What Ebola Taught Susan Rice About the Next Pandemic

In October 2014, national security adviser Susan Rice was steeling herself to resign.

Ten months into a vicious outbreak of Ebola, a terrifying virus that caused some victims to bleed from their eyeballs, the United States was struggling to contain its spread across West Africa. The disease had seemed to vanish in the spring only to return with a vengeance in June, to the surprise of health experts. The World Health Organization and international NGOs had proven unequal to the task. Cable networks were airing footage of corpses left to rot in the streets. President Barack Obama had sent U.S. troops to Africa, but they had yet to deploy in full.

Ebola had arrived in the U.S. in late September when a Liberian man visiting family in Dallas, Thomas Eric Duncan, fell ill with the disease. The discovery set off a scramble to trace his steps—and an explosion of public recrimination and fear. “You don’t want us to panic?” Fox News host Jeanine Pirro said in a diatribe typical of the reaction on the right. “How about I don’t want us to die! Tell us the truth for once!”

When she heard the news of Duncan’s diagnosis, U.S. ambassador to the United Nations Samantha Power later recounted, “my stomach sank.” That moment, a former Rice aide recalled, “Was when my world started to melt down.” With the midterm elections only weeks away, Republicans were calling the administration incompetent. Governors were threatening to bar incoming flights from Africa. A New York real estate mogul and reality TV star, Donald Trump, was whipping up fears and calling for a travel ban. The media was swarming. Ebola had the makings of a political disaster.

Obama, somber after an Oct. 6 meeting with Rice and other top officials, unveiled new steps the administration was taking to battle the outbreak. Duncan would die two days later, fueling another damaging news cycle. The pressure from Congress was intense. Some officials, notably Secretary of Homeland Security Jeh Johnson, wanted to stop issuing new visas for travelers going to and returning from the Ebola hot zone—Guinea, Liberia and Sierra Leone—to mitigate the risks. Obama was listening.

Rice hated the idea of closing those borders. Not only did it strike her as bowing to “racially stoked fears,” as she wrote in her 2019 memoir, but health officials were adamantly against it. The month before, she had pushed hard for the U.S. military to join the Ebola fight in West Africa, in part to keep an already struggling region from collapsing. If the U.S. started banning travel from West Africa, she worried, other countries would follow. Health and aid workers would stay away and the epidemic would explode across the continent. “It was a really tough discussion and it was really stark and it came very quickly,” one participant in the internal debate recalled.

Along with her close friend Gayle Smith, an experienced Africa hand and the National Security Council’s top development official, Rice took her case to the president. “She was furious about it, and rightly so,” said Smith. Leaving the meeting, they weren’t sure they had persuaded him—Obama’s style was to hear out all sides of an issue, hold his cards closely and make a decision after weighing his options.

Rice privately considered quitting. “I worried that he and I might face a reckoning, if we found we had irreconcilable differences on an issue about which I felt so strongly,” she wrote.

Six years later, another epidemic is raging, this time in the U.S., with Trump himself in the White House and seemingly unable—or unwilling—to slow it down. Rice, now a private citizen, has emerged as a leading prospect for vice president, a job whose responsibilities are likely to include a laser focus on stopping the spread of Covid-19. And uniquely among all the VP prospects, she had a seat at the table the last time the U.S. faced a pandemic threat. This account of her role is based on conversations with roughly a dozen people who led the Obama administration’s response, contemporary news accounts, and numerous after-action reports and other documents produced by various government agencies, along with her memoir. Not everything went smoothly, and the disease was far different from Covid-19, but one metric leaps out: Only two Americans died.

In the argument with Johnson, Rice’s view prevailed, and Obama ultimately decided against banning travel. But it was politically risky, and he needed to assure Congress—and an increasingly hysterical public—that there would be no more Thomas Eric Duncans. Travelers were already being checked for Ebola on leaving West Africa. Next, as a first step, the White House rolled out new screening measures for anyone coming from the affected countries at the five most commonly used airports.

