Jeffrey Bryant

Jeffrey L. Bryant

Q: This is Sam Robson, here today with Jeff Bryant. Today's date is May 31st, 2016, and we're back in the audio recording studio at CDC's [United States Centers for Disease Control and Prevention] Roybal Campus in Atlanta, Georgia. This will be my second interview with Jeff as part of our CDC Ebola [Response] Oral History Project. Jeff, very excited to have you back. Thank you again for coming. Last time we finished off just before you got involved in the Ebola response. I think we were in 2014. Should we just take it from there? How was it that you got involved in the response?

BRYANT: I was working in the Division of State and Local Readiness at the time in the Office of Public Health Preparedness and Response, OPHPR, and I was the lead for the unaccompanied children disaster response that we were running with our colleagues up at HHS [US Department of Health and Human Services]. We were in the EOC for that response. Actually, the agency truncated that response in 00:01:00order to start Ebola. I stayed on that State Coordination Task Force in DSLR [Division of State and Local Readiness] and just transitioned from the unaccompanied children response to the Ebola response. My initial involvement was on that taskforce.

At that time, the response was still all international, but everybody was thinking and wondering and forecasting, what if we get a case in the US? A lot of the planning we were doing then was, those were the "what if's," working with state and local public health departments. What if we get a case? Some of the messaging from the agency at that time, too, was any hospital ought to be able to effectively isolate with proper infection control procedures if we get an 00:02:00Ebola patient, if they happen to make their way to the US. Those were the very early days in July and August of 2014.

Q: One aspect of this whole story which I think I've probably missed a little bit, but is important, is how the Ebola response affected ongoing projects here at CDC. People were pulled away, assigned to Ebola. Can you just tell me briefly about that unaccompanied children project that you were on before?

BRYANT: Right. Our EOC, the agency's Emergency Operations Center, was activated for the unaccompanied children response. This was a response we were working with ASPR [Office of the Assistant Secretary for Preparedness and Response] up at HHS, up at the department, to handle the influx of unaccompanied children along the US southern tier. We had thousands of children that year that were finding their way across the border, and we have public laws that govern how the 00:03:00US is going to handle those populations. Our main involvement was trying to ascertain if these children posed any health risks. Were they largely an unvaccinated cohort of children? Could they come across with measles or other communicable diseases that we typically vaccinate against? And then the health conditions of their living facilities, they were in congregate living arrangements. The HHS mission and the CDC mission was to advise on the public health concerns around large numbers of unaccompanied children that come across the border.

Q: Looking back, what's your viewpoint on how Ebola affected that whole initiative?

BRYANT: Well, the guys up at HHS remained activated for the response, but we deactivated here. That work was still being run out-of-program, it just wasn't 00:04:00at the level that we were going to support it from an Emergency Operations Center activation any longer. Some of that work continued. There were residual things to do there, but clearly the main efforts shifted to Ebola.

Q: What's the next thing that you do?

BRYANT: I was in the State Coordination Task Force. I got approached by someone in the IMS structure, the incident management structure, and asked if I would deploy to Germany to be the CDC liaison to the Department of Defense's US Africa Command, US AFRICOM. Interestingly, I had worked in that office before it was AFRICOM. It used to be just EUCOM, European Command, but sometime later they divided it into AFRICOM to handle the continent of Africa and then everything else remained at headquarters, European Command. But I was the deputy surgeon 00:05:00there in the late nineties and early 2000s, and CDC sent me back to the exact office I worked in a decade or so earlier, fifteen years earlier. I still had friends there, I still had local friends in the Stuttgart area, and so in some ways it was like going home for me, quite honestly. I spent two months in Germany as CDC's liaison to AFRICOM and then left Stuttgart to go straight to Monrovia before coming back to the States.

Q: Which two months was it?

BRYANT: I was in Stuttgart October and November of 2014.

Q: So you were there during the whole rollout of US troops to the affected countries.

BRYANT: Right. When I got there, there was a small military contingent that was working the response. There was a small advance team that had been to West 00:06:00Africa, Monrovia specifically. During my time there, the 101st Air Assault Division rolled into Monrovia. While I was in Stuttgart, I had daily contact with the guys on the ground, and then of course when I went to Monrovia, one of my primary duties when I got to Monrovia was to be the conduit between CDC and the Defense Department on the ground. But it was greatly facilitated by the fact that I knew these guys over the phone for the last six or seven weeks, and so a pretty seamless transition there.

Q: While you're in Germany--can you just take me chronologically through that? If there are any big events in that that you remember?

