John Hoover

John Hoover

Q: This is Sam Robson. It is March 23rd, 2017, and I have the pleasure of sitting here with Ambassador John Hoover at the US Embassy in Freetown, Sierra Leone. I'm interviewing Ambassador Hoover today about the Ebola response that happened in this country for our CDC [Centers for Disease Control and Prevention] Ebola Response Oral History Project, David J. Sencer CDC Museum. Ambassador, thank you so much for joining me for this.

HOOVER: My pleasure. Welcome.

Q: Awesome, thank you. Could we just start out, this is kind of silly, but would you mind saying "my name is" and then just pronouncing your full name?

HOOVER: Sure. My name is John Hoover. I'm the US Ambassador to the Republic of Sierra Leone.

Q: And if you were to summarize your part in the Ebola response as ambassador very briefly, like in a couple sentences, what would you say?

HOOVER: My principle role was really to make sure we were coordinated, because we had the largest ever CDC overseas deployment I think in the history of the 00:01:00agency. We had one hundred CDC responders here on the ground on any given day for about a year and a half, much bigger than our mission actually, but we also had USAID [United States Agency for International Development] emergency responders. I think my job and the job of the DCM [Deputy Chief of Mission] was to make sure everyone was working together, and then also making sure we were working well together with the other international players and the government of Sierra Leone. My other role was also to be pushing and lobbying back in Washington to get the resources that we needed to fight the war here.

Q: Makes sense. Thank you. Backing up for just a second, would you mind telling me when and where you were born?

HOOVER: Sure. I was born in Boston, Massachusetts, in February 1960.

Q: Did you grow up in Massachusetts?

HOOVER: I did. I grew up in a little town outside of Boston called Acton.

Q: What was that like?

HOOVER: It was a great place to grow up. It was a small town. This was the 1960s 00:02:00and 1970s, which is before your time, Sam, but that was a time in our history where I think kids had probably too much freedom. We had plenty of freedom, we had good schools, we had great sports programs so it was just a great time and place to grow up.

Q: What do you mean by too much freedom?

HOOVER: I just think back in those days it was probably coming out of the sixties and the seventies. The seventies were probably the most permissive decade for our society, and our parents were not helicopter parents. They gave us a lot of slack and latitude, so as adolescents sometimes we had a little bit too much freedom I think. But it was a lot of fun.

Q: What did your parents do?

HOOVER: My dad was a children's dentist. My mom did a couple of different things. She was a social worker for a while, then she worked for one of the big tech companies in Massachusetts.

Q: Can I ask what kinds of things interested you when you were growing up?

HOOVER: Mostly sports. Baseball and ice hockey.

Q: Did you always know that you wanted to go to college? What were your 00:03:00aspirations like upon graduating from high school?

HOOVER: I think in the setting that I grew up in there was an expectation that everyone wanted to try to go to college, so that was definitely the goal coming out of high school was to get into a good college, hopefully to be able to play ice hockey there, and then beyond that I didn't have that many longer term visions beyond that.

Q: So did that happen? Did you go to college and play ice hockey?

HOOVER: I did. I went to Princeton University and played a little bit of ice hockey.

Q: What did you study?

HOOVER: Politics.

Q: What specifically drew your attention?

HOOVER: I think it was a course I took at the end of my freshman year. It was an international relations course. The professor was fantastic and I just got real interested in international relations and so that kind of converted into--it was a degree in politics but with an emphasis on international politics.

Q: So what happened after college?

HOOVER: I wanted to travel and live outside the US. It really didn't matter 00:04:00where, so I went to Tokyo, Japan, as an English teacher at a Japanese high school for a couple of years.

Q: How did you find that?

HOOVER: I found it through my university. They had a program that placed teachers mostly in small schools all over Asia, all over the Far East.

Q: How was the experience for you?

HOOVER: It was fantastic. I'd never really--I'd spent a little bit of time in the UK [United Kingdom] when I was in college, but this was my first time to really live overseas. I spent my entire childhood growing up in one house in one town, so it was mind blowing. The Japanese culture is really unique but accessible and friendly and safe, and so I had a great time making new friends and seeing another part of the world.

Q: So what happened after that?

HOOVER: So after that I went back to the US and wasn't sure what I wanted to do career-wise. I was interested in the Foreign Service, so I took the Foreign Service exam, but in the meantime I ended up in New York City getting a job with a big US investment bank.

Q: And how about after that?

HOOVER: I did that for a year in New York and then they transferred me back to Tokyo, to the branch of the bank in Tokyo, so I worked there for two years. It was about that time when the process through which you joined the Foreign Service kind of came to a head, and so when I left the bank, I was able to come into the State Department and join the Foreign Service.