In mid-October, two nurses who had treated Duncan at the Dallas hospital tested positive, and all hell broke loose. One of the infected nurses had flown to Cleveland for a wedding and potentially exposed more people there. The incident exposed shortcomings at the Centers for Disease Control and Prevention, which had wrongly assured the White House the hospital in Dallas could handle Ebola patients, and at the Department of Homeland Security, which had failed to intercept Duncan in the first place. Obama felt misled. Republicans were livid.

“The U.S. domestic response started flat-footed,” Rice acknowledges in her book. At her direction, NSC aides worked with the agencies to spin up more aggressive options. Now, DHS would proactively funnel visitors from the affected countries into just five airports, drawing on the same tools used to identify potential terrorists. The CDC would narrow its focus to a set of hospitals with the expertise and facilities to handle Ebola safely. A public health SWAT team would rush into communities where any cases popped up.

In Africa, the epidemic was still raging. “President Obama needs personally to ramp up the urgency of the American response and the level and speed of the resources provided,” the New York Times editorial board warned. Writing in the New England Journal of Medicine, the scientist who in 1976 had first identified the Ebola virus said the outbreak “seems out of control.”

Obama was stung by the criticism and alarmed by the mistakes. The month before, announcing the military intervention at CDC headquarters in Atlanta, he had personally assured the public that the risk of an outbreak in the U.S. was “extremely low." One top official remembers hearing the president say at one point, “I may not know much about epidemiology, but I do know politics.” He pressed his team to get the epidemic under control. Now.

“Our shit is not tight,” the president complained in an Oct. 15 Cabinet meeting that promptly leaked to the Times. Two days later, with Rice’s full backing, he tapped Ronald Klain, a trusted longtime aide to Vice President Joe Biden, to be the new full-time Ebola coordinator—tasked with, to put a fine point on it, making their shit tight.

Klain, a bureaucratic wizard, proved highly effective, bringing new focus especially to the lagging domestic efforts. But his contribution has in some ways overshadowed that of his boss, Rice—without whom Obama’s bold decision to intervene in West Africa almost certainly would not have happened.

“Ebola wasn’t gonna fall off the map because of who she was and how she saw the world and what she believed in,” John Gans, Jr., a scholar of the National Security Council, said of Rice, who declined to comment for this article.

More than perhaps any other crisis of her four-year tenure, her colleagues say, Ebola shows the qualities they admire in her: tenacity, passion, hard-won knowledge of how to work the creaky gears of federal power, an orientation toward action, an insistence on honesty from subordinates—and above all her bluntness.

“You can’t bullshit Susan Rice,” said Beth Cameron, a career civil servant who worked on Ebola under Rice and later headed the pandemic preparedness office she set up in its aftermath. “You just can’t.”

As Biden finalizes the search for his No. 2, Rice remains an unlikely choice, yet also a surprisingly plausible one. She lacks the star power of Kamala Harris, the domestic policy chops of Elizabeth Warren and the prosecutorial bent of Val Demings. Her only elected office is president of the student body at the National Cathedral School, the all-girls prep school she attended in Washington. But in the middle of a pandemic that has claimed more than 150,000 American lives and ravaged the economy, Biden may decide he wants someone at his right hand who has fought a deadly outbreak before—and learned some searing lessons from it.

Scary as Ebola was—and it was “really freaking scary,” as Gayle Smith put it—it was also fairly easy to detect. Unlike today’s coronavirus, it didn’t spread through the air, and only those with symptoms could transmit the disease, mainly through bodily fluids. And because it was so lethal, victims often died before they infected too many others.