BRYANT: Shortly after I arrived in Germany, the two US nurses became infected from the case that ended up in Texas. It was terribly interesting. We got CNN 00:07:00[Cable News Network] and Fox News over there, but those aren't the main news outlets. It's BBC [British Broadcasting Corporation], it's CNN International. The mainstream news media over there is a little bit different. From the international perspective, they were reporting on the dynamics in the US and it seemed like the US, or CDC specifically, may have been struggling a little bit then because some of the early messaging--and this is just my take on it--but some of the earlier messaging was "any hospital ought to be able to isolate a patient and exercise adequate infection prevention and control practices." Then we had these two nurses get infected, and so that called into question, is that the right guidance? Do we have the right personal protective equipment? All of that was playing out domestically, and it looked like CDC was taking a slight 00:08:00hit with that.

But let me just give you one short story of the international viewpoint on CDC, and this is an n of 1, it's a single anecdote. I got to Stuttgart on a Thursday, I started in-processing Friday. All the buildings over there are secure, so you've got a--they're SCIFs [Sensitive Compartmented Information Facility]. The environment over there is a SCIF environment, so classified information can be left out during the day and the whole building is a secure facility. You have to have special access to get into these buildings. I was getting my access that Friday, and a young German lady was helping me get badged and all that kind of stuff, and it's the standard thing. Who are you? Where are you from? What are you doing here? As soon as she found out I was from CDC and I was there for the 00:09:00Ebola response, she stopped what she was doing and she looked at me and said, "My husband will feel so much better knowing that you're in our country." A tiny little story, but CDC didn't seem to--the brand of CDC didn't seem to suffer internationally like it did domestically, and I think that's pretty much an accurate statement. It was really a domestic thing and not an international thing. The CDC brand remained very, very strong internationally, is my opinion.

The early days were spent--in Stuttgart--spent trying to understand what the right PPE [personal protective equipment] was going to be. Was the Defense Department going to buy it? Was CDC going to buy it? Was there enough to go around? Was one type of chemical suit adequate or did it take the Cadillac 00:10:00version of the chemical suit? All these things were being worked through. In addition to that, we were trying to advise DoD [US Department of Defense] on the proper monitoring period for servicemen coming out of West Africa. In the end, DoD ended up taking a more strict posture on this than CDC recommended or HHS recommended. Completely their prerogative, up to them to do, but it was a little overkill as far as the rules of engagement that CDC was going to operate under and recommend to the international community.

Q: Do you remember what specifically they ended up doing? Did they put people in--

BRYANT: They quarantined them. Yeah, they quarantined them for twenty-one days before they could be released to their home duty stations. Again, a little stricter of a return policy than we had, or that others had, but it's what they chose to do. It's easy to Monday morning quarterback these guys, but you're 00:11:00talking about a disease that at this point there was great public paranoia about, there was fear and anxiety about, and senior military leaders are charged with preserving the fighting force of America. From their perspective, putting guys in quarantine for twenty-one days to protect the fighting strength of America was a tradeoff they were willing to make. I spent twenty-three years in the military, so I know how their brain works, and if there's a chance this could become an outbreak within the fighting military force of America, then it's a no-tolerance, zero--that's a zero acceptable outcome. So they were more conservative than a lot of others were.

Q: Can I ask also about the PPE? Was this PPE for the soldiers going into Liberia?

BRYANT: Well, the primary DoD mission on the ground was to build ETUs, to build Ebola treatment units. They contracted a lot of that work, but they also had a lot of staff that were on the ground in very rural parts of Liberia. So it was several things. There was a training mission, DoD also had a training mission on the ground to train host nation forces or international medical workers on proper donning and doffing procedures for PPE. That was part of it. It was to understand what really needed to happen on the training side. It was to ensure that military personnel were protected, and then to see if DoD needed to have some type of logistical function to support the overall international effort. So there were several different facets of the PPE question that were relevant to them.

Q: I actually hadn't heard before about the DoD's involvement in training people 00:13:00on donning and doffing.

BRYANT: I don't remember exactly what the final counts were, but yeah, they did that. They did it over an extended period of time.

Q: So what happens next in Germany?

BRYANT: I was coming up on my sixty-day mark in Germany, and it was conversations with Dr. Inger [K.] Damon, the incident manager at the time, and there was some waffling on, do we need Jeff to go to Monrovia? Do we need Jeff to come back to the States? Interestingly, in the interim I had been contacted and asked to apply for the position as the division director for DEO [Division of Emergency Operations], the acting position, to apply for a detail. So I did. While I was in Germany, I applied for this, and I had been selected for the position. It was a tug of war between Jeff needs to come back and start his 00:14:00acting role as the DEO division director versus we really need Jeff to go to Africa. Ultimately, a couple of days before Thanksgiving I think, maybe a week before Thanksgiving, the decision was made for me to go to West Africa. I ran up to Berlin, got a visa at the Liberian embassy or consulate there, and then on Thanksgiving Day, I traveled to Monrovia.