Q: Do you remember what year that was?

HOOVER: 1988.

Q: So you joined the Foreign Service. What do you do then?

HOOVER: Well, I swore into the Foreign Service on a Friday in 1988 and the next Saturday I got married to my current wife, and so my life changed quite radically there, going from a single banker to a married Foreign Service officer. Then you go where the career takes you I guess. We ended up going to Paris for our first assignment. It was a short assignment because it was our first and we had our first son there. It was the beginning of what's been a very 00:06:00interesting and rewarding career.

Q: If you were to look back over your career just in general in Foreign Service, what are some of the places that really made an impact on you?

HOOVER: Every single place we've been made a big impact on me in different ways, but almost all in positive ways. We were in Shanghai, China, for four years when our kids were at that middle school age, so they were still somewhat under control, and it was just a really exciting time to be in China. It was the early 2000s when China was trying to kind of join the world community and join the World Trade Organization, and there was a huge amount of economic development and growth. Just literally in six months you could see major changes to the city. We were there when 9/11 struck, and a couple of months after 9/11, China was hosting the APEC [Asia-Pacific Economic Cooperation] summit, so President [George W.] Bush--it was his first major overseas trip after 9/11, and so he 00:07:00came and stayed for several days. It was really an interesting and thrilling time for us. But all of our assignments have been really great. We've got great memories from everywhere.

Q: Was there anything in your previous experience that was anything like a big outbreak?

HOOVER: A little bit, actually. When we were in Shanghai, I think it was 2003 I want to say, but it could've been 2004, I believe it was 2003, there was a major outbreak of SARS [Severe Acute Respiratory Syndrome] in China, in Hong Kong but especially in China and in Beijing. Shanghai at that time was a city of twenty million people. As we realized that SARS was going to be the first major epidemic of the century, people thought there must be cases in Shanghai and there were. But they were single digit numbers of cases where they were getting dozens of cases in Beijing. So we were there trying to manage the fears of people in our community and the US business community. People just couldn't 00:08:00believe that there were only six or seven cases in all of Shanghai, but as it turned out, that was the case. So managing fears, trying to make people comfortable so that they didn't panic. And we had an American citizen who was one of the victims, so we were keeping tabs on him as well. So I had a little bit of experience with--nothing like Ebola, nothing like Ebola, but it was also a little scary.

Q: Sure. I don't know if you worked with CDC at all during that time?

HOOVER: The WHO [World Health Organization] sent a team down to Shanghai from Beijing and I think seconded to that team were some CDC folks. Who's the fellow with--he's Japanese-American? Fujisawa? I can't remember his last name. Keiji, I think--

Q: Oh, Keiji. He's in the WHO now, right?

HOOVER: Yeah, he's back, WHO. He was seconded to the WHO team that came down, and they sort of randomly went through the hospitals in Shanghai to see if the 00:09:00government was hiding cases basically, and they found that they weren't.

Q: Right. Keiji Fukuda?

HOOVER: That's it. Keiji Fukuda, yeah.

Q: Wow. So is Sierra Leone your first ambassadorial post?

HOOVER: Yes, it is.

Q: When did you become ambassador here?

HOOVER: I was nominated by President Obama in July 2013, so I should've come in 2013 later in the year but I got delayed by the tussle in the Senate over nominations, so I didn't arrive here until October 1st, 2014.

Q: October, oh, wow.

HOOVER: Nominated in 2013, I didn't get here till more than a year after that, like a year and a half after that.

Q: What was it like then, watching the Ebola epidemic start throughout the region and start to catch fire in the country where you were going to serve as ambassador?

HOOVER: Right. As I was waiting to come out here, I wasn't assigned, so I was 00:10:00working the Ebola issue in Washington at the State Department. I was watching it very, very closely, here, obviously in Liberia. Liberia had the earlier spike in cases, so Liberia was kind of the focus of attention. By the time I got here in October, that spike had come here and we were just getting four, five, six hundred new cases per week, which was mind blowing actually and a little bit scary. So I sort of knew what I was getting into when I came out because I had been tracking the issue and helping at the State Department to manage it, but nonetheless a scary moment. A scary moment for everyone.

Q: Can you tell me about moving out here?

HOOVER: It was kind of a blur, waiting, waiting, waiting for the Senate to confirm me. When they finally did confirm me, I moved as quickly as I could to get out here, to swear in and move out here. I could not come with my wife because we were under evacuation for dependents and so it was a real quick, 00:11:00fast, just get on the plane with some suitcases kind of arrival.

