David Bibo
Former COVID-19 Lead
U.S. Federal Emergency Management
Make Them Proud To Wear The Shirt
As the lead for FEMA’s COVID-19 response, David Bibo had the daunting task of scaling disaster emergency capacities designed for a smaller number of cities or states to stretch across all 50 states, the District of Columbia, tribal nations, and territories. The effort relied on strong collaboration among emergency response and public health officials at the federal, state, and local level. It revealed the importance of FEMA’s workforce, logistics, and data systems during national health emergencies.
Public Health’s “Hurricane Katrina”
“I think everybody being honest knows there are so many things we would have done differently during the COVID-19 pandemic, knowing what we know now, while also knowing that the work of emergency management, the work of public health, and the work of everybody else saved a ton of lives. The question is, how do you carry that forward with an honest accounting where so much more needs to be done?”
I joined the Federal Emergency Management Agency (FEMA) in 2009. Former FEMA Administrator Craig Fugate joined in May 2009. While it never appeared in Craig’s strategic plans as a goal or an objective, one of the things we all noticed in the early days at FEMA was that the FEMA logo was nowhere to be found. People did not wear the FEMA shirt.
“The logo had been removed from vehicles and from facilities after Hurricane Katrina. I don’t know that it was a whole wholesale edict from anybody, or that it just happened organically. But, an unwritten strategic objective that I used to hear Craig and his deputy saying was, “Let’s make them proud to wear the shirt.”
“When I left the agency in 2022, I remember looking out at an audience that was full of FEMA people wearing FEMA shirts.”
There’s so much bound up in what you have to get right in order for people to feel proud to wear the shirt again—to wear it on the Metro, to wear it on the way home and to the grocery store. You have to be prepared to stand by your work – you have to be proud of what the agency has been able to accomplish.
That’s the key. It’s about being able to look back on what you accomplished and have confidence in what you accomplished and be willing to stand by it. That grew over time at FEMA.
“Craig was unabashed in his belief that the culture of the agency needed to change, that FEMA needed to be a lot more aggressive, “Go big, go fast and be smart about it” was a mantra and a way of life for those who worked at FEMA.”
Scaling emergency response capacity to meet the moment
Prior to March 2020, FEMA hadn’t regularly been asked to scale its capacity for public health emergencies (e.g., providing medical surge capacity en masse, supporting diagnostic testing, or vaccination missions). Before March, HHS’s Assistant Secretary for Preparedness and Response (now the Administrator for Strategic Preparedness and Response) took a leading role in the COVID-19 response, but – at the time – had neither the mechanisms to pay other federal agencies and states at the scale required nor the systems to ingest state requests for assistance and to track and prioritize needs across the country.
The pandemic also revealed divides across public health and emergency responders at the state level, with public health authorities being given the lead without the operational capacity in many cases to execute on the public health measures and guidance being given.
States where the emergency management enterprise had gotten more activity over the years may be states where it was more important for that element to be deeply involved and integrated because the governor demanded it or because a state viewed that enterprise as having competence and an ability to help change the outcome.
“There were critical systems for states to have in place that really matter over the course of a pandemic, like the ability to deploy human resources to change the outcome – whether it’s staffing a vaccination center, distributing test kits, or moving material from one place to another. These systems were an enormous advantage that FEMA had during the pandemic.”
For example, within FEMA – there were people, there was a process, and there was a technology system that could scale to meet the moment. It was never designed to work across 50 states, the territories, and the District of Columbia – but it did.
“We were able to see what we had in terms of resources available – whether it was people or materiel, we were able to assign those resources to a place, we were able to get those people on travel orders and get materiel moving, get them out the door, check in on status, tell them when to demobilize, and see how long they’d been out there, etc. In a world where you have to put a lot of people or things in a lot of different places very, very quickly – whether that’s on a national, regional or state level – that ends up being really important.”
The Federal Front Door
Throughout the early days of the pandemic, the federal government struggled to provide an organized approach for state, local, tribal, and territorial officials to request and receive support. FEMA’s ability to simply take in and respond to requests for assistance was a game-changer for the federal government.
“One of the major limitations in the early days of the pandemic was that there was no central place where the federal government could understand what states and local jurisdictions needed. The requests were flying in via emails, they were flying in through phone calls.”
A major advance in the COVID response in March 2020 was switching to FEMA’s system for ingesting those requests for assistance. Until that happened, the federal government couldn’t see itself in the response. It couldn’t see what was actually being sought or the articulation of the need.
“After FEMA got involved, the Vice President, the President, and Cabinet officials could say to governors who were calling, “If you need something, ask your FEMA Regional Administrator.”
Once that happens a few times, the system starts to get reinforced: That there are not a million different ways into the federal government. There’s a federal front door. It can handle the surge of requests. It can’t handle the surge of actually providing everything that was needed, but the system was there to ingest it. This is the iceberg that we were chipping away at.