Q: What did you do there?

BRYANT: In Monrovia, like I said, I was the primary liaison, the primary link to DoD, the 101st Air Assault Division, and I was their deputy response team lead for the response teams that were going out. But really, what I focused on was--that was the very beginning of the conversations about the RITE strategy, 00:15:00the Rapid Isolation and Treatment of Ebola strategy, where we were going to send these small strike teams into rural parts of the country, help a local community in collaboration with our county health officials, help them quickly manage outbreaks as they occurred in the fifteen counties of Liberia. In order to do that, you've got to have rapid transportation in and rapid transportation out, and so a lot of what I did was focus on the helicopter, the rotary wing transport capabilities that were on the ground there. It was a partnership with USAID [United States Agency for International Development], who actually secured, leased helicopters for us just to support this mission. But they were run by the United Nations Humanitarian Air Service, UNHAS, and run by the World 00:16:00Food Programme. I worked with a great guy from Spain and a great guy from Australia and the three of us planned the rotary wing lift, the helicopter support to infil [infiltrate] and exfil [exfiltrate] our teams quickly, and then also move laboratory samples. These laboratory samples were considered hazardous cargo, and so we had to meet the UN shipping requirements for hazardous human cargo or human biologicals. I was only on the ground from Thanksgiving to Christmas in Monrovia, but that's what I worked on mainly in Monrovia.

Q: I've talked a little bit with Joel [M.] Montgomery.

BRYANT: Yeah, absolutely.

Q: I don't know if during that time he was also helping to liaise between the 00:17:00military and CDC, but he did eventually--

BRYANT: Joel was on the ground before I got there, and so I would speak with--you know, worked a lot with Joel and worked a lot with DoD. By the time I got to Monrovia, Joel had already left, but he was one of the early liaisons to DoD there and he did a wonderful job in that role.

Q: He mentioned that there were some limitations in some of the air support that actually took place. For instance, transporting samples wasn't always easy or transporting people after they had been in areas with Ebola transmission was a little problematic. Did that come into play with your time in Liberia?

BRYANT: It did. DoD had their own rules of engagement and their own practices on the ground, and so they would infil our guys without any questions at all, but 00:18:00in order for us to get them to pick them up once they had been in a quote-unquote "hot zone" by DoD standards, that was more problematic. What we had to do essentially, our CDC staff, we had our own rules of engagement which limited--you know, no direct patient contact, not even being in or around an ETU without proper PPE. We had our own rules of engagement that were put into place to protect the safety of our staff. A couple of times I had to actually write a letter to the Air Ops [Operations] guys at the task force there that's saying, look, the following four people, yes, they've been in Grand Bassa County or Grand Cape Mount [County], but they have had no contact with Ebola patients, known or suspected Ebola patients. With documentation like that, we were able to 00:19:00get some of these teams out. Our other teams had to come out by ground. We couldn't get them out. The critical part of the RITE strategy was getting them in quickly. Getting them out, while terribly inconvenient to drive twelve or fourteen hours along a really crummy road, getting them out was less time-sensitive than getting them in.

Q: Anything else that you remember from those thirty days you spent in Monrovia that really stands out to you?

BRYANT: It's interesting. I later went back. I went back ten months later after my initial deployment there. The first time I was there, what struck me, Monrovia is a densely populated city. It is packed wall to wall with people, and none of the kids were in school. What markets were open when I was there initially, they were not crowded, and there was this sense that it's still 00:20:00dangerous to be out in big public gatherings and in places. So terribly interesting when I went back ten months later--completely different dynamic. People were shaking hands. They were giving hugs to friends and colleagues. The kids were back in school. The children wear uniforms over there, just the cutest little kids you've ever seen. The markets were packed, packed, the marketplaces were. It very much was a tale of two different periods of time in this city, in this country's history, where they were struggling and then they recovered, and it was quite the interesting contrast to see a few months apart.

Q: I'm also interested more in just working with the World Food Programme and working with the Humanitarian Air--

BRYANT: Yeah, the United Nations Humanitarian Air Service. It's called UNHAS.

Q: Right. You mentioned working with someone from Spain and someone from Australia?