Even so, the pathogen’s march across West Africa in 2014 stunned public health experts. Past Ebola outbreaks, usually confined to rural areas, had been snuffed out relatively easily. But this one was hitting vulnerable countries that were still shattered by years of civil war, and had no experience with Ebola. By one count, Liberia had just 51 doctors for a population of 4 million; Guinea ranked dead last in the world in hospital beds per capita—0.3 for every 1,000 people. Caring for Ebola patients, with symptoms ranging from severe headaches and fever to violent diarrhea and vomiting, required specialized skills and facilities in addition to rare courage.

Rice, like Obama, was no epidemiologist. But she did have a fingertip feel for Africa, having spent years wrestling with the region’s crises as a young aide on Bill Clinton’s NSC staff and then as a State Department appointee. The experience exposed her to harsh criticism; A Problem From Hell, the book that made Samantha Power famous, tells the story of Rice asking if using the term “genocide” to describe events in Rwanda would be politically unwise. Later, when Rice was under consideration to be Obama’s secretary of state, Wall Street Journal columnist Bret Stephens cited that (disputed) incident and other episodes from her Africa work to accuse Rice of “failing up.” But all that time in the region also attuned her to the particular weaknesses of African governments and infrastructure—which is why Ebola made her so nervous.

Throughout the spring, NSC officials were monitoring the outbreak closely, periodically updating Rice with the latest intelligence and epidemiology data, along with any notable U.S. personnel movements. But during April and May, the widespread belief within the administration was that the disease was largely manageable with minimal American help.

By late June, that assumption had proved tragically wrong. Ebola hadn’t disappeared. Instead it came roaring back, popping up in more than 60 locations across Guinea, Liberia and Sierra Leone. With the death toll now at 350, Doctors Without Borders declared on June 21 that the epidemic was “totally out of control.” A dozen or so American medical experts had been on the ground for months to monitor and bolster the international response, nominally led by the World Health Organization. Yet the number of new cases was still rising faster than the WHO and assorted NGOs could handle. Government health officials were utterly overwhelmed. Belatedly, the hapless WHO, which had stiff-armed the CDC and downplayed the crisis, began asking for help.

By July, Rice and her aides were growing alarmed at the reports from West Africa. There was no time, to use one of her common admonitions, to sit around “admiring the problem.” The NSC’s pace of activity on Ebola—meetings, briefings, memos—accelerated rapidly, but it was still getting organized. Led by Smith, federal agencies and departments had to hash out who would do what. “Ebola was weird because it didn’t fall neatly into anyone’s bailiwick so it wasn’t clear who owned it initially,” said Jeremy Konyndyk, who was the head of the USAID office that oversaw disaster response efforts at the time.

Most concerning, for U.S. officials nervously monitoring the outbreak, was the disease’s arrival in major cities. Never before had Ebola gotten loose in a metropolitan area the size of Monrovia, the Liberian capital. “That was hugely concerning,” recalled Konyndyk, whose rapid-response teams had not yet surged into the region. The city’s entire healthcare system was collapsing as medical staff began dying in large numbers.

“The Ebola virus hadn’t changed,” reflected Michael Osterholm, an infectious disease expert at the University of Minnesota. “Africa had changed. It was urbanized. Nobody had seen that type of dynamic transmission before.”

An inflection point came on July 23 when the first American—Kent Brantly, a doctor for Samaritan’s Purse, the NGO operating the only sizable clinic treating Ebola patients in Monrovia—was diagnosed with the disease. The State Department arranged to fly Brantly home to the United States on a specially configured “biocontainment” plane. His arrival was broadcast live by cable networks, and condemned with opportunistic fury by a man few suspected would become America’s next president.

“The U.S. cannot allow EBOLA infected people back. People that go to far away places to help are great-but must suffer the consequences,” Trump tweeted around that time. “The U.S. must immediately stop all flights from EBOLA infected countries or the plague will start and spread inside our ‘borders.’ Act fast!”

