In this episode, Acting Assistant Administrator for the Bureau for Democracy, Conflict, and Humanitarian Assistance Admiral Tim Ziemer and Hurricane Dorian Response Director James Fleming sit down with the Administrator to discuss “Strengthening Our Capabilities for Relief and Response” through the lens of USAID’s efforts in two major crises: Hurricane Dorian in the Caribbean and the Ebola response in the Democratic Republic of the Congo.

Carol Han: Administrator Green, you and I have spoken about the road to self-reliance before. In the context of disasters and disaster response, why is it important that USAID helps other countries become more self-reliant when crises strike?

Mark Green: We'll always stand with countries when disaster strikes because that's who we are as Americans. We also believe that true compassion means not only meeting urgent relief needs, but also helping those countries strengthen their resilience, bolstering their capacity against future shocks and crises that are likely to occur.

Carol Han: Administrator Green, the Democratic Republic of the Congo declared an Ebola outbreak on August 1st of last year. As of November 24th, there have been approximately 3,300 confirmed and probable cases and nearly 2,200 related deaths. How do you see this situation from your vantage point?

Mark Green: Well, certainly the situation is getting better in the sense that the infection rate is down from where it was some months ago. That's all good news, but there are still underlying challenges. Remember what made the outbreak here so difficult to tackle and contain, is where it occurred. It occurred in an area in which every bad thing and every bad challenge in development terms had struck this poor area and the people of this area for decades; poor governance, limited access to water, electricity. So you put on top of that people who are already distrustful of outsiders and institutions. So a challenging situation, but the team led by the Disaster Assistance Response Team, or DART made up of professionals from USAID, CDC, and others, I think has done a remarkable job. A ways to go, but great progress.

Carol Han: Admiral Ziemer, you recently traveled to DRC. In fact, you've made three trips so far. Could you paint a picture of what you saw happening on the ground, and what are the challenges that we as an agency face in containing this outbreak?

Tim Ziemer: Each of those trips showcase something different to me. It's really important for everybody to understand, we're dealing with three dynamic factors. We know the virus, we have vaccines now that are experimental, and also other interventions that have actually been a positive point. So even though we have vaccinated 300,000 plus people, even though we have interventions, that if you show up at an Ebola treatment center early enough, there's a good probability of being cured.

There are other vectors, the insecurity of the two provinces of the 25 where this Ebola outbreak is manifesting itself, is one of the most insecure places in the world. There were two attacks in Beni Town, which is the epicenter of the outbreak. An Ebola treatment center was burned, seven people were killed, and nine were injured. There was a protest to advocate for getting rid of the UN Security Forces. So that is not a surge, that is a characteristic that has manifested itself and made this so complex over the last 18 months.

Then thirdly, the community distrust is at a high point. Each village population city center is its own community in itself. And we're finding that they have their hands up, the roadblocks are up, and it's been a challenge to get all three of those vectors, the virus, the insecurity and the community to come together so that we can start seeing an improvement.

The good news is, over the last couple months, we've seen the number of cases reported drop from over 200 a week down to the last report to 27. And we've seen the footprint shrink from 19 to 20 health centers down to 4. We are able to understand and focus the interventions more effectively, but the jury is still out whether or not we're going to be able to get in there with our partners, working with the government, working with WHO, to bring this to an end as quickly as we possibly can.

Carol Han: Administrator Green, please correct me if I'm wrong, but I believe you also spent some time in the DRC. What were some of the impressions that you got when you were on the ground, sir?

Mark Green: Well, I did two trips. One to Eastern DRC, the area most afflicted. I was struck by how scattered people were. There really wasn't a sense of community structure that would pull people in, that quite frankly, would make our interventions more effective. Instead, people were being chased away because they were distrustful of their community leaders. The very people they should be turning to are people they don't entirely trust.

I think there's been progress made. We've been able to make some investments that we think will slowly begin to rebuild that trust. But it's a real reminder of how important, not just democracy writ large, but responsive governance is, to taking on a challenge like this. We know what to do, we have better tools than we had during the last outbreak, and we have the lessons learned from the last outbreak. What makes this different is that you have community institutions that don't have the same level of trust that they did in other parts of the continent; areas that with these challenges that make it difficult to bring those interventions to bear, to apply those lessons, and to be able to bring those new tools.

