CareTalk Podcast – Joseph Votel: Generals & CEOs Team Up to Prevent the Next Pandemic

The US was rated as “best positioned to respond to a pandemic,” yet it has struggled in its fight against COVID. General Joseph Votel (Business Executives for National Security) joins CareTalk to discuss where the US went wrong.

David Williams:

Hey, John, a CEO, a general, and a professor walk into the bar. What do they come out with?

John Driscoll:

Nice try at the joke, David, they came out with a call to action on the U.S. emergency response.

David Williams:

Guess we better answer it.

Welcome to CareTalk, your weekly home for incisive debate about healthcare business and policy. I’m David Williams, President of Health Business Group.

John Driscoll:

And I’m John Driscoll, the CEO of CareCentrix. So, David, who do we have joining us this week?

David Williams:

Well, John, we had one general, I think we should take a second and I’ll tell you why, we’ve been lamenting the fact that the U.S. has done poorly on the pandemic response in saying, “Who’s going to help? Who’s going to figure out what we need to do in the future?” So, John, I said, dial up another general, since we had one before, General McChrystal, and you were able to find yet another winner.

John Driscoll:

We are very lucky today to have General Joseph Votel, who has a storied career as a warrior, and as a leader, and as a public servant, who’s currently the CEO of Business Executives for National Security, which is a bit of a mouthful. Welcome, Joe, do you want to just first introduce us to who BENS is and what they do?

Joseph Votel:

Sure, John, it’s great to be with you and David today. Thanks for the invitation. So, BENS is a national nonprofit made up of business executives from across the nation, east to west, north to south. What we do is we share best business practices with our government partners. If you’re going to Abbottabad to get bin Laden, nobody really cares how much that costs, but the normal stuff of national security is in fact business and there is an awful lot that can be learned from the expertise of our members. So what we try to do is bring that expertise to real government national security problems and help our partners out.

John Driscoll:

You had a remarkable career running Joint Special Operations Command, and really playing a central role with coalition partners in kind of cracking the Islamic caliphate. It’s an unbelievable career. What drew you to this job? Why this job right now? To give people a perspective on how you’re approaching BENS’ mission.

Joseph Votel:

First off, I had experienced with BENS when I was in uniform on several occasions. I’d actually reached out to them to get some experts to come in and help me as we worked through some fairly difficult issues. So I had a very good impression and general understanding of what the organization did. Right before I retired, I was called by my predecessor General Norty Schwartz, who is an officer that I have a great amount of respect for, and he mentioned he would be leaving and asked if I wanted to be considered for this. And I said, sure, expecting never really to hear anything more it, but lo and behold, I did. So the fact that Norty reached out to me as an officer that I really respected and had a very deep and good relationship with, spoke very highly of the organization.

And then finally, the members have sold it to me as I went through the selection process. And the way I kind of look at it is, I think, as a way many of my predecessors have looked at it, is it’s another way to be involved in national security through another means. So you’re out of uniform now, so you’re not doing that type of thing, but this is a great way to leverage your expertise, to get to know the business community, and then to really help move forward on hard problems for our government partners.

John Driscoll:

Well, I think the biggest challenge we’ve had in national security has really been this pandemic and so we’d love to talk about how you and BENS and the Commission on National Response have come up with a quick report card and recommendations for the country. But, at least from where we sit, I think the country didn’t … While we have very successfully engineered vaccines, it certainly felt like we really weren’t prepared for a pandemic that at lot of different levels, we should have predicted.

Joseph Votel:

Well, yeah, I think that’s largely true. And I think as we got more and more into the pandemic, I think we began to see where a lot of our challenges were. I think we failed to do a few things up front that contributed to some of the problems we have with this. We had some very good plans in place that have been developed over a number of years about how to deal with a pandemic, and yet it seems that we didn’t pay attention to those, and we didn’t try to implement some of those plans. We had dismantled a number of offices and relationships over several years here that had made it very difficult for us to have the right tripwires in place and the right safety nets in place to understand what was happening and how quickly this was moving.