Worst of all, from Konyndyk’s perspective, was the news that Samaritan’s Purse had withdrawn from Liberia after Brantly and a second American, Nancy Writebol, fell ill. Doctors Without Borders, the major remaining NGO, didn’t have enough people to plug the gap. U.S. officials at that point were faced with a “nightmare scenario”—that there would be no place in a city of 1 million people for Ebola cases to go. Dead bodies were piling up in Monrovia so fast that local officials were resorting to mass cremation to prevent the corpses from infecting the city’s water supply.

Two days after Brantly’s positive diagnosis came a moment of abject terror for U.S. officials. The CDC learned that a man carrying Ebola had arrived in the capital of Nigeria, a city of 21 million people. “This was absolutely horrifying,” CDC director Thomas Frieden said later. “There's no doubt in my mind that if we hadn't stopped it in Lagos, it could’ve spread and changed from what has been a terrible epidemic to a true global catastrophe.” Nigerian officials, with a surge of help from CDC experts, managed to prevent that scenario—but the scare left an impression on Rice and others.

On Aug. 1, as the overall death toll from the outbreak reached 729, the director of the WHO admitted defeat. “This outbreak is moving faster than our efforts to control it,” she conceded. A week later, the WHO declared the Ebola outbreak a “public health emergency of international concern” and called for hundreds of millions of dollars in fresh aid.

The timing was extremely inconvenient for the Obama administration, which was planning to host dozens of African leaders for a first-ever summit the first week of August. Republicans were warning that they could be bringing the virus with them.

“That’s when it really starts becoming a domestic political issue,” remembers Ned Price, a former CIA official who handled crisis communications for the NSC during the Ebola crisis. Some officials wanted to cancel the event; Rice won the argument to proceed. The summit came off without a hitch, but getting the necessary screening procedures in place consumed precious bandwidth. And there was little public discussion of Ebola at the summit, which some experts saw as a missed opportunity.

Testifying before a House subcommittee on Aug. 7, Samaritan’s Purse vice president Ken Isaacs castigated the international response as a “failure.” It was not until the two Americans were confirmed positive, he said, “that the world sat up and paid attention.” Rep. Frank Wolf, a humanitarian-minded Virginia Republican, ripped the Obama administration for underestimating the outbreak. “Little action was taken to get out in front of this problem, and now we’re seeing the results,” Wolf complained.

The U.S. was now sending civilians into West Africa drip by drip—another USAID rapid-response team here; a few dozen more CDC experts there. The military agreed to send a mobile medical unit to Monrovia, but it was just 25 beds, and wouldn’t be operational until October. And none of it was enough. Frieden and Raj Shah, the USAID administrator, were at wit’s end. They needed at least 300 beds, and they needed them now. As Smith observed, “If you're not moving faster than the virus, then it's winning.”

By late August, it was evident to everyone that the current plan was failing. USAID and CDC officials were having to take dangerous risks in the field, like hand-carrying blood samples out of remote villages. In Washington, Rice’s staff was working brutal hours trying to come up with a more aggressive approach. One aide recalled being so busy that her husband would pack her a peanut-butter sandwich each day because otherwise she would forget to eat.

In any administration, most of the professional staff members of the National Security Council are experts on temporary loan from their original agencies—Defense, State or CIA, for example. Rice, herself an NSC aide during the Clinton administration, had been careful to surround herself with career officials who had deep working relationships within the agencies they came from. This proved especially useful during the Ebola crisis, because the Obama administration was trying to do something that had never been done before—attacking an epidemic at its source rather than simply hunkering down and trying to keep it out.

Those relationships gave Rice’s staff what Gans called “the ability to call around and get ground truth.” They could dial up their counterparts deep in the bowels of, say, the Pentagon, and find out what untapped capabilities the military was keeping under wraps. They could get “the bad news,” as one Rice acolyte put it, about where things were really going wrong—the kind of weaponizable information that was often guarded jealously or otherwise buried in the bureaucratic labyrinth. Here Rice’s famous bluntness came into play. She expected them to bring her good information, not bullshit, and they worked hard to get it.

