The Men and Women in Blue: A Revealing Perspective

In 1995, as a young lieutenant in the Commissioned Corps (the Corps) of the US Public Health Service, I watched the movie Outbreak. The plot portrayed an uncontained outbreak of the fictional Motaba virus that spread from Zaire, Africa, to a small town in California. I used to say, “I want to do that someday.” As unusual as that may sound, years later, it happened. In 2014, I was the acting Deputy US Surgeon General, discussing a potential mission with Acting US Surgeon General RADM Boris Lushniak and 2 other colleagues. The World Health Organization had declared the Ebola outbreak in West Africa a Public Health Emergency of International Concern on August 9, 2014. ¹ The White House National Security Council suggested a deployment of the Corps as a tool to curtail Ebola’s spread at its source in Africa. The outbreak came with uncertainty and fear. The discussion for and against deployment of the Corps was diametric: from “absolutely, we must go” to “it’s not possible.” Ultimately, it came down to the Corps’ ethos and the fact that the Corps was the only resource (uniformed or other) in the US government with the appropriate mission and mandate to accomplish the task. The response became arguably the most visible, austere, and unique deployment in Corps history.

To pave the way for this unique deployment, we conferred with all the appropriate leaders in the US Department of Health and Human Services (HHS), the HHS secretary’s advisors, legal counsel, and political appointees. We cleared several hurdles (and persistent myths) about the Corps’ legal authorities and ability to complete this type of international mission: caring for Ebola-infected people in other countries. At the time, those within the ranks knew the decision could have and should have been easy. This was the perfect health mission for the Corps. Could you imagine the US Department of Defense debating the use of the US Army or US Navy in times of war? Ultimately, the HHS secretary gave the green light, and on September 16, 2014, President Obama announced that the Corps would be deployed to Liberia. ² In doing so, the decision to deploy had long-standing positive effects for the Corps; it was a clear demonstration that the Corps could be wielded in an important way by future HHS secretaries to protect the health of people in the United States and assist other countries during crises.

Although it was a potentially life-threatening proposition, our officers were anxious to go. More than 75% of the Corps proactively volunteered to deploy within the first week of notice. With each tick of the clock, we knew Ebola was another step closer to the United States. In a subsequent planning session, the acting US surgeon general turned to me and said, “You’ll be the commanding officer.” It was a humbling appointment, knowing the responsibility was immense. However, I was 100% certain the Corps would succeed.

On the Ground

The facts about Ebola are rather sensational. Consider that the overall case fatality rate of COVID-19 in 2022 was just higher than 1.1%. ³ Ebola, on the other hand, often has a greater than 50% case fatality rate across outbreaks in history. It does not discriminate among young, old, those with or without chronic disease, any race, or geographic location. Fatality is usually caused by failure of an organ system or excessive internal bleeding—and death occurs quickly. Survival is basically the flip of a coin. Monrovia, Liberia, was the epicenter of the virus. At the height of the outbreak in 2014, nearly 400 cases of Ebola occurred in Liberia per week. ⁴

Given the gruesome nature of the disease and the loss of life among both African citizens and international health responders, one of the most critical and visible missions of this deployment was to establish a field hospital with a treatment unit dedicated to providing direct clinical care to Ebola health workers. ² This plan was strategic, because the volume of health responders from outside of West Africa was not sufficient in the fight. Speculation as to the low numbers was that options for quality care would be limited if responders were infected.

Standing up the Ebola treatment unit, which was known as the Monrovia Medical Unit (MMU), had many challenges, especially with so much uncertainty about the spread of disease, political sensitivities, and the support needed for a comprehensive solution. Enter the US Department of Defense’s logistics, procurement, and security resources, which proved to be a perfect partnership with the Corps’ medical and public health expertise. We forged the way together. In addition, we needed to train Corps officers in Ebola protection and clinical care. Few people have extensive experience in treating Ebola patients. One cannot simply provide personal protective equipment (PPE) (eg, face masks, gloves, Tyvek suits) and a stethoscope to an officer and expect that officer to care for Ebola patients. That is like attempting to train a special forces sniper in a day. It takes years. Our officers would be thrown into the hot zone to fight Ebola, so we not only had to provide intensive, quality training but we also had to do so in a setting with real patients—and quickly. A 2-phased process was developed. First, through a partnership with the Federal Emergency Management Agency’s Center for Domestic Preparedness in Anniston, Alabama, the officers received specialized PPE training. Second, we were able to strike a unique partnership in country, with Médecins Sans Frontières and the International Medical Corps, 2 nongovernmental organizations (NGOs) that were already established in Liberia. This was likely the first time in history that joint federal–NGO Ebola training was established. It proved essential. Our officers experienced Ebola care and hot zone training in 2 locations in Liberia before entering the MMU. It was a critical piece to success. Other challenges arose; for example, while we were in Liberia in the final planning stages, hospitals in the United States bought all available PPE, leaving no supply of appropriate PPE for our mission. We had to seek assistance from the National Security Council to ensure we had enough PPE for MMU personnel.