The other trip I took was to the capitol itself, and what I saw there was again, how governing institutions have an important role to play, and if not played well, they can actually exacerbate the challenges. One of the reasons that we were seeing insecurity in Eastern DRC is that truck drivers, surveillance officers weren't always getting paid in a timely fashion, and that was creating agitation and strife. That strife created insecurity in places that we couldn't get to; some of the places where we knew in fact the interventions were warranted. So again, a complex situation, getting better, but still some ways to go.

Carol Han: Administrator Green, you just brought up the previous Ebola outbreak. There was a big one back in West Africa in 2014. A question to you and both Admiral Ziemer, who had worked on the response while you were at the White House. How do you feel that this current outbreak compares with what happened back in 2014?

Mark Green: Well, again, to me it's the complexity of the underlying situation. Things are better in the sense that we have the experience of the past; lessons learned and new tools. But the complexity of the situation in Eastern DRC. And I should also mention we not only had the problems of kleptocracy and corruption, but you also had an election taking place at the very time that we are trying to get into some of these areas with some of the tools that we know can make a difference; very, very complicated situation. That to me, is the big difference from my perspective, but really Admiral Ziemer is the one who would know best given the perches that he had now and then.

Tim Ziemer: Clearly, the West Africa outbreak in terms of cases and deaths superseded this one. This one in DRC is now number two, but in terms of just total cases, it's really, much smaller. But I would make a case, this is much more challenging. Lots of lessons learned from West Africa. We've applied those lessons. We have the new vaccine. We have new interventions.

This Administration is committed to responding and containing to infectious outbreaks where they occur. It is a priority not only for Administrator Green as the lead foreign assistant Agent, but it also is a priority for Secretary Pompeo, and Secretary Azar. The collective State, USAID, HHS, and our CDC colleagues coming together represents that responding to not only the previous outbreak, but this one, and the next one is a significant challenge. I might add, our congressional partners have been all in and making sure they understand the dynamics; they continually ask USAID, what more can we do to bring this outbreak to an end?

Mark Green: To me what we need is, after the outbreak is fully contained, is to make sure that we never let our guard down; that we continue the vigilance because we'll need to continue to make investments, particularly in surveillance systems and making sure that we have adequate stockpiles of interventions. The good news is Congress on a bipartisan basis really made key investments that have positioned us well for the current outbreak, but we need to make sure that we remain vigilant, sadly, because there will be another outbreak.

Carol Han: You penned an op-ed in which you explained that when it came to fighting the outbreak, there were quote 'long difficult months ahead'. How do you stand now with that statement?

Mark Green: It's still true. I think the trajectory is a positive one. I think real progress is being made. The numbers are clearly improving. Understand that people are still dying every week, and this is continues to be an ongoing tragedy. The trajectory is a good one, but again, what I would say is that we can't let our guard down, so when this is quote unquote 'finished', it won't be finished. It'll be instead time to shift to a different phase in which we make sure that we're well prepared for what is unfortunately likely to happen again in the future.

Carol Han: Do you see a glimmer of hope though, especially with as what Admiral Ziemer says, some of the cases maybe going down the trajectory looks positive. Do you have a glimmer of hope when it comes to this response?

Mark Green: Very much. Very much. The commitment as Admiral Ziemer mentioned, the U.S. government across the inter-agency, both sides of the aisle in Congress, and the lessons learned. We have new tools; we have tools we did not have before that provide reasons for help, and the improvement in the numbers suggest that we're making progress. But anything can upset it as we know, and we've seen some of the insecurity, the new acts of violence; anytime the violence occurs, and the team is not able to get into those areas, that creates a risk.

Carol Han: In addition to the Ebola outbreak, USAID responded to other disasters this year including Hurricane Dorian, which struck the Bahamas on September 1st as a Category 5 storm. James, you served as a response director for USAID's Hurricane Dorian response. Can you tell us about USAID's role in the aftermath of the storm?