Q: Can you just take it from there? What happens then when you get in country?

HOOVER: When I got here with regard to the Ebola outbreak and the epidemic, like I said, it was running away from us. It was accelerating away from us. It was a really scary moment. I was struck initially by the lack of coordination. It wasn't clear who was in charge of the response. Obviously, the government was in charge, but which part of the government? Was it the Ministry of Health [and Sanitation]? What were the roles of international partners like the UK, the WHO, ourselves? That wasn't very clear. There were structures in place, but just in terms of making the hard decisions and making those really fast decisions that you have to make in a crisis situation, wasn't really happening. That was my first impression. Again, not a really positive impression but things got better from there.

Q: Can you just continue?

HOOVER: Sure. We were all late in figuring out what this thing was and how serious it was. "We" meaning the US government, US CDC, the State Department, the National Security Council, the president. We all kind of thought it would go away. In fact, that summer, the number of cases subsided and everyone said, oh, it's over now. So it took a while. It was about in that timeframe, September/October, that everyone said, holy cow, we've got a major epidemic here that could spread well beyond West Africa. Once I think people had that realization, they started to bring resources to the table including the US government through CDC, also through USAID's Office for Foreign Disaster Assistance, OFDA. USAID OFDA came in initially with a small bit of money but then a lot more. It was just about that time, October/November, with this thing running away from us in Sierra Leone, that CDC I believe in November put out a 00:13:00public analysis which said basically if we don't do anything about this in the region, we're going to have 1.4 million cases of Ebola by January. That scared people, and that encouraged people to bring resources to the table. It was at that time that the government made a decision to set up a National Ebola Response Center, the NERC, with help from the UK and from us also, from US CDC. That created command and control, so that issue of coordination and not knowing who was in charge sort of went away. The NERC kind of took control of the situation, with a lot of help and resources from partners. They started to get a grip on controlling the epidemic and eventually beating it back. Then they opened district level emergency operations centers as well, the so-called DERCs [District Ebola Response Centers]. The one that was here in Western which Dr. Frieden visited at least once if not twice--extremely effective, extremely well 00:14:00organized, met that sort of military style command and control which was so necessary to start to bring the numbers down.

All the other pieces that were lacking came together. There was a lack of ETUs, of beds, the Ebola treatment units. There was not enough lab capacity, there were issues with ambulances, there wasn't an emergency call system. All those things kind of came together in that timeframe October/November, so that by early January we saw that very steep curve, which was accelerating up away from us, started to break and crash the other way. That was sort of the first big sigh of relief, was January when that curve just broke and the number of new cases started to decline sharply.

Q: Who were some people you worked with most closely from like October to December in those earlier months?

HOOVER: Initially, CDC had thirty-day rotating country directors or guys in 00:15:00charge. I knew some of those guys because I bumped into them in other parts of Africa. It was great working with them, but there was a little bit of a lack of continuity, and I think it was November, I'm not sure, that CDC sent out Oliver [W.] Morgan to be the country director. He was here for--I'm not sure how long, but close to a year I think, I'm not sure. We all became fellow soldiers in the war against Ebola. It was a great experience working with him and with all of his team. Often it was a rotating team but sometimes the same people would come back again and again. Good relationships. Also on the USAID OFDA side, we had two or three people who rotated and took turns coming out to Sierra Leone, so we had good continuity there. It came together very nicely. As an interagency US government team, we came together really well. I was really proud to be part of that. And we also did the same with our other partners like the UK and the 00:16:00government. There was a very strong sense of unity of purpose, and that we're all in this together. For me, that's the strongest positive, lasting memory I'll have of the Ebola crisis was what people are capable of doing when they work together. It's fantastic. I wouldn't want to have to do it again but I'm glad I did it.

Q: Thank you, Ambassador. This is a strange question, but I've spent several hours with Oliver Morgan interviewing him--very enjoyable for me. Would you mind describing him from your own vantage point?

HOOVER: Sure. Oliver is a great teammate. He's a great person. He's got a nice personality. He's kind of soft-spoken, super smart, great sense of humor, and that's what you need when you're in a crisis. You need someone who is calm and has perspective and even has a little bit of a sense of humor. And he just did a great job. He worked really hard in managing CDC's effort and in keeping your 00:17:00headquarters up to speed and making sure they had what they needed. I know it was just huge pressure on him and I know he was very stressed out, but again, he kept his cool.

Q: Awesome. I know things came together pretty well as you said, with all the US government agencies, but I figure in such a chaotic environment there were probably some bumps on the road. Do you remember any of those that you were able to try and smooth over between US government agencies like CDC and USAID?

