Bob [Roberto] Ruiz and Jeff [Jeffrey L.] Bryant in particular brought them on, and were able to get them integrated in the system. People processed quickly. They took the jobs, and they did the jobs really well. They were assigned a specific duty, and they did them well. They became good comrades, as you called them. Then, once their tour was 00:41:00over, there was a second batch that came. They didn't stay quite the amount of time, because by the end of their tour, we were able to bring in contractors and bring in temp [temporary] hires, which some are still here, for year, two-year appointments. Term appointments. So they were a help. They bridged a gap that we had, and they did it real well. The first batch was in the fall. Went through Christmas. Because some were actually still here on Christmas. The first batch was from [FEMA] Region IX, [San Francisco], California. Many of them were here, away from their families, during Christmas. They didn't go home. They stayed here. That was tough on them. I remember talking to many of them, and they were like, "My wife and kids are back home. But I'll see them soon." That kind of thing. It's kind of like being in the--similar to being in the military, and 00:42:00being away at a combat zone on Christmas. That's kind of what it was like. But we were lively here. We had a good group here. We worked right through Christmas, and through the seasons, and New Year's. We were here. That was the height, at the time.

Q: What was the FEMA staff working on? Was there--

HUTCHINS: They did a lot of the functions of staffing, of processing. They assisted EPST [Emergency Personnel Staffing Team] and the planning group. They assisted Dave [David N.] Kennedy's planning branch. They assisted them with their functions. Because they just didn't--neither one, EPST or the planning--PPT [plans, evaluation, and training] it's called--had enough staff to do what they needed to do, and continue their day work as well, for response training and so forth. Basically, each one was assigned to do things. Maybe 00:43:00something such as the training. Get the training forms together for people that were doing the long-term training. State Department has so many--I won't say "restrictions," but so many requirements to be able to deploy for longer than thirty days overseas. You have to meet those State Department requirements. That comes with that, there's training courses and scheduling and getting people in and getting them there. They took on those responsibilities. Things such as that. They were a big help.

Q: One thing I've heard repeated a lot by people who are, I don't know, in more administrative positions in West Africa, is the difficulty of having--of course, staffing was extremely difficult. But the difficulty of having people for the limited tours. Then they had to leave, and then come back, and somebody new had to come up to speed. It's just a constant process of coming up to speed--

HUTCHINS: It is.

Q: --almost.

HUTCHINS: That's probably--as I said earlier, the Ebola outbreak's response was one--it was the first time that we've ever done anything outside of the continental US. What goes with that is--and you're exactly right, that was the biggest, the chief complaint, was that by the time we get someone here, we get them trained, they have to leave. Because you get there--let's say you're on a twenty-nine-day. Because anything over thirty days, you have to have this additional State Department training. The State Department requirements. State Department basically drives your length of time. So in a thirty-day deployment, it takes a week to get up to speed. It takes two days to get there. Takes a week or three, to four, five days to get up to speed with what you're doing. You spend two weeks doing what you're doing. And then, by the time you come back and help train a new person taking your place, or looking to write out the reports, 00:45:00do all the paperwork that goes with being deployed, you've spent basically two weeks out of the thirty days doing what you do to help. That is the chief complaint. It was impossible to keep someone for a long time until we got the term hires in place. Now, as the response progressed, we were able to work with the State Department to get waivers on some of the trainings and requirements that were required. We could get people to stay longer. Which meant that we had to prepare them up front. There's a week-long training course, for instance, called FACT [Foreign Affairs Counter Threat training]. It's an anti-terrorism course that you must take in order to be deployed more than forty-five days. That is a week-long training. You're very limited to where the training is. It's in West Virginia or in Brunswick, Georgia. The classes are very limited, they're 00:46:00very small. And it's expensive. It has to be paid. It's fifteen hundred dollars, I believe, or eighteen hundred dollars, to attend it for the week. You have to do that preparation up front. But as time went on, we were able to prepare individuals to stay longer to help eliminate some of that quick changeover. But the first eight to ten months, it was constant changing in and out.

Another thing I do believe that happens often, particularly in Ebola it did happen, was that people were prepared for one function here in Atlanta. But when they got to Guinea or Monrovia or Sierra Leone, their functions changed. Completely something different than what they prepared for here. Some people adapted really well, like you roll with the punches. Some do not. That becomes 00:47:00kind of personality issues and things of that sort. Yeah, there's a lot of that. That's probably going to always happen, unless you have a mandated, "This is your response role, and this is what you do." But when you're volunteering, "I'm going as an epi. And I go over there, and gosh, I'm doing health communication. I'm not very good at that, but I'm going to try it." So, yeah. That happens.

Q: Can I ask, just to clarify. The training course that--and was it FACT?