BRYANT: Right. Yeah. Those guys were amazing, and they do this for a living. They're part of the United Nations program. They will show up, they'll establish an air service at an airport. Interestingly, in Monrovia, too, there are two airports. There's Spriggs Airfield [James Spriggs Payne Airport], that really isn't capable of handling large volumes of big fixed-wing aircraft. Most of the helicopters were staged at Spriggs, which was great for us because it was like ten minutes from the embassy, five minutes from DoD. All of the DoD aircraft, the Black Hawks or the UH-60s, were there at Spriggs Airfield as well. Then all of the big fixed-wing aircraft went to Roberts International [Airport], which was over an hour away from downtown Monrovia. It wasn't even in Montserrado County, it was in Margibi County, and it was quite the road trip to go to the 00:22:00airport to either pick up cargo or pick up people. It was really something else. But the UNHAS operation mainly operated out of Spriggs, which was very convenient for us, and the airport was big enough to handle all the rotary-wing aircraft that was there. Typically, on any given day at that airfield, you would have the South Africans running several Russian [Mil] Mi-8 aircraft, you would have the teams that we traveled with a lot which were a mixture of Russian and Ukrainian pilots, again, on the large Mi-8 Russian helicopters. We also had smaller Bell helicopters that were run as well.

It was interesting, and this is a facet that I haven't talked about yet: the DoD guys, Lieutenant Colonel Derek Barker, national hero. I mean Barker was just an 00:23:00amazing young man, and then there was a young captain working with him. I think the captain's name was Edgars but I don't remember exactly. But Derek, we would have a mission, like for example in Quewein, this tiny, tiny little village where we had an outbreak, I could either email or go to the air operations tent there and find Lieutenant Colonel Barker and say, "Okay Derek look, we've got a mission, these are the best coordinates we have." He would pull up his satellite imagery, say Jeff yes or no, there's a landing zone there, or yes, there is a landing zone there, but it's not big enough to handle an Mi-8. You've got to take a small Bell helicopter because the rotor wash from a helicopter landing there would've either blown the thatch roofs off of the huts that were surrounding there, or in some of these villages--Quewein is one of them--MSF, Doctors Without Borders, had already set up tents, and where do you set up the 00:24:00tents? You set up the tents in a field. Several times we were evaluating landing zones only to find that they were too small for the helicopters or MSF had set up tents there and we couldn't land because the rotor wash, again, would've blown the tents down or damaged those facilities. So these guys were instrumental in helping us do the mission planning for--again, this was the very beginning of the RITE strategy--but to help us plan these missions on how to get people in quickly.

Q: Do you remember one of those specific instances where it was hard to determine a landing site?

BRYANT: Well Quewein is one of them and so--

Q: And how'd you deal with it?

BRYANT: You just had to deal with it. In Quewein, I think we were able to get a small Bell helicopter to land there. Interestingly, Laurie Fuller came out of--she was in Monrovia with us, and Laurie and I got there about the same time. 00:25:00We worked together for that month. I think Laurie was coming out of Malawi, I think she was permanently assigned to Malawi. I think that was her country, she's in a different country now. But she and I actually flew to Quewein on a USAID flight to evaluate firsthand, because the RITE strategy mission was leaving the next day. We flew up, we got eyes on the landing zone as part of a more extensive mission that day, and we saw the MSF tents were right there. You couldn't land a big helicopter there. Quewein was just an example of--it just takes a lot of mission planning. It's not as easy as throwing a bunch of guys and a little bit of gear on a helicopter and saying, we'll see you in three days. It's just not that easy. A lot of mission planning went into each of these sorties.

But something else I'll mention about Monrovia was on that flight that day, we were traveling with the new regional director from USAID, I forget the guy's name. High speed kind of guy, in a lot of international work. The main objective that day was to travel to a small border crossing between Liberia and Cote d'Ivoire, and the little village there was Lagatuo, the village name was Lagatuo. We got there that day, we were going to evaluate the border crossing, which was really a cement bridge that was wide enough for one vehicle to go across at a time. And this Liberian town had a sister village on the other side of the river, and families had intermingled over the years, marriages, and these villages were very connected or these cities were very connected. And the border was closed. This was also a bridge that was the mechanism or the means for a lot 00:27:00of commerce, and so for this border crossing to be closed, it drove people to use unofficial border crossings because the commerce on the travel continued--restricted, but it continued nonetheless. When we got into the village that day, the village elder--he was a young guy, leopard-skin hat and a jacket or a robe kind of thing. Great young man. Seemed to be a very good ruler of that village, or elder of that village. But he explained to us that he had to periodically travel to Monrovia for government business. This was in Nimba County, which is pretty far removed from Monrovia. This was in Nimba County on the border of Cote d'Ivoire, so it was pretty far away from Monrovia. Once Ebola 00:28:00hit and he had to travel to Monrovia, he came back and he quarantined himself for twenty-one days. This is a culture where the village leader or the village elder really can do pretty much anything they want to do. So we asked him, "Tell us about your decision to quarantine yourself for twenty-one days." He said, "We got a message from someone," I don't know if it was CDC or if it was MSF or somebody else, but they came and spoke to the lead medical authority in his village and explained in terms they could relate to and understand the importance of these quarantine periods. He said, "I got back and essentially my chief medical officer told me to quarantine myself for twenty-one days, and so I did." At that time I was there, they had not had a single case of Ebola in that village. What that drove home for me probably better than anything you could 00:29:00ever learn, other than being there doing it, was the value of social mobilization and getting the right message to a trusted agent for that community, which happened in this case. We were able to--and I say "we," I mean the international community, not CDC--was able to create a behavior there that helped them get through this Ebola outbreak. The social mobilization, the risk communication aspects of the response, they aren't very sexy, they're not helicoptering people in, but I will tell you that pound for pound, they probably had more impact in these areas than any other thing that we do.