HOOVER: I think on our interagency team we had really good working relations. Everyone saw themselves as being part of one team. I never had to officiate between different agencies here at our mission. The State Department presence is 00:18:00a permanent presence, and we were the logistical management platform to support the emergency responders from USAID and from CDC. Our Department of Defense here pitched in. They procured a lab which was used in the response. Everyone worked together very well. We occasionally had friction with other international partners. That occasionally happened. The UK, for example, would sometimes see trends a little bit differently than CDC would see trends and so there'd be some friction over that and I would sometimes have to smooth those feathers a little bit.

Q: Do you remember a specific example of that?

HOOVER: Let me think about this. Yeah, I think it was around that November timeframe 2014 when, again, CDC came out with what some people thought was an 00:19:00alarmist estimate about the number of new cases by January. It was kind of around that. Oliver was very serious. He was super smart, very serious, very concerned about the numbers, and I think that the UK wanted to play it down a little bit because they were sort of the lead international partner and they didn't want people to panic, and so there was a little bit of a disagreement of a scientific nature over how bad the situation was.

Q: Makes sense.

HOOVER: You know, you just step in and, hey guys, everyone's on the same side here, let's just work it out and talk to each other. In the end, as I said, our relationships with everyone were fantastic.

Q: Can I ask what your day-to-day life was like back then in the heat of the thing?

HOOVER: Yeah. It was all Ebola all the time pretty much, and because of the time difference with the East Coast in the US, we were working every night. I have my work computer, I have a version of that at home so I would work here, leave on 00:20:00time but then go home and end up working late into the night answering a million emails from people in Washington. As I said earlier, one of my roles was to sort of manage Washington a little bit so that we could focus here on what we had to do.

Q: Can you talk more about that role of advocating for resources here?

HOOVER: Yeah. As I said, initially as you know, the US government response in Liberia was massive. We literally sent a brigade of Army folks in to help build Ebola treatment units and CDC had a big presence there as well, as did USAID. The response here, the US government response was smaller even though really the epidemic was probably more severe here in the end than it was in Liberia. So I realized, as I said, when I got here and I wasn't clear who was in charge, who was going to do what, that there were going to be resource gaps in the overall 00:21:00response and that the UK, although it had the lead and had pledged to do most of the effort, wasn't going to be able to do it by itself. So we had visits from USAID administrator, at the time Raj [Rajiv] Shah, and then we had a visit by our US UN ambassador, Samantha [J.] Power. I think we were instrumental in getting her to come. She initially I think was just going to go to Liberia. And they saw firsthand that no one really had it under control here. Having them come and see that, talking to them, having them speak to the experts here, the stuff that we wrote and sent back I think helped sway Washington to give us more resources, which they did. We got a national increase in our OFDA budget. I think CDC was already here in a pretty big way, but it definitely helped so that we could get resources that OFDA could very quickly use to fund burial teams, or 00:22:00they funded a couple of Ebola treatment units. Wherever there were gaps, they could step in quickly and fill them in coordination with the UK and the host government.

Q: At that time, was funding for global health security generally still in the conversation or was that about to come up?

HOOVER: The Global Health Security Agenda had been in the making before Ebola. And I think maybe it's a good thing--if there's a positive thing, Ebola accelerated all that and so we're working on that now. I'm not exactly sure what pots of the CDC budget that the money came to do this work here but CDC did just great work, really great work.

Q: You talked about Samantha Power coming and getting some firsthand experience, really learning how awful it was on the ground here. Do you have some of those experiences of your own of witnessing something or something where the experience really hit home?

HOOVER: I think it was on one of Dr. Frieden's trips. It was the first trip he made when I got here. I think he came in August before I arrived, and then he came again at some point there I think before Christmas when things were still pretty tough. We did a lot of different things on his program, but we went to King Tom Cemetery and that was brutal. Hundreds of people milling around outside with their loved ones being buried, burial teams bringing in bodies in the white body bags. You couldn't even walk--could barely walk between the graves because there was no room, and just marked with these little, crude, wooden crosses. We were standing there with Dr. Frieden and Oliver--I've got a picture of it and you can see one of these little, tiny wooden crosses on a grave, and then there was an ambulance there and they were pulling a body out of the back of the truck and the guys were spraying. It was like apocalypse, you know? It was awful. And 00:24:00then talking to survivors also just brings you to tears every time when these young people who lost their parents and their siblings and their aunts and their uncles because they were all in the same house and somehow they survived. Samantha Power did that and I think that really moved her. Anyone sitting in the room was moved. So that's also a memory that I won't lose.