HUTCHINS: It's called FACT for short. Federal--something, something. I can't remember.

Q: That was in order to have people stay over forty-five days when they were overseas. The solution, in part, was to have them do an initial training while they're still here in Atlanta? Was that right?

HUTCHINS: We did actually bring some back, and they go through training so they can go back and stay longer. But by and large, the latter part of the response, you prepared them up front here. We were able to get waivers for--there's 00:48:00numbers of requirements, and courses, and things that have to be met. And also with that is the medical requirements. You have to make sure someone's sound of mind, and that you don't--we had a few instances--isolated instances where people weren't always forthcoming with their medical conditions, and got over there, and things happened. Or we had some accidents. We had a couple accidents where persons fell and broke a limb, or broke a bone in the leg, and had to be transported back home. Or medevacked. We've had several that came down with fevers, but never confirmed Ebola virus. Thank goodness. But we had to have medevac issues in place. That's quite a bit of coordination with State Department and with private companies. Phoenix Air, which is what we used and medevacked a few people, American citizens, back. State Department was pretty 00:49:00good, for the most part, about--originally about waiving some of the requirements. Granting us waivers.

Q: What's a requirement that would be waived?

HUTCHINS: Maybe--let's see, I'm trying to think offhand. There's a course--I can't remember what it's called. There's a course that if you stay more than thirty days--I can't think of what it's called now. It's a medical training course that you have to take. And they would waive that if your medical conditions were okay. Initially, they would waive it, but over time, then they began to, "No, you must take this." Because once you get to a country, the embassy has its charge, is to protect all American citizens. You have to be 00:50:00cognizant of that. You have to realize you're under the stress of the embassy. That's basically who you answer to. They're charged with accountability for all US citizens. So, you understand that, how it works. But I can't remember exactly what it was called, I apologize.

Q: That's okay. No worries.

HUTCHINS: But it did allow people to stay a little bit longer time. Then to stay for an extended length of time--sixty, ninety days--you had even more stringent requirements.

Q: So, if this were to, God forbid, happen again. Something like the Ebola response--or, I don't know, maybe it's already happening with Zika, to some extent--where we would have to send a bunch of staff overseas, and it would be helpful if they could stay for longer term. Are there now more systemic things in place that can make that easier? Or not? Where are we on that?

HUTCHINS: We know they exist. To answer your question, we do not have a one hundred percent streamlined process to be able to get past that quickly. We still have the growing pains. One of the things that we haven't done well is we haven't put these processes in place. We have the relations established with State Department, for instance, but we don't have these systems that would help expedite that, like you would think we would have. We learned a lot through Ebola. Part of the problem with Zika is it happened right on the heels of Ebola. We honestly, as an agency, need a break to be able to develop these things. Will we do it? I hope so. I think that's what OPHPR and Steve [Stephen C.] Redd, who's the new director, Admiral Redd, is committed to doing. But he needs a break. We all need a break in order to put those kinds of things in place. Are 00:52:00they there now? No. I don't think they are, one hundred percent. But I think the relations are better. We're dealing with the same individuals, the same names, the same people. They understand what our needs are, and I think they're able to work through that a little bit faster. With Zika, if there is a good part, it's that it's primarily in Puerto Rico, which is a commonwealth of the US. We don't have quite the issues as we would have in South America. It will be interesting to see--not to get off on tangents--it'll be interesting to see how the Olympics piece works out.

Q: Oh, interesting. Absolutely. So how did your part in the response develop in the next year? In 2015?

HUTCHINS: Like I said, in the beginning, I was there to assist Stuart with setting up the operations. Peter Rzeszotarski from DEO [Division of Emergency Operations] was actually the first chief of staff. Peter took a new position with DEO as the global health director. Consequently, my program assumed the 00:53:00role of chief of staff, which we have done for other responses. A colleague of mine came over as the chief of staff, and I served in the role as the deputy. So we basically are part of the command staff, and basically run the thing, helping guide the incident manager and the deputy incident manager. Help ensure things flow smoothly. Work closely with our agency chief of staff, Carmen [S.] Villar, and Sherri Berger, the COO [chief operating officer]. Try to ensure things run smoothly, and maintain a semblance of stability. Then over time, towards the latter part, I became--I was the chief of staff for a while until Flint came about. It's working with different groups and different interactive processes with the various centers, particularly CGH. CGH was a new player in this. Other 00:54:00than Haiti, CGH has been a piece of it, but hasn't really ever been in the lead, forefront, so a new branch was created out of CGH: the Ebola Restoration Branch [note: Ebola Affected Countries Office], and Barb [Barbara J.] Marston heads that up. They have a whole new funded organization to deal strictly with Ebola in West Africa. That's what they do.