These traits became invaluable once it became time to get serious about an idea that had been kicking around the staff level for weeks: sending in the U.S. military.

It wasn’t a crazy idea. The military had grown increasingly involved in humanitarian operations over the years, notably in the aftermath of the 2010 earthquake in Haiti. The Pentagon had unique capabilities, from its ability to airlift supplies to remote areas to its prowess at setting up all kinds of facilities on short notice. And the Defense Department was sitting on piles of cash, while the civilian agencies—the CDC at one point had to scrape together a paltry $3 million just to get its people into the hot zone—had already burned through their meager funds for the year.

Meanwhile, the number of infections was doubling roughly every three weeks. “Our work was expanding in a linear way and the virus was expanding in an exponential way,” explained Konyndyk. “We needed to expand the fight in an exponential way, and that’s why we needed the military.”

Still, the U.S. had never deployed soldiers to battle an epidemic, let alone one as frightening as Ebola. An extraordinary number of details would have to be worked out in a hurry, from the scope of the mission to the protocols for protecting the troops from the virus. Congress would be nervous. Many in the uniformed brass were more comfortable planning for tank battles across the Fulda Gap or airstrikes against terrorists in Iraq than they were grappling with cross-border threats like Ebola. Asking for troops would be no small thing.

As August turned to July, at one of her standing 5:30 p.m. interagency meetings on Ebola, Smith polled the room. “Do you think we can get ahead of this virus with only civilians?” she asked. “Do you think we need the military?” The answer was a unanimous yes.

Ebola was just one of several hair-on-fire emergencies facing Rice at the time. The Islamic State was beheading people in Syria; Russia had annexed Crimea and invaded eastern Ukraine; the Iran nuclear deal was still being hashed out; the U.S. had intervened to save the Yazidis, a minority sect, from certain slaughter. There was the usual endless cycle of meetings, summits to strategize for, world leader calls to plan.

But in early September, while traveling with Obama for the NATO summit in Wales, Ebola was on her mind. She recalls fielding a late-night call from Smith, who was despondent over the administration’s inability to keep pace with the virus. “It was a race to evade a tsunami, and we were losing,” Rice writes.

They talked through some ideas for how to scale up the civilian response. “As we talked,” Rice recounts, “I realized there was one option we hadn’t yet discussed: utilizing the unmatched capacity of the U.S. military. They could bend the curve.”

Still, some in the administration remained leery of greater involvement. A Sept. 10 meeting in the White House Situation Room was pivotal. Rice had orchestrated the meeting, and the key participant was Frieden, his memory still fresh from a disturbing trip to West Africa that he described to others as “like a visit to Dante’s inferno.” Frieden passed around a graph projecting as many as 1.4 million infections if aggressive new measures were not taken to halt the epidemic. In the argot of White House power meetings, Frieden’s move was known as a table drop—unveiling a crucial piece of information that hadn’t already been circulated.

Frieden’s message, despite the sharp upward trajectory shown on his hockey-stick graph, was actually meant to be optimistic. “Ebola has always been beaten. Ebola will be beaten,” he told the room.

Rice, who hadn’t seen the graph before that moment, was stunned by the presentation. “I couldn’t stop staring at the hockey stick. It blew my mind,” she recalls in her memoir.

“I think it scared everybody,” remembered Amy Pope, who at that point was leading the NSC’s transportation security team. In her own book, Samantha Power refers to Frieden’s single-page handout simply as “The Slide,” and describes the assemblage of top officials sitting in stunned silence for “a full thirty seconds” as its implications sunk in.

Rice quickly sized up the potential consequences of Frieden’s projections. “It could spread across the globe and kill hundreds of thousands, potentially millions,” she recounts in her memoir, “while sinking West Africa and much of the rest of the African continent under the weight of economic collapse, and massive refugee flows.”