“We had all sorts of questions about how credible the numbers coming were. Some states were doing math and saying that they needed 456,872 N95 masks, and others were saying they needed a million N95 masks. Once the FEMA system was put into play, there was an ability to actually see what was being asked for, so we could step back and say, “Here’s what the folks tell us they need. And here’s what we have.”
“We very quickly found ourselves in a position of managing shortages rather than managing resources, which is not the model the federal government typically finds itself in for the disaster response context, because we are usually taking items from around the country to move items to a particular place. In this case, it was needed across the country, so we had to decide how to make prioritization decisions.”
Supplying The States
FEMA played a vital role in bridging public health responders with emergency response structures, in large part because of its regionally dispersed workforce and logistics systems.
“The ten FEMA regional administrators know their states well. They know how their states are going to approach things. They know their states’ weaknesses, and they know their states’ strengths. They can help to tailor the assistance that the program provides with that localized knowledge. The same is very true with most state emergency management structures.”
FEMA’s system to manage the logistic supply chain was built around distribution centers, positioned strategically from the Pacific to the Caribbean, with a fairly discrete set of material: generators, cots, blankets, tarps, meals, water, infant and toddler kits. The system – which was not designed for what we saw in COVID – was able to scale to accept new locations and new capacity. What states needed ranged from PPE, to refrigerators and freezers to thermometers. Where states could not source those in the vaccination mission, we had to help them figure that out. Also all of the people, whether it was during the medical mission or during the vaccination mission.
Who’s in Charge?
Confusion among public health and disaster response authorities over who held the leadership reins – at the federal level and on the ground in states – characterized much of the pandemic experience. Resolving the leadership question was vital to success in key missions – like PPE distribution and mass vaccination efforts. Clarifying roles, responsibilities, and systems for future pandemics will be vital to avoid the mistakes we made as a nation during COVID-19.
The punchline is – the places where you’re going to find the types of systems needed to manage a pandemic at the state and local level, if they exist in the state, are in the emergency management enterprise. That is why our national public health system and our national emergency management system are inextricably linked – from a systems perspective and from a capacity perspective.
“But, also, there’s a real question about whether there’s been a sufficient level of investment in the public health domain, in view of what we went through with COVID. I think investment in public health at the state and local level is really important.”
“I think role clarity is also something that is important, as well as lifting up examples of strong collaboration between public health and emergency management – and not just celebrating that there was strong collaboration, but saying, “In these specific ways, this is what emergency management was able to bring to this most devastating public health response,” and “these were the things you saw where these capabilities worked well together and were able to change the outcome for people.”
“Leveraging the operational strengths of emergency management agencies to stand up vaccination sites was crucial – not because they had stood up vaccination sites before, but because they had stood up points of distribution to hand out supplies. You have to find a way to get cars into that place or people walking into that place. You have to set up ways to give them the thing they need.”
But also emergency management had to look to the public health authorities to say, “How do we get the right people in here who are in greatest need? How do we make sure that we do this in a safe fashion, that people get the right thing in their arm?”
“These are examples of how public health and emergency response can work well together.”
Fast, Flexible Spending
One of the largest challenges of the national COVID-19 response was the lack of fast capacity in the public health system to tackle large missions – like mass vaccination campaigns – by surging funding, logistics, and workforce across the whole country at the same time. FEMA has the authority to create “mission assignments” to pay other federal agencies to perform tasks for which they have the capacity. For example, the Department of Defense sourced medical providers from the DoD medical system around the world to support vaccination and medical missions across the country, and FEMA paid for that capacity.
All of those systems are built into the emergency management enterprise. It would be suboptimal to rebuild them in another place. Often the request was for funding, and, when you bring in emergency management, there’s an established way – a pipeline – to move funding very quickly.
“For example, on Inauguration Day 2021, President Biden had given FEMA the mission of establishing mass vaccination capability across the country.”
Before we even spun up the logistics of actually going and setting up sites, we started paying states for capacity to set up vaccination sites. I think we put out the first billion dollars on day 5 or 6 of the Biden Administration. Emergency management at the state level is familiar with the Public Assistance program that allows states to very quickly get grants from FEMA, in a Presidentially declared disaster, to carry out broadly defined “emergency protective measures.”
Getting Prepared for the next one
While it’s vital to align public health and emergency response systems and approaches for the next pandemic, it’s equally important to determine a more sustainable way to provide resources to states during the next major health emergency – what Bibo called “flattening the boom/bust cycle.”
I think COVID helped to train a next generation of subject matter experts in government, who are coming in from the outside. But, there also is a benefit to having more steady state capacity and less boom/bust.
“At the start of a disaster, the floodgates open, and there’s funding to do a lot to save and sustain life. You can hire a lot of subject matter experts and contractors who have varying experiences. They can really help change the outcome. “
“But having those people on hand beforehand would be preferable, building capacity in a state before something bad happens. FEMA is working with Congress to advance a measure that would allow for some evening out of the boom/bust staffing cycle, by carrying over management costs from one disaster to another.”