Q: Thanks for telling that story. Tell me about what happens after you come back from Liberia.

BRYANT: I come back and I go straight into the DEO job, to be the acting director for the Division of Emergency Operations. I left DSLR the first week of 00:30:00October, and I never went back. Nobody really knew that was going to happen, but it just kind of happened. So yeah, I showed up. I think I got back to the States on Christmas Eve or the 23rd, one of those two days, and took the next week off and then started early January as the acting director for DEO. I ended up applying for the permanent position when it came out later that month, or it was either in February, and then ended up being selected as the director there. I'd been gone for ninety days working Ebola internationally, and I'd been on all the daily IM calls, and so coming back was really pretty seamless. It was just kind of understanding where the division was and what the division needed and what the IMS structure needed and making sure those things were in place.

Q: How do you go about--what does your work entail in the beginning, and how 00:31:00does that develop?

BRYANT: I found myself in a situation where I was having to support an IMS structure, the largest in the agency's history; also support polio, we were still activated for polio eradication; and then start leading a brand new division at the same time. My time was definitely split between getting to know the men and women in our division, getting to know the current leadership in the IMS structure, both IMS structures, polio and Ebola, and that was the daily, you know.

We had one area of the division that was struggling, that had really had a lot 00:32:00of impact on what the rest of the agency was doing. I met with all twenty or twenty-five members of that one branch individually to see where their head was, how they were doing, where they were in their career. I did that early, and then ended up meeting with everybody in the division one-on-one as the year progressed. But that was our hot spot in the division. That was an area I had to concentrate on immediately. There were some damaged relationships, there were some unfortunate perceptions associated with this unit, and we were able to correct those and get that unit back to a highly functioning team. Probably by March or April, they were full-up round again. They were back to being completely value added, doing the things that we needed them to do and--

Q: Can you talk about that with just a little more specificity? I know that it's probably a little sensitive.

BRYANT: Yeah, it's a little sensitive. Prior OPHPR leadership had made a 00:33:00decision to essentially disband this unit, and this was a unit that dealt a lot with risk communication, like we just finished talking about. When I got there, this team was down to like eight or ten people, and there wasn't even enough critical mass there for them to start a response. So working with OADC [Office of the Associate Director for Communication], with Katherine Lyon Daniel upstairs on the twelfth floor, working with Dave Daigle who was ADC, the associate director for communications in OPHPR, we put this team back together again quickly, in a matter of months, and they haven't missed a beat since. I had to evaluate, was the right leadership in place? Did I have to replace that leadership? I chose to keep that leadership in place and support them 00:34:00differently than they had been supported in the past. When I say "I," it wasn't just me. It was the twelfth floor, it was the sixth floor. We got everybody going along the same way again. We reconstituted this team. There are twenty, twenty-five people back on this team again. But having to do that in the middle of a response was--you just had to make sure you paid attention to the right things for that day. You know, what was the highest priority thing for that day, and that's kind of how we got through it.

Q: Tell me about some other things that you were working on.