Q: Were you able to do any coordination with the embassies of the other countries where Ebola was really--

HOOVER: We stayed in regular touch. I was emailing with my counterparts in Guinea and in Liberia pretty regularly. The epidemics were slightly different in each country and the timing was different as they came and went. Guinea was more unique I think than the other two of us, but yeah we stayed in regular touch. It 00:25:00was more just sort of moral support I guess.

Q: Can you tell me about the end of the outbreak and how that was for you?

HOOVER: Yeah. It was amazing. It was a long time coming. As I said, we sort of broke the back of the epidemic in January but we didn't have zero cases until November. November 7, 2015. I remember that day.

Q: What do you remember from the day?

HOOVER: That summer of 2015, just not a large number of cases, but we still had to keep our eye on the ball, so it was--I had already been through a year of this so it was fatigue. I think it was a feeling of just emotional fatigue and we had to--we the US CDC--we had to make sure that other actors and players, especially in the government, didn't just sort of stop, and made sure they stayed engaged until they got to zero and beyond zero actually because then we 00:26:00had a couple of more cases even into January 2016. So by the time we got to November 7th and they had this big ceremony down in Aberdeen at the big conference hall and the president [of Sierra Leone] was there, for me, I was just exhausted. Relieved but just exhausted. I guess it's almost like a form of post-traumatic stress disorder or something like that. I was really tired but happy that it was over.

[break]

Q: When you look back, how do you think your experience with the Ebola epidemic here in Sierra Leone changed you as a person or changed how you approach your work?

HOOVER: I think it made everyone who went through it more resilient, made us stronger because it was extremely stressful and difficult. But I'm more appreciative I think of having comrades, having colleagues that you can work 00:27:00with and depend on. That was a wonderful thing. It definitely made me smarter when it comes to viruses and epidemics. I learned a lot, unfortunately, but as I said, I wouldn't want to do it again. I wouldn't want to go through it again, I wouldn't want other people to have to go through it. But having done it, I wouldn't trade it for anything because of the friendships made, the bonds of trust and friendship with all the people who came out and did this.

Q: I just realized I should've asked--who among the officials in the Sierra Leonean government did you have the most contact with? Was it President [Ernest B.] Koroma or was it--

HOOVER: Not so much the president. We dealt a lot with the fellow who is the director of the NERC, [A.] Paolo Conteh, who had been previously the minister of defense and who, when I first arrived and literally the first week I arrived in 00:28:00Sierra Leone, I went to go on a run with a group of guys who were running and I didn't even know who they were. Paolo was one of these guys who was in the running group, so I met him just accidently in a social way and we sort of became friends. He's a nice guy. Again, he brought that military perspective in the way he directed the NERC. He was always at the NERC and we were often at the NERC at briefings and things, so he was the one guy we--and he had a whole team of folks who we worked closely with and CDC folks worked closely with.

Q: I know you really defined your role as organizing the US response and then asking Washington for resources. Was there any diplomacy that was involved with you with the Sierra Leonean officials when it came to, I don't know, some policy issues or how to tackle this thing?

HOOVER: No, I think we were all pretty much on the same page. When there were instances of disagreement about some aspect of the response between the 00:29:00government and the other international partners, I think it got worked out at a working level and it actually turned into the key role that the UN played, the head of UNMEER [United Nations Mission for Ebola Emergency Response] here was I thought very good. She [Bintu Keita] was kind of a broker between the government and the other international partners whenever there were issues, whether it was a disagreement or people were irritated with one or the other. So that was--I didn't have to do that so much because we had the U.N. and that was their role.

Q: Thank you again, Ambassador. I think my last question for you is, is there anything I haven't asked about, that we haven't talked about, or a reflection or a memory that you have of Ebola that you'd like to share for the historical record?

HOOVER: I think I'd just like to say thank you to Dr. Frieden and everyone at the Centers for Disease Control. As I said, this was the largest ever overseas deployment by CDC. I've worked with CDC in other countries and always had a lot 00:30:00of respect and admiration for their work, but the work they did here was truly, truly heroic and obviously vitally important. We had several cases of Ebola in our own country so we know this could've gotten out of control, and without CDC here--not that CDC could've done it all by itself--it was absolutely a vital component of the response. Dr. Frieden's personal commitment to ending the Ebola outbreak and his three trips here and the leadership he showed, his communication to the public here and also to the government were really important and we should all, all Americans as well as Sierra Leoneans, should thank him and his CDC team.

Q: Thank you so much, Ambassador Hoover, really appreciate it.

HOOVER: My pleasure. Thank you.

END