Q: How did your responsibilities change as you became chief of staff?

HUTCHINS: They didn't, per se. No, they all kind of morph into one. [laughter] It's a catch-all. The chief of staff is responsible for--in the structure, you're responsible for the general services. The planning, the staffing, the finance. The logistics. The whole bit. And that didn't change. That doesn't change. Probably a little bit more--not so much with the science. You have your 00:55:00own scientific resources section in the various task forces that directly work with the science. But realistically, those task force leads and staff on the task forces need your assistance to help them with things administratively or operationally. You leave the science to them. We're not into the science. But you have to understand the science. You have to be able to understand how it works in order to ensure the stability and maintain that the IMS [incident management system] structure operates as it should. So it didn't really change. It's a bit of a nomenclature thing, but it's also just a bit of what you would consider your job duties. "Other duties as assigned."

Q: Can you tell me more about your work with Carmen Villar?

HUTCHINS: Well, Carmen is the agency's chief of staff, of course. She does a 00:56:00wonderful job at informing Dr. Frieden and helping make decisions. My guess is he relies on her and Carmen's deputy, Becky [Rebecca L.] Payne, quite a bit to ensure that the right information is provided to the White House and to the NSC, and to HHS, and to Dr. Lurie and the [HHS] secretary. It's very adamant that you have a good relationship with Carmen--or whoever's in that role--and Becky both, in order to provide what they need on a daily basis, and as quick as possible. She's been very open and very willing to solicit information, and she's very open to provide input to her. It's been that way from the very beginning. She's been very open. Her team and her staff up there have been great to work with. 00:57:00They're very professional. They're very efficient. It's been a good relationship in helping move the agency, inform the agency, and for the agency to inform those in Washington.

Q: Now I'm wondering about your time with the various incident managers. Stuart to Oliver, I suppose, it would be. Is that the progression?

HUTCHINS: Well, it was Stuart, Inger. Then it was Cyndy. Dr. Whitney. Cyndy Whitney. And then Dan Jernigan. And then Oliver. And then Dan again. And then Oliver again, as they would take time off. Cyndy had been a task force lead, the Medical Care Task Force lead, earlier in the response. Cyndy's done this many 00:58:00times before. Cyndy was also the deputy, and Dan was the deputy. They started to intermingle, serve as deputies, and then they would serve as incident managers. But those were the primarily five. There were a few others that acted here and there, but primarily those were the five incident managers.

Q: Do you have any specific memories of any of them that stand out to you?

HUTCHINS: Stuart's very much of a guy who says what he thinks. I love all of their personalities. They're very honest, but he's very much the scientist, and he very much says what he thinks. That was the most refreshing part, because he didn't mind speaking his mind, even to Dr. Frieden. He would say what he thought. I think you need more honesty like that. But he also realized that he's a scientist, and he did not stay in that position long because he truly needed to address the outbreak itself, and you can't do that doing the administrative 00:59:00and the command type of things that you need to do as an incident manager. He did a really good job at getting off the ground, because he's able to address--he knows exactly what is needed to stop an outbreak. He was a perfect choice to be the first.

Inger is the most caring--how do I say this about her? She is the most caring, love-filled person around. She's a brilliant, brilliant doctor and scientist, but at the same time she cares about what happens to people. And she has a side of seriousness. She has a side of humor. It's nothing to say, "Inger, let's go drink a beer after work." She will go. Someone of her stature and of her--not grade, but her leadership qualities like that. She's really a good leader of people. People loved her and followed her. She was really good at developing 01:00:00strategy. It was a great time to be able to listen in and pick the brain of someone like that who you admired, but you also learned from, from an academic perspective. It was quite an interesting--Inger's quite a private person. But she shares a lot of things about her life and her personality that you'd find interesting. She was a big swimmer. She and her husband, Greg [Gregory L. Armstrong], who was the polio--it was the first time we ever had a couple that was director of two separate incidents at CDC. They're both big swimmers. She has a Jack Russell [Terrier] that will do tricks, and she'll show you on her video, her dog doing tricks. Things like that. And Cyndy's a Commissioned--well, they're all Commissioned Corps officers, except for Stuart. But Cyndy was very 01:01:00straightforward. She's very experienced, as was Dan Jernigan.

Dan's strongest suit was finance. He had the daunting challenge of separating out the money situations. In H1N1, centers were giving the dollars. The money was controlled in the EOC. Dan was responsible for figuring out how that went. In Ebola, the strategy was that the centers would own the money. The EOC would not have the money. The centers would do that. And that presents its own challenges. A huge challenge is who gets what, and who pays for what, particularly when you've got something such as infection control that resides in EZID, but it's in another country, which is overseen by CGH. All of this money management was critical, and Dan assumed that role. That was a tough challenge, was being able to parcel out the money and figure out how to account for it. And 01:02:00be accountable. He was really good at that. He's now a division director in influenza, and he really did a wonderful job at that.