BRYANT: Well, as time went on, things started getting better. I would say by May or June of 2015, we were actually at or nearing--I don't remember the exact dates, but we were at or nearing a point where we were getting close to zero in Liberia. Then the conversation shifted to Sierra Leone and Guinea more, and then 00:35:00talking about, what do you do when you get to zero? Those conversations started. What kind of structures need to be in place? What kind of residual capacity do we leave behind in these countries? What's the messaging? Do we change the travel advisories? Do we stop doing monitoring for people coming out of Monrovia? All these kinds of transition questions started coming into play. Those were as complicated as the initial response because this had become an international response and a national response. We had fifty-five Ebola treatment centers set up in the States, we had a couple of hundred Ebola monitoring or community-type hospitals set up, a network set up across the 00:36:00States. It was very much, when do you start turning stuff off in a smart and responsible way? There's an operational piece of that and then there's a political piece of that, and there are political pieces to every single response I've ever been involved with. Navigating our relationship with the NSC, the National Security Council, with ASPR in the Department [HHS], and then our other international partners, Department of State, others, managing these relationships and getting to the right answer, you can't do that very quickly. You're telling people we're screening everybody coming into these five US airports, and then all of a sudden you're starting to talk about, maybe we're not going to do that forever. There's an emotional piece of that, there's a science piece of that, there's a political piece of that. Probably again, by 00:37:00May, June or July 2015, we were starting to think through what the transition was going to look like while we were still very engaged in Sierra Leone and very engaged in Guinea. Liberia got to zero first. Since all three countries have been declared by the World Health Organization to be free from active Ebola transmission, there have been seven individual flare-ups since these declarations by WHO. And in all seven, the countries were largely able to do it on their own based on the capacity and the capability they had built over the last year and a half. If you're going to sit down at the beginning of the response and draw out your desired outcome, it's kind of where you want to be is you've established capacity, established capability that's sustainable. Not completely on their own--with some CDC help and some international help--but the mechanics of epi [epidemiology] and contact tracing and active case finding and 00:38:00safe burial practices, these are things these countries built over time, over a year and a half. Like I said, for all seven flare-ups, a lot of this work they've been able to do on their own.

Q: When you're reflecting on that work that you had to do, considering how to draw down some of the efforts that you were making, what actual decisions did you make about that, about the timeline for that?

BRYANT: Well, you always defer to the guys on the ground. It's kind of like a rule of thumb. If you've got a deployed force that's forward in a location, you always defer to the guys on the ground. A lot of this work was negotiated and worked out between our International Task Force and Barb [Barbara J.] Marston, Dr. Marston, and then the actual country teams that remained in these countries. It was a dialogue. It wasn't a unilateral Atlanta decision. It was a negotiated solution based on where they thought they were, where we thought we were, and it 00:39:00was very much a mutual dialogue over days and weeks. This isn't something that we turned on and off quickly. Having a great relationship with Dr. Marston and the country teams--I mean, I had been in Monrovia for a period of time, and so I knew Brian [D.] Wheeler, I knew Des [Desmond E.] Williams. We knew each other, and so working through this, it was something that we just talked about daily and weekly and it became evident what the right answers were as we approached these decision points. We just kind of knew what the right answer was going to be, and it wasn't unilateral. It was multi-disciplinary and collaborative.

[break]

Q: Where did your work go from there?

BRYANT: We got to zero. Through the fall and winter of 2015, we modified our 00:40:00travel advisories, we modified our screening procedures, exit screening and entry screening, and got really close to where we are today. What's gratifying for me, Ebola was emotional and like I said, political, but the difference was made because we had an operational capacity and capability that we created with the international community and we brought that to bear on these three countries in West Africa. The operational decisions often are the easiest decisions to make, and then you've got to navigate the emotion and the politics after that. Getting the White House to sign off on these draw-down measures of going from full blown monitoring, entry and exit screening, twenty-one days--I do have one 00:41:00other story as well, but getting the White House to back down or understand that there's acceptable risk now, getting the Department of Health and Human Services, getting the American public, etcetera, State Department--it's a negotiation and you do it in bite-sized chunks. You can't just go to them and say listen, we're--it takes time for them to get used to the idea and warm up to the idea and understand that there really is acceptable risk now and this is the way we need to go. But CBP [US Customs and Border Protection], [US Department of] Homeland Security, they were big partners with us at these airports and largely unsung heroes. We had our quarantine staff, we had numerous volunteers from the agency to deploy to these airports, but the work that CBP did, Customs and Border Protection, it was really quite impressive and quite significant. Kudos to our sister department, Homeland Security, on the collaborative work we 00:42:00were able to do with them.

Q: You mentioned that you had a story?

BRYANT: Yeah. I had to go back to Africa again. This time it was a pleasure to go back. It was a pleasure to go the first time as well, but this time it was to hand over the emergency operations centers to the host nation. These were funded through the CDC Foundation and the Paul G. Allen [Family] Foundation funded these. I was asked to go back to these three countries with representatives from Paul G. Allen, with CDC Foundation, to have the ribbon cutting and actually hand over these emergency operations centers to the host country. That was a privilege to get to be involved in that work. I went to Guinea first, and then I went to Liberia, and then we had aircraft failures. We weren't able to get into Sierra Leone, but we did have these ceremonies in Guinea and Monrovia. When I came back, then you have to go through your whole twenty-one day monitoring 00:43:00again. Not because I was in Liberia, because Liberia was free from Ebola transmission at that time, but I'd been in Guinea and there was some active transmission in Guinea. So I had to go through the twenty-one days again.