And then I think, finally, we really failed to orchestrate an effective communication strategy to the American people, in terms of how we were doing this. As everybody would recall, this became fairly political quickly and that I think really complicated it. And so rather than getting everybody focused on what they needed to do to prevent the spread, I think we lost a lot of valuable time early on as we were trying to get organized for this and we had mechanisms in place to help us with that.

David Williams:

Yeah, I think it’s pretty clear that the U.S. didn’t do a very good job and it’s good that BENS was there in order to convene this Commission on the National Response. Before we get into some of the lessons learned from that, are there things that are fundamentally different about COVID from other disasters? Certainly you mentioned how the response became politicized and so on, but is there something fundamentally different about COVID?

Joseph Votel:

Well, I think what’s fundamentally different about the pandemic, about the COVID pandemic, is that it was a sustained and nationwide emergency for a long period of time. Our emergency response system, it is excellent, it is really good, we got great people doing this, but it is geared for regional, local, shorter duration disasters. Tornadoes, hurricanes, floods, natural fires, a lot of natural disasters that we can deal with in a relatively short, confined period of time.

What happened with the pandemic and with COVID-19, is it persisted, it was sustained, and it affected everybody at once. So the demand wasn’t just one state, one locality, one region, it was the whole nation. And what that ended up doing, I think, is it exposed the vulnerabilities and weaknesses in our system. When everybody is asking for help at the same time, and we’re having to sort through significant priorities and everything as we do this, I think it just really, really exposed a lot of vulnerabilities in our system.

John Driscoll:

And do you think … I mean, for me, the reason why this is such a pertinent topic is there’s no greater public disaster than all of the people who’ve gotten deathly ill or who passed based on COVID. I mean, if you take Dr. Birx’s own retrospective view, we could have saved a hundred thousand more souls if we’d gotten our act together. And certainly New Zealand, Hong Kong, there were other countries that seem to … Taiwan, rather. Seem to get their act together quickly, at least partially because they’d sort of seen this in viral explosions with the avian flu. But I think that the thing that’s hard to crack from a healthcare perspective, you’ve got a problem with a federal system, but even a more discombobulated healthcare system. And I don’t know that we, as a country, are really well suited for a national viral attack. I think it sort of challenges some of the basic structures that the United States has been built on.

Joseph Votel:

I would agree with that. And I don’t want to pass myself off as a healthcare expert, I’m a general officer, and by definition, I’m generally knowledgeable about a lot of things, but I’m not a healthcare expert on this, but it seems to me that what you’re saying is correct here. But a way of overcoming that is by strong initial leadership from the federal level to get a plan in place, and establish good communications with people, and try to set priorities and make it clear how we’re going to approach that.

My personal view is I think we struggled with that certainly in the first few weeks, but probably the first few months of this. And I think as anybody would recognize, when you’re responding to a disaster, when you’re responding to a rapidly developing situation, it is much better to get it early on than it is to allow it to develop and then you’ve got a bigger problem to control. So I think we needed to be stronger and more affirmative in our approaches in the early weeks and months of the pandemic.

David Williams:

So clearly there’s some lessons learned about the role of federal government versus state and local agencies. What about the role of the private versus the public sector? Clearly we have a strong private sector in this country and the healthcare system is more private than it is elsewhere. How do you think about the role of the private economy versus government?

Joseph Votel:

Well, I think it’s absolutely essential. I mean, the problem statement that we laid out for ourselves when we undertook our commission to address this, was how do we develop a better model for private, public, and civil sector cooperation, collaboration, and communication in times of sustained emergencies like this. So no doubt the private sector has a huge role to play in this. And a lot of the supplies, a lot of the materials, a lot of the necessary tools that are needed to address the situation, reside in the private sector. And so there has to be an effective way of tapping into that.

I think the big lesson learned out of all of this is that the federal government can’t do it by itself, the state governments can’t do it by itself. It takes this layering approach of government, the public sector, the private sector, and civil organizations to really bring all the tools that need to be applied to address a sustained national emergency like this one was.