“The global economic implications,” she continues, “were also mind-boggling—a halt to much international air travel and commerce, quarantines of whole regions, panic, and a Hobbesian inferno where no man helped another out of fear.”

Frieden’s graph proved to be a galvanizing moment. So, after securing Obama’s blessing, Rice worked to get Gen. Martin Dempsey, the chairman of the Joint Chiefs of Staff, to bring the might of the U.S. military to bear on the problem. "I think Ambassador Rice’s most important contribution was bringing the energy into the room early so that we all became serious about generating a response," Dempsey recalled in an email.

The Pentagon had been hesitant to get involved, wary of a mission well outside its traditional duties. The military was busy fighting a newly potent terrorist insurgency in Iraq and Syria, while still trying to fend off the Taliban in Afghanistan. Dempsey and his colleagues on the Joint Chiefs of Staff needed time to "assess the risks to other missions around the globe," as he explained it. Never in its history had the U.S. deployed troops to stop an epidemic. What if some soldiers got infected? They had signed up to be shot at, not to get Ebola. How was this even supposed to work?

Chuck Hagel, the defense secretary, was skeptical, as were some in the military brass. “If we’re gonna engage the U.S military, I want to be damn sure what we’re talking about,” he remembers thinking at the time. “It wasn’t a matter of being obdurate or skeptical or difficult.” Hagel was conservative by nature, and reliably suspicious of missions outside the military’s traditional role. A Republican and hardly a Rice ally, he was already at loggerheads with the White House, and would be gone by late November.

“I keep hearing you all saying, our soldiers will ‘suit up’ and do this and that,” Power recalls Hagel saying during one meeting. “Suit up? What does that even mean? My guys have never even seen these HAZMAT suits, apart from in horror movies.”

At another point in the discussions, Frieden explained the CDC’s request for the military to transport and build Ebola Treatment Units—essentially tented field hospitals to treat patients. “Hire the circus if you want to put up tents,” Dempsey quipped, in Power’s telling.

In reality, Dempsey didn’t need much pushing. Months earlier, he had asked his aides to investigate what sorts of capabilities the Defense Department might offer to help fight Ebola, and to begin thinking through options and building relationships with other agencies. He had been deeply affected by meeting pandemic specialist Laurie Garrett, author of "The Coming Plague," and did not take lightly the national security threat a virus could pose to U.S. interests.

Still, Dempsey wanted absolute clarity before committing. After an intense flurry of meetings and discussions, he laid down his red lines: The military would provide logistical muscle, but not medical personnel. That was a job for civilians. And U.S. soldiers would come nowhere near the virus.

“To his great credit,” Rice writes, “Dempsey decided to find a way to get to yes, rather than marshal a plethora of excuses to avoid action, as the Pentagon is adept at doing when it wants to avoid an unwelcome tasking. … It was a gutsy move.”

Within four days of endorsing the decision, Obama would announce the deployment of 2,800 U.S. troops to West Africa, where they would be tasked with standing up a regional command center, setting up emergency hospital facilities, establishing supply chains and supporting the doctors and infectious disease experts that would soon be streaming into the hot zone.

Obama’s argument was a pragmatic one, and a succinct expression of how he and Rice viewed the proper use of American power. “If the outbreak is not stopped now, we could be looking at hundreds of thousands of people infected, with profound political and economic and security implications for all of us,” he said. “So this is an epidemic that is not just a threat to regional security—it’s a potential threat to global security if these countries break down, if their economies break down, if people panic. That has profound effects on all of us, even if we are not directly contracting the disease.”

In the presidential motorcade on his way to CDC headquarters in Atlanta, where he delivered the speech, Obama had asked his aides if they were 100 percent sure the commander of the new mission was on the ground in Monrovia. The plan had come together so quickly that Darryl Williams, the U.S. major general suddenly in charge of something called Operation United Assistance, was walking off the aircraft and on the tarmac when he learned of his new assignment.