I get back, I'm checking my temp [temperature] twice a day. I tell you, the system at least here in Georgia is high accountability. If I had not electronically reported my results by 1:00 pm every day, I got an email. If I hadn't reported them by 3:00 pm, then I would get a phone call saying, Jeff, what the heck, you haven't reported your results from last night and this morning. So very accountable. Well, doggone it if I didn't make my last report on my twenty-first day and spike this major 102 temp that night. So, I called my primary care doc [doctor]. Well, I called here, I called the clinic and said, "Hey look, I'm sick, but I just finished my twenty-one-day mark today. I just finished today." Everybody's a little nervous. I called my primary care doc and 00:44:00they say, "Hmm, okay, when you get to the parking lot, call us." Just come in, no appointment. I got to the parking lot, I call them and they said, "We want you to come into the back entrance where the staff come and go. We've got an exam room right by that back entrance, we're going to put you in there." I get to the back, I'm met by this nurse in full PPE, head to toe PPE just like I had Ebola. She escorts me into the room closest to that back door and the doc walks in and says--I'm masked, you know, all the precautions they think are necessary. The doc looks at me and says, "Jeff, do you have Ebola?" I said, "No sir, I don't." "Take your mask off." He took his PPE off, and I had a normal clinic visit. But what's interesting about that visit is I'd never been in and out of that facility so quickly. They could not get rid of me fast enough, didn't want me in the waiting room, and if I remember, I don't think I ever even got a bill 00:45:00for that patient encounter. But it's just how it is. They're nervous and they're anxious and they're taking the precautions they believe they need to take. But I'm sure returning deployers and others that have been over there have similar stories.

Q: Sorry, I'm kind of triaging my list of questions here, which I want to go for first.

BRYANT: I can be a few minutes late for my eleven thirty because I'm speaking, and so they have to wait on me to--[laughter]

Q: I won't push that too far. One question I have is just reflecting on the ceremonies where you're handing over the EOCs to the countries. I know from speaking with other people like Dr. Frieden, so many others, that so much of what CDC did was, you know, it's an advisory role. Ultimately the government is 00:46:00responsible for how things--the governments in West Africa are responsible for how things go. If Sierra Leone is going to go after a quarantine policy, CDC is not going to stand in the way of that, for instance. But the idea that a facility was handed over to the government then seems to be in a little contrast because it's as if it was ours and then we gave it to them, but was it theirs--

BRYANT: Well, this was funded through the CDC Foundation. It was never CDC's. But we helped them design it, we helped them with the floor plans, we helped them with procurement, we helped them with the contracts to build it. This was a joint effort between CDC, the CDC Foundation, and the Ministry of Health. I think all three entities, the Foundation and us and the Ministry, felt like they had great ownership in this capability. Really, we did turn over a building to them in Monrovia, but the building isn't the EOC. The EOC is a collection of 00:47:00trained staff, standard operating procedures and protocols, and the facility. The facility by itself is nothing. So we spent a lot of time training the Liberian staff, the Sierra Leonean staff, the Guinean staff. That's the EOC, it's the people, not the building. But it was a brand-new building. It's a two-story building in Monrovia. When I left Monrovia the first time, the ground had been excavated, the footings were in, and I think a lot of the building materials were on site but they hadn't actually started vertical construction yet. When I went back ten months later, it was finished, and they were in it and it was a fully functioning EOC. So you're right, we never owned it. The ribbon cutting was ceremonial because it was always the Ministry's. It was never not theirs but, again, a lot of ownership in that endeavor.

Q: Okay, that clears it up. Thank you. Just reflecting on all of your 00:48:00experiences with the Ebola response, one thing you talked about last time was--and this was when you're in the military, there are politics around supporting NGOs [nongovernmental organizations]. Sometimes, an NGO would want the capacity that the US military provides, but they don't always want that to be public because that might compromise their relationship with their donor base. Were there any parallels to that, that you saw in this Ebola response? I know you're at CDC now.