James Fleming: USAID led, the U.S. Government's response to hurricane Dorian. Even before the storm hit, USAID deployed an elite Disaster Assistance Response Team, or DART to The Bahamas. At its height, the DART comprised 106 members, including search and rescue personnel, and experts in shelter, health, food security, and water sanitation and hygiene. The DART included a search and rescue team from Fairfax County, Virginia. The team searched more than 1,000 houses and buildings. They also assessed structural damage to schools, health clinics, police and fire stations, stores, and bridges to determine whether they were safe to use. USAID also provided approximately 53 metric tons of USAID relief supplies from our warehouse in Miami. This logistics operation was done via commercial air lift, U.S. Coast Guard transport, and a flight donated by the United Parcel Service, UPS. We also asked the U.S. Military to provide critical logistics support for our response. Over the course of 12 days, U.S. Northern Command flew 142 missions, delivered more than 147 metric tons of humanitarian cargo, and transported 445 response staff, including members of our DART. In total, the U.S. Government through USAID and the U.S. Department of Defense provided nearly 34 million dollars in humanitarian assistance for the hurricane Dorian response.

Carol Han: James, what did we prioritize during the month long response?

James Fleming: So this is an effort in prioritization. What we focus on first is lifesaving types of responses. That's why you saw a heavy emphasis on search and rescue in the very beginning. Then we very quickly come in with other lifesaving types of responses, whether that be shelter, water, sanitation, hygiene, and food for the people who need it.

Carol Han: Administrator Green, you made several trips, not only down to Miami where we have our emergency warehouse, but also to The Bahamas. What was your vantage point of how you saw the response every time you were down there?

Mark Green: First off, incredibly proud of our team; a remarkable job they did, as you heard from James. Not only pre-positioning, but the approach that we took was one of being clear-eyed and hard-boiled in how we took a look at needs. So there was lots of coverage from the media; sometimes not necessarily an accurate depiction of what was going on, on the ground, because by definition they couldn't get to those areas. So what our team did was to do a clear-eyed assessment; to make sure that we prioritize based upon hard facts, and what needed to be done, and never wavering from that. That, I think was a real testament to the team. On top of that, I was impressed with how quickly our team worked with our counterparts, and our partners in The Bahamas to enhance their capacity. So this was their response; building their capacity not only to prioritize in the response for this storm, but also making sure that they had stronger capacity for the future.

Not only immediate response, but always with an eye towards the future; making sure that what we leave behind is not only a legacy of compassionate relief and response, but also a stronger partner for the future. That was impressive to me.

Carol Han: Helping them on the journey to self-reliance.

Mark Green: Well, very much so. Obviously, The Bahamas is a country, which has economic means, but they lack the capacity to be able to prioritize and handle some of the strategizing around the relief efforts.

So that is again, bolstering the resilience of our partners for the future. This is their country. They need to lead the response and respond to their people, but we have a lot of lessons learned to share with them, as well as the outpouring of compassion, not only from the U.S. Government in terms of the immediate public assistance, but also helping to make the private assistance that came from so many parts of the country more effective; that it got to where it needed to go, that we broke down logistical barriers that prevented it from getting there in some cases. God willing a storm like this doesn't hit again, but making sure that they're better placed to respond in the future when storms of any kind do hit The Bahamas.

Carol Han: USAID leveraged the private sector to help support our response. Could you talk about some of the things that we did together and why you felt that they were so effective?

Mark Green: The hallmark of a USAID response is making sure that we're all about outcomes, so that we get there the quickest, most effective, most efficient way we possibly can. In some cases, that's the military, and in the case here, there were moments early on where the Coast Guard and others played a key role for us. But most cases it's commercial. In most cases, it's working with commercial partners that we can actually make dollars go farther, and can respond more quickly. So that partnership's important.

But also increasingly it's the power of information technology and social media. It allows us to partner with organizations like NeedsList, which create a matchmaking service, needs versus capacity. We also have the ability to open up lines of communication more quickly than we could before, so that we're able to prioritize; get to those urgent need areas, but also understand in some cases rumor versus reality. I think the information technology that's coming online is a great boost to our efforts.