John Driscoll:

General, where would you start? I mean, you’ve called out personal leadership and ownership of the problem. The second thing you called out is making sure there’s a national and a state solution. Those make sense, I mean, everyone understands governors and presidents, how would you pull in the private sector and what would you have them do? Because I don’t think that this is going to be the last pandemic we’re going to deal with. If you look at just zoonotic species, the convergence of a much more connected world, not just in terms of communication and data, but in terms biology, if that’s a threat that’s going to happen and that piece, you wonder … I think of public-private partnerships as sort of an unnatural act, in some ways, in the United States. How would you make it work?

Joseph Votel:

Yeah, to some extent it is, but I think there’s good examples of where this has taken place. I mean, the way that I think about this, John, is … I mean, I’m a military guy thinking about this here, I think one of the things you have to do upfront is get your command and control [inaudible 00:12:23], you’ve got to get somebody in charge of this. And the organization that is best suited in our government to handle all kinds of federal disasters is FEMA, the Federal Emergency Management Agency. That is what it is designed for. It’s not peculiar to natural disasters, it has got the right people, the right structures, the right support to really help manage this. So it’s really critical to get the right people in place. And what needs to happen within that is we do need to look at some of the structures that we have within FEMA that bring in the private sector and include them in the planning early on.

There is a tendency, frankly, to view the private sector as vendors and not partners in this and I think this is a big problem. I think you learn that over time, that they have got to be partners in this, they’ve got to be incorporated into this, they have to be integrated into the National Response Coordination Cell that FEMA has, and we’ve got to make sure that there is a very clear representation in these entities right here, right from the start. It’s absolutely essential. If you don’t and try to bring it in later, you’re going to miss something.

David Williams:

John, I noted in this report that there were 11 different recommendations in across three different categories, and maybe we can delve into a couple of the more interesting ones, they’re all interesting. But the three categories, as I read them, were about facilitating communication and coordination, delivering supplies and volunteer resources, and leveraging technologies and all of those had multiple things within it. One of the things that was interesting on the facilitating communication and coordination, there was a recommendation to expand the inclusion of non-traditional partners. What sort of partners are they and what kind of role could they play?

Joseph Votel:

Certainly, David. It certainly includes businesses and it includes businesses of all sorts. I think what we learned out of the pandemic here, is that there are so many different sectors of the business community affected by this over a long period of time, that there needed to be more people brought into this. So the first piece is we’ve got to have a more effective way of reaching out to businesses. I think the other aspect is we’ve got to have a very effective way of working with civic organizations as well. There are a variety of them around the country, and most of them are locally oriented, but they bring some extraordinary capabilities. If you look at an organization like Team Rubicon, for example, that leverages veteran resources across the nation and brings veterans volunteer services to disaster areas or areas in need. I mean, this is an extraordinary capability that has continued to be refined over time, but there are more out there like that that can do more for us.

One of the things we found out of this is there is no shortage of Americans willing to step forward and volunteer [inaudible 00:15:32], but there is a problem with how those people get to the point of need. And so one of the recommendations we do make in this is the establishment of a volunteer aggregator that provides, through an app form or a website, there are a variety of different forms it can take, where people can actually get on and volunteer and then be directed in the right way. I don’t think that’s something the government needs to do, I think there’s organizations out there that can probably do this, but we need to do a better job of leveraging those types of resources that are so essential to responding to these kinds of crises.

John Driscoll:

Sort of a COVID corps.

Joseph Votel:

Well, yeah, we would call it a Civilian Expertise Reserve, if you will, loosely modeled after the National Guard. There are a couple different categories. I mean, there are certain people that have emergency skills that have to be refined, that are in short supply, and we really have to know about those and we have to be able to leverage them quickly. And we’ve got to incentivize people, we’ve got to incentivize businesses to support that kind of stuff.

And then there’s the broader volunteers, people that are labor and can do things for us, but they don’t necessarily have specialized capabilities, they just have the willingness to help. And that’s important as well and that can be helped through the volunteer aggregator and the Civilian Expertise Reserve could handle some of the more sophisticated technical skills that are needed for emergencies.