BRYANT: I think the culture of CDC is if we do something and it never becomes public knowledge and it's behind the scenes, largely as an agency, we're okay with that. In fact, a lot of the international work we do, it's better if it's branded under WHO than if it's branded under CDC. We work with WHO even today 00:49:00still on a weekly and monthly basis. If we can help them draft a framework or a document or a policy and CDC's name is nowhere on there, that's okay with us as an agency, and it's even preferred because then we're not selling a Western solution to a Middle Eastern or an African problem. It's WHO, and WHO is established in these countries with the ministries. It is the health authority these ministries of health look to for guidance, and so to the degree that we can prop them up, help them, support them, whatever the right words are for that relationship, then that's in the global interest.

Q: Is there anything you can tell me about that you know CDC was really involved in but didn't end up having name recognition?

BRYANT: Yeah, a lot. We worked with WHO for almost two years on their framework 00:50:00document for emergency operations centers. That finally got published last December, a year and a half to two years in the making, and we really were the architects of that document. We, CDC, were the architects of that document. But we had to get to a place where WHO wrote it, they understood it, they agreed with it, they bought into it, and that just takes--WHO is a very complex organization. Nothing goes through that agency quickly. So that's just one example of something that's on the street now that is accepted internationally as the standard for EOCs, that framework document. We're thrilled that it's out, we're thrilled it's under WHO's name because there's really good international buy-in with this document.

Q: Again, kind of doing my little triage here. What were some ways in which you 00:51:00think you were able to draw on your previous experiences setting up medical systems in this response?

BRYANT: Well, I'd spent a decent amount of time in Africa when I was active duty with the Air Force. So number one, I knew what to expect when I got there. Nothing about the environment, as crummy as it was--I knew how to prepare and I knew what to expect. That's a big check in a block that I just didn't have to worry about. But in the Ebola response in Liberia with having the US military there, they were tremendous force enablers, and I knew how to work with them without any additional effort at all. It was seamless for me. They knew my background, they knew the positions I had held in the past, and so I walked in with credibility with them and it made things easy to work through and navigate.

Q: I know that the incident management system drew down March 31st, is that right, of 2016?

BRYANT: We deactivated. We deactivated the EOC for Ebola on March 31st, and that was even during the middle of the seventh flare-up in Guinea and Liberia. But the work was at a level where we didn't need to have the EOC activated any longer. The work continues, and I continue to work on Ebola myself with Barb and CGH, Center for Global Health. Not every day anymore, but as needed.

Q: Can you tell me about that work?

BRYANT: It's just making sure that--well, most recently the heavy lift was when we had the last flare-up. It's okay, what do we need to get in the country? Do we need additional logistics, additional people? Working with her [Barbara Marston] just to make sure she had what she needed to get the job done. I think 00:53:00we deployed a few epis [epidemiologists] for her this last flare-up, but really nothing big. No major muscle moves. We also continued to have DEO personnel in these countries continuing to help the ministries work through their EOC operations. I have a continued presence today of DEO staff that go to Guinea, Sierra Leone, and Liberia, trying to make sure that there are sustainable practices in place so these countries don't lose their newfound ability and capability to manage a public health emergency response.

Q: That's great. Another thing I wanted to ask also, we've talked about the mentors that you've had in the past, informal or however they might be. What were some opportunities that you had, looking back on your Ebola response, for learning from other people with whom you were working or even teaching others?

BRYANT: Well, it's both. I did way more learning than I did teaching. CDC is 00:54:00filled with the world's leading authorities on pick-a-disease, and so to get to work side-by-side with these people every day either in Monrovia or here in Atlanta, it's actually quite sobering. I learn way more than I contribute in these types of operations. But there is a next generation that's coming up behind us. I'm way closer to the end of my career than the beginning of my career. Watching these young epis, these young public health advisors, public health analysts, get a chance to deploy and get plugged into something that a month earlier they would not have dreamt they would be in one of these countries, in one of these villages--there's a responsibility of people that are in the position that I am now in my career, there's a responsibility to try and 00:55:00raise this next generation and make them as capable and give them capacity as quickly as possible.

Q: I think we're about at the end of our time. Is there anything else though that you want to make sure that you have on the record that we haven't talked about, or just looking back?

BRYANT: I would say that there were probably numerous times--we never knew how bad this was going to be, specifically in Nigeria. Hopefully you're talking to people about Nigeria. But Nigeria; Bamako, Mali; a brief little thing in Senegal. I don't think anybody could accurately forecast and predict how bad this could have been. To be now almost two years, it's been almost two years since we activated for Ebola, July 2014. To be at zero now is not something you 00:56:00always get a chance to do in a response. Some responses don't have a definite end. Not saying we're done in West Africa, but to see us get to zero is a credit to the international response and CDC who led most of that international response.

Q: Thank you so much, Jeff, for being with me. This has been a total pleasure and a learning experience for me. Thank you.

BRYANT: Thank you.

END