Amid all the critical decisions, one simple, yet unknowingly impactful decision, concerned the deployment uniform. It sounds pedantic, but there were arguments at HHS to have officers deployed in civilian wear to avoid visibility and the potentially negative sentiment of a military response. Admittedly, I may have been less than diplomatic in requesting that Corps officers deploy in blue operational dress uniforms (ODUs), a standard deployment uniform, for cohesion and visibility. The US Army had already deployed in its army combat uniforms. After early pushback from HHS, the HHS secretary authorized the Corps to wear its ODU. Then came the impact. Liberians and key leaders from the Ministry of Health, US Embassy, NGOs, and other international responders saw that Corps officers, both men and women in blue ODUs, were providing direct patient care, saving lives, and giving hope to a decimated country. The officers began to engender respect, trust, and optimism. As Corps officers ventured into rural areas, and as they treated Ebola patients from across the country, they were easily distinguished and continuously thanked by the local population as the “men in blue.” The local population saw the Corps and our nation caring for theirs.

The MMU had to be remarkable. We had to provide care for health care responders and demonstrate that quality Ebola care could be achieved in the field so that other countries would respond. As the world watched, Corps officers and partners generated the intended effect: other nations felt confident in sending their medical assets to West Africa to support the response, knowing our MMU was available. One month after opening the MMU, more than 1000 new health care responders and multiple new countries engaged in Liberia. The US response and the MMU were a beacon of hope that helped galvanize an international response. Ultimately, it stopped Ebola at its source. The objective was met.

To me, the most meaningful comment came from Colonel Thomas Harbaum, the commanding medical officer for Germany’s Bundeswehr in Liberia, who said, “When you showed up, you changed the tide of the response.” Our Corps-specific goals were accomplished despite many obstacles and challenges. One unintended impact of this response was that the Corps had written a new chapter in its history as a unique and essential domestic and international force to protect America’s health.

Need and Neglect

In the end, more than 300 trained Corps officers rotated through the MMU between late 2014 and spring 2015. ⁵ They cared for 42 responders from 9 countries. ⁶ However, more than 1000 officers engaged in additional deployments and missions, mission support, and domestic Ebola surveillance and training. Importantly, no Corps officers contracted the deadly virus. And, after strict quarantine requirements, all deployed officers returned to their homes safely.

The White House approved a Presidential Unit Citation to all officers in the Corps. It would be the first ever for the Corps—an incredible honor. On September 24, 2015, almost a year to the day President Obama announced our mission at the Centers for Disease Control and Prevention, I accompanied HHS and Corps leadership to the White House, where the president congratulated us for the mission we accomplished. ⁷

Once again, the Corps aptly responded when a need arose. From 9/11 to the Ebola response in 2015, officers were deployed to a public health emergency nearly every single day—and deployment continues today. Whether it is a natural disaster such as hurricanes Katrina, Rita, or Ike; a mass shooting such as Columbine; the anthrax attacks; suicide clusters in the American Indian population; or the COVID-19 pandemic, the Corps stands ready and responds 24/7, 365 days a year. Always there, behind the scenes, getting the job done. The Corps is 1 of 8 uniformed services of the United States with active-duty and ready-reserve components. Its servicemembers and retirees are veterans. What is even more surprising is that funding for all members of the active-duty Corps who maintain their full-time, day-to-day public health roles and stand ready 24/7 to deploy for public health crises, plus the Corps’ entire infrastructure, training, headquarters, payroll, and administrative services, costs less to US taxpayers than three F-22 Raptors. This comparison highlights the fiscal efficiency of a service that protects the health of Americans from disasters, outbreaks, disease, and public health emergencies that have killed far more people in the United States than all wars combined.

The Next Chapter

Since the turn of the century, the United States has witnessed a more discernible increase in public health emergencies, specifically viral outbreaks, than in the preceding 100 years. The threat of another pandemic is always around the corner. Unfortunately, within 2 short years after the historic and successful Ebola response, the Corps was slated for dissolution. ⁸ What has become customary since the turn of the century, however, is that the Corps has been threatened with dissolution multiple times. Serendipitously or not, another crisis comes before any dissolution has occurred. From hurricanes Katrina, Rita, and Ike to Ebola and the COVID-19 pandemic, the Corps has proved its worth when the country has needed it the most. To recognize that success, the Corps received a second Presidential Unit Citation in 2021, following its response to the COVID-19 pandemic.

The Corps is now 136 years old. It is a unique, agile, and fit force, responsive to public health emergencies and day-to-day health needs with domestic and international capabilities. The Corps’ mission, to “protect, promote, and advance the health and safety of the nation,” should resonate with the Trump Administration. These resolute service members have protected people in the United States and abroad repeatedly during outbreaks, from bioterrorism to responses to disasters and to providing care to medically vulnerable populations, such as American Indian/Alaska Native people and those who are incarcerated and detained. During the May 22, 2025, release of the “Make Our Children Healthy Again Assessment,” Secretary Kennedy stated, “It’s common sense that ultra-processed, nutrient-poor food contributes to chronic disease. It’s common sense that excessive screen time and isolation lead to anxiety and depression, especially in children. It’s common sense that exercise and healthy food come before prescriptions and surgery.” ⁹ This preventive paradigm, protecting and promoting healthier lifestyles, ultimately could reduce the health costs to the nation. The Corps, as a Uniformed Service of the United States, has attempted to promote and exemplify similar messages for decades.

By allowing the Corps to rise again and model the way for a healthier America, the Trump Administration will have unleashed its “health warriors,” an underused asset often muted until it is almost too late. My hope is that elected government leaders understand the true value of the Corps, with skilled officers, men and women, willing to step into the breach for the health of our nation. Our country depends on it.