Oliver was actually, I believe, before he came in Ebola, he was actually a country manager in the Dominican [Republic], I believe. He went as the acting country manager in Sierra Leone for quite a bit of time. He came here as--he had never actually been here in Atlanta, in the CDC offices. He took a position here, actually, in my division, as our deputy in DPEI [Division of Preparedness and Emerging Infections], although he never actually officially served in that. He spent his entire time as the incident manager. Oliver is not a US citizen, so that would sometime present some challenges. He couldn't get certain security 01:03:00clearances. We'd have to go through hoops to get security clearances for him. But he was really instrumental in being able to see the big picture, and being able to downsize. Once the case counts drop, once the contact tracing was proven to be effective, he was really good at developing that strategy. He was very instrumental in bringing in all the command staff to help him think through. That was good to be a part of that. You began to really figure out how to demobilize, rather than just say, "Okay, we quit." There's a strategy to it. He was very open to suggestion, so we provided quite a bit of input to him on that. For demob [demobilization].

Q: Can you describe how you made the transition from Ebola to Flint?

HUTCHINS: Did I? Well, my background is water. Drinking water, per se. That's 01:04:00what I did at EPA in an emergency capacity. I also, once upon a time, worked in the Childhood [Lead Poisoning Prevention] Program at CDC, which sits in NCEH, as a project officer years ago. The water activation issue in Flint, Michigan, became such that--they tried and tried not to activate the EOC for that. I don't know how much you know about it, but the citizens--the government in Flint decided to switch water systems, and when they did--from Detroit city water to the Flint River--their treatment system technology is just not up to speed to be able to prevent corrosivity. When you have corrosivity in old infrastructure piping, lead leaches. Leaches into the supply itself, and through the soil, and paint, and all that. Long story short, I was still with Ebola and the response 01:05:00when it was decided that NCEH would ask to activate the EOC for Flint to help support EPA and HHS, which is the lead agency for Flint. To help support them. I was asked if I would become--if I would be Donna's--Donna [B.] Knutson's incident manager, which Donna is the deputy for NCEH/ATSDR. Asked if I would be her chief of staff. I said sure I would because I had a little bit of knowledge about how water systems work, and how the lead issues work, and so it was kind of like going back to my roots, basically. Yeah, it was just a natural progression over there. So we were activated. We did not use the EOC here. We used it in Chamblee. Built an EOC there. OPHPR provided all the support. We ran 01:06:00it for about two months. There's still activities going on, and things of that sort, but it's pretty well wound down, now.

Q: When you look back over your Ebola response, are there any other memories that stand out to you that we haven't gotten to that you think, maybe we could put this on the record?

HUTCHINS: I would say the number one thing that stands out is we had over three thousand--over five thousand--I think about a third of the agency volunteered. For a volunteer agency, that's pretty phenomenal. For people to want to--it may have led to some issues now with Zika because of burnout. But by and large, people wanting to volunteer. I've been in almost every center at one time or another, which may or may not be a good thing. But by and large, to have almost 01:07:00five thousand people volunteer at any one given time, including those overseas, is phenomenal. For people to leave their families at Christmas time, or holidays, and spend Christmas and New Year's in a foreign country where they don't speak the language. Or they speak the language, but don't know the customs, and things like that. That's rather telling about the fact that people do care about what happens around the world, in all honesty. I was asked many times, "When are you going over there? When are you going over there?" Well, some people do real well here. They provide support here. Some people do real well over there. Some people do both. Just the fact that they're willing to do--it says a lot about people that come here. They want to change the world. You have a lot of younger people that come into agencies--public health agencies--that want to change the world by the tail. But the fact that they're 01:08:00volunteering to go do things such as that, and try to do what's asked of them, is pretty phenomenal. I think that's the biggest takeaway.

Secondly would probably be that we as an agency need to learn to do more, and do it faster, and do it more efficiently. That could be probably said truly for every government agency. But if we're going to continue to run this role of response--no telling what the future will hold with elections coming up--but if we're going to continue to do this, we need to make sure that we're effective and we're quick. That might happen in my lifetime. It might not. We'll see what happens. But I think it will. We're kind of on the wave. We've learned a lot just in the last two to three years with the various responses that we've had. We've learned a lot. And I think as a whole, our leadership is addressing these, little by little.

Q: Thank you so much for your time and energy here, David. This has been great.

HUTCHINS: I've enjoyed it. I probably rambled. Got off track a little bit.

Q: No, no. This was great.

END