John Driscoll:

I think a lot of people wanted to help, but didn’t even know how to plug-in. There was a sense that … I think Team America will show up, if Team America knows what role it needs to play.

Joseph Votel:

That’s right and that’s the whole point. That’s the whole point. We have to have a way of bringing all that together and getting people’s interest and efforts focused at the most important locations.

John Driscoll:

And that’s, for me, David, how it ties back to healthcare, because if we don’t have this connective tissue or spinal structure to lean on in a crisis, I don’t think our healthcare system … Which we have the best public lab system in the world, we’ve got the best CDC in the world, we’ve got the best hospitals in the world. We’ve proven through the vaccine program that we can actually invent and deploy at scale quickly, but without those other parts of emergency response, I think they’re disconnected. They’re disconnected from the body that you need to put together to respond at scale.

David Williams:

John, I thought it was interesting that the report mentioned a couple of things that were related to the conversation you and I had about infrastructure and its role in healthcare earlier. Two of these were in the leveraging technology section of the recommendations. One was about connecting every American and the other one was keeping pace with security and technology advances. Can you explain how that fits in?

Joseph Votel:

Sure, absolutely. So when we started this out, when we started our commission, we actually focused our BENS members and outside experts in really five different areas. We looked at supply, we looked at surge, we looked at human resources, we looked at roles and responsibilities, and we looked at infrastructure. And frankly, when we stepped into that, we actually thought we’d be looking at what people think more traditional about infrastructure, roads and railways and airports and things like that. But what we very quickly arrived at was the infrastructure that is most vulnerable to us is our digital economy. And it’s our reliance on digits to communicate, to do everything for us. And what we came to recognize was that we had real inability to share information between local, state, and federal level. It’s extraordinarily difficult to have, what those of us in the military would call, a common operating picture about what was happening in a particular area.

All of that of course is driven by data, but yet we lack the ability to pull all of that effectively together and use it to help drive decisions and policy making at the national or state level. So this really, really highlights it. I mean, a lot of the … We talked to a number of state emergency managers as part of this and what we came away with is we did have a variety of outdated systems. I mean, all of these have to be updated routinely. We’re really hedging our bets if we don’t do this and so you’ve got to get these things updated. We’ve got to establish commonalities for how we share information in times of emergency. There’s at least 50 different ways we’re doing it out there right now with all of the states.

And as you mentioned, when the pandemic struck and people we’re working from home, they’re going to school from home, they’re getting their information from home. The fact that somewhere between 19 and 40 million American families don’t have reliable access to broadband is a real problem. When you can’t get on and access information, you can’t get your kids to school, you can’t work from home, this exacerbates the problem. And this was a really strong point in the commission and to the point where some of our commissioners really viewed this as a right for Americans to have access to the reliable broadband. And there’s a huge amount of interest on this topic, in and of itself, in Congress right now, just to try to address this broadband issue.

John Driscoll:

Right, and I think once you get everyone connected with broadband, which is absolutely necessary, the other thing we have to solve for is data standardization and access in healthcare specifically, because from a Healthcare National Security perspective, we have to have visibility. It’s like you can’t be blind to the enemy you’re fighting when you’re fighting this kind of a virus, and today we, as a system, don’t have a way to systematically grabbing that data. I guess, unless you were to somehow twist the Defense Production Act into some [inaudible 00:21:50] that you would build and then just require folks to report it. But there really isn’t an easy way today to know how many people are hitting which one of the five or 6,000 emergency rooms, with what conditions, on any given day. And that means we are relatively blind.

Joseph Votel:

Yeah, I think this is an absolutely essential aspect of this. Trying to create common tools between different levels of emergency management as we share information, and I know you’re focused on the healthcare information here, which is absolutely vital in this, I think is essential to this. I would just share with you on the technology piece, I think one of the other areas we focused in on was this idea of modeling. I know early on, there were a lot of different models being developed by academic institutions and businesses and others across the country here. And they got better as time went on, but we need a more mature modeling capability as well. And that, I think, gets into the digital aspect of this, the ability to model and understand what’s happening based on the data that’s coming in, is absolutely essential, especially when we’re trying to [inaudible 00:23:06] control over something like a pandemic.