For the next few weeks, even as the administration was getting pilloried for lapses like Duncan, Obama, together with Rice, Power, Secretary of State John Kerry and others wheedled and cajoled the rest of the world to pitch in. “The whole of the U.S. government shamed, bludgeoned and begged countries to join us,” she writes. It sometimes seemed that no contribution—like the handful of French-speaking Canadian health experts sent to Guinea—was too small. By the end of October, there were nearly 1,000 U.S. personnel in the region, and as many as 10,000 health workers from all over Africa eventually volunteered to help.

It would be months before the full effects of the military deployment were clear, but the announcement itself immediately gave the desperate governments of West Africa an important boost. “Beyond the tangible impact, it signaled that we were taking a leading role and fully invested, which in turn gave us leverage to press others to send workers,” said Ben Rhodes, a Rice deputy. “Compare that to any other outbreak,” Rhodes said. “There’s just never been a global response like that.”

Tolbert Nyenswah, the Liberian official tapped in August to rescue the government's losing battle against the virus, said the involvement of the U.S. military was "not only critical but pivotal! Without that we were not going to end the Ebola outbreak in West Africa."

By the time the crisis wound down in mid-2015, Rice’s worst fears had not been realized. With Klain free to focus all of his time on Ebola, reaching deep into agencies for information and handing down marching orders, the Obama team’s shit got tighter. The disease never spread inside the U.S., while the global approach, led by Rice, helped crush it abroad. America saw just 11 cases and two deaths—fewer, Power points out in her book, than the number of Kim Kardashian’s marriages. Worldwide, the epidemic killed an estimated 11,000 people, mainly in West Africa, and infected at least 28,000—a terrible toll, but well below what Frieden’s hockey-stick chart had contemplated.

Osterholm, who was critical of the Obama administration’s response early on, now marvels at the results. “What they did in Africa was remarkable,” he said.

The officials who worked on Ebola, Rice among them, remain fiercely proud of how they handled the outbreak. “I’d follow Susan Rice into war,” says Pope, who succeeded Klain as Ebola coordinator.

But they also understand that they got extraordinarily lucky. Ebola easily could have ripped through Nigeria, becoming endemic in the region. And an airborne pathogen, like the novel coronavirus holding the world hostage today, could wreak orders of magnitude more havoc.

They took from the experience a few maxims about fighting epidemics: The White House has to lead. Go in with overwhelming force. Follow the science. Be fact-based. Communicate clearly and soberly and dispassionately and honestly. Understand that diseases cross borders, and so travel bans by themselves do not work.

A member of Rice’s staff, Christopher Kirchhoff, put together an unsparing “lessons learned” review of the administration’s response to the Ebola epidemic. The resulting 73-page document tallies up the successes and failures of the administration’s response; altogether, it synthesizes more than two dozen self-assessments from different arms of the federal government. Rice read every line of it and signed off on the final draft.

They had one more job to do: Turn the lessons they’d learned into an action plan. Whatever disease came next, the next administration didn’t have to be caught flat-footed. The U.S. needed a “Pandemic for Dummies,” as Rice colorfully put it, to help the incoming crew avoid some of their mistakes and keep from making new ones.

“We all realized the global triggers for action in a high-consequence epidemic or pandemic weren’t good enough,” said Cameron, who helped lead the effort to codify those lessons into a playbook and transfer them to the incoming Trump administration. Cameron stayed on at Rice’s request for three months into the new term, leading an office Rice created to prepare for and respond to the next global health crisis.

Six years after the first case of the Ebola outbreak was identified in rural Guinea, as a new disease arose in China, the playbook sat unused. The pandemic office has since been disbanded. Rice’s team is despondent, haunted by how their successors ignored their work.

“It’s easy to be overcome by anger,” acknowledges Price. “The spread of coronavirus here may have been inevitable, but the scale and the toll of it—that was not inevitable.”