Every response creates lessons learned. I think one of the hallmarks of the work that we do at USAID is that lessons learned after action, where we ask ourselves difficult questions and challenge ourselves. I think we learned a lot from Dorian, but I think we also in a very positive and promising way also saw some new tools and new capabilities that perhaps we didn't know existed before that will help us in our work in the future.

Carol Han: It seems like our response to hurricane Dorian was a good example of how we could be working more closely with the private sector to save lives. How does this new way of, let's say, doing business help ensure that all of us provide more effective assistance?

Mark Green: Well, in our private sector engagement, what we're trying to do is move beyond the traditional private engagement, which is traditional partnership in the form of a contract, or a grant, to instead going towards co-creation, co-design, and co-financing, in which we sit down with our partners in the private sector, and ask them for their ideas, and how we get to the outcomes we're looking for. That allows us to tap into and harness some of the ingenuity that we believe comes from competition in private enterprise, but also, I think it allows us to have, I think greater visibility on some of the emerging technologies. Oftentimes, these are our newer technologies that may come from small businesses that have not previously engaged in efforts like this, or engage with the U.S. Government.

So that's what I hope we will be doing more and more of in private sector engagement. And certainly we saw that in Dorian; our partnership with Amazon Air, our partnership with UPS, and again, sites like NeedsList, I think those were made our effort more successful, and certainly much faster and more efficient.

Carol Han: What a success story for NeedsList. I know USAID has sponsored the Humanitarian Grant Challenge. If I'm to understand, NeedsList was a recipient of one of these challenge grants, and it got to actually be used for this response.

Mark Green: I am amazed. Every single day I learned about new technologies, and new innovations are not always technologies; new ways of doing business are coming online that relied upon early money, seed money from USAID. And in most cases, the seed money is very modest; these are not big sums of money, but it's money well spent because we are encouraging and incentivizing big thinking, new thinking, and pushing the envelope.

Carol Han: Boy, what a year though.

Mark Green: Yeah. Busy year. Good year. Good year. I'm incredibly proud of the team. Everyone challenges themselves and challenges their colleagues to make sure that we are best in class, and that we're looking at all these promising emerging opportunities in terms of technologies and applications. On the challenging side, you're right; the world's on fire in a number of ways. We responded to a number of crises; obviously natural disasters. I remember in Mozambique and Zimbabwe, the storms that hit them as well as The Bahamas, and then there are the manmade regime driven disasters, which sadly are protracted, but are stretching us in a number of ways; from Venezuela to what's going on in Yemen, and elsewhere. So it's been a busy time; a lot of success in terms of making a difference in people's lives, but a lot of work to do.

Carol Han: Anything to add Admiral Ziemer, or James?

Tim Ziemer: What we do today needs to prepare us for the future. This is a professional, big league business that USAID is responsible for. So we've heard and reviewed some of the benefits of the previous preparation and investments that came to bear during Dorian. Our charter is to look for other mechanisms, because when the storm, or the emergency hits it's too late. Then we have to depend on the professional response training and durability of the team that we have at hand.

James Fleming: Can I just add, in terms of disaster response, one of the things that makes us successful is speed in response. As the administrator mentioned, we were in The Bahamas even before the hurricane hit. But it's not just us. We have partners that we work with that also responded very quickly, and this is UN organizations, national or nongovernmental organizations, even The Bahamas Red Cross were operational very quickly. The Administrator, hosted a congressional delegation to go to The Bahamas and take a look at what the entire community was doing, and I was impressed at how impressed they were at the response, and the success of the response led by USAID in The Bahamas.

Mark Green: Very, very proud of what was done, but there's certainly work for The Bahamas to do ahead. Again, we'll take the lessons that we've learned and apply them that sadly to the next time they were called into duty.

Carol Han: Thank you everyone for the great discussion. To our listeners out there, thank you for joining us and be sure to follow #USAID on Twitter, Instagram, and Facebook. This episode and more are available in the App Store, just search for USAID Leads. Thank you, gentlemen.