David Williams:

One of the things that I really liked about the report was the specificity of the recommendations, which lend themselves to being incorporated into policy, into legislation. Sounds like that may already be happening. I did note there was another broader and kind of a vague thing, but it may be particularly important, which is about the role of trust. You mentioned early on about how the pandemic response became politicized, and you noted the importance of building trust, and I’m wondering, how important is that? How do you do that, especially now?

Joseph Votel:

Yeah, well, I think you’re hitting on perhaps one of the key challenges of the whole pandemic here, and that is that we did not have great trustful relationships between multiple levels. Between multiple levels on government and then in some cases, between the different sectors, public, private, civil, and I think that does slow it down. Trust is really what brings those different levels, those different sectors, together and allows them to focus on the problem at hand. From my own personal view here, my own experience with trust, again largely through a military lens, but I think it’s universally the same, is that I think it requires that people at both sides of the trust equation here to listen, understand, before they start responding, understand what people are telling you.

I think it’s absolutely essential to invest in relationship building. That is why the routineness of relationships with business, relationships with state and local emergency managers, is so important. My boss one time was Bill McRaven, of Osama bin Laden fame here, but what he used to always say is, you cannot surge trust in a crisis. That has got to be developed beforehand by investing in the relationships. And when we don’t do that, we can’t expect people to immediately enter into trusting relationships if we haven’t done the work upfront.

And then finally, I think what’s absolutely key for trust, is to be responsive to people and to be inclusive of their views and opinions, data, information, other things into the bigger problem. Everybody I think can agree, we wanted to address this quickly, but yet we were unable to do that. And I do think trust and lack of trust played a significant factor in this case.

David Williams:

John, last question to you.

John Driscoll:

So where do these recommendations stand? If people agree with you and agree with what we’re bloviating on, how do we turn the ideas into reality?

Joseph Votel:

That’s a great question. So BENS is not a think tank, we think of ourselves as a do tank, so we’re really focused on trying to force implementation of this. And so what we’ve done is we’ve been engaging with Congress. I’ve testified and we’ve had other members testify, on a couple of different occasions here, to various committees up on the hill. As part of our commissioners, we had two U.S. senators, Senator Hassan and Senator Cassidy were both commissioners, and they have been extraordinary champions for us and are actually drafting and moving legislation now related to our recommendations.

We’ve also reached out to the National Governors Association, we’ve had several sessions with them. Talking to emergency managers in each of the states and trying to share the ideas with them. We’ll be meeting with the Federal Emergency Management Agency’s National Advisory Council, actually tomorrow, to talk with them about this and we’ve talked with people in the administration. So it’s an all hands, all domain approach here trying to get the recommendations out. And what we’ll do is we’ll watch the progress as they move forward and apply effort where we need to, to kind of keep these things moving forward.

David Williams:

Well, that’s it for yet another edition of CareTalk. I’m David Williams, President of Health Business Group.

John Driscoll:

And I’m John Driscoll, the CEO of CareCentrix. Thank you General Votel for joining us.

 

About Gen. Joseph Votel:

Continuing his long, distinguished career of service and senior leadership, General Votel today serves as President and CEO of Business Executives for National Security (BENS) – a national, nonprofit comprised of senior business and industry executives who volunteer their time and expertise to assist the U.S. national security community. In this role, General Votel leads a driven, multidisciplinary staff – spread across seven regional offices – and advises and executes on the strategy put forth by the BENS Board of Directors and the organization’s 400+ dedicated members.

General Votel joined BENS in January 2020 following a 39-year military career where he commanded special operations and conventional forces at every level; last serving as the Commander of U.S. Central Command (CENTCOM) where he was responsible for U.S. and coalition military operations in the Middle East, Levant, and Central and South Asia. General Votel’s career included combat in Panama, Afghanistan, and Iraq. And he notably led the 79-member coalition that successfully liberated Iraq and Syria from the Islamic State Caliphate. General Votel preceded his assignment at CENTCOM with service as the Commander of U.S. Special Operations Command and the Joint Special Operations Command.