Obama Tries A 'Throw Everything Against The Wall' Approach To Ebola

WASHINGTON -- One of the biggest challenges facing health care workers trying to solve the Ebola crisis in West Africa is the clothing they wear.

Hazmat suits protect doctors from contracting the highly dangerous virus. But in climates as humid and hot as Liberia and Sierra Leone, they can also become proverbial death traps. Medical officials often can spend only 40 minutes in their Personal Protective Equipment (PPE) before they have to take it off, struggling under heat stress to do so.

There is lighter gear available that allows for longer shifts. But even there, the problems persist. Because it's a laborious process to take equipment on and off, the constant need to change limits the time that doctors can spend with patients. The frequent, tricky donnings and doffings also endanger medical workers by potentially exposing them to the virus.

Faced with this hurdle, the Obama administration did something at odds with its reputation for insularity. It asked anyone and everyone outside the White House for solutions and offered $5 million in prizes for the best ones. The resulting Ebola Grand Challenge has, in a matter of weeks, seen more than 600 submissions.

"This is an unprecedented outbreak that required an unprecedented global response," said Wendy Taylor Director at USAID's Center for Accelerating Innovation and Impact. "By creating this grand challenge, we are engaging that broader global community of solvers to put the best minds to coming up with solutions that are desperately needed in the field."

The level of interest in the Ebola Grand Challenge has heartened Obama administration officials like Taylor, who hold out hope that from the heap of submissions they can pluck a medical breakthrough.

But more than that, the challenge exemplifies what has become a throw-everything-at-the-wall approach to the Ebola crisis from the administration. Not only is the White House asking innovators for help improving PPEs, it has also reached out to the academic research community and robotics community for suggestions on how technology can be leveraged for medical care in West Africa. The president met with his Council of Advisers on Science and Technology (PCAST) last week to encourage them to contribute ideas for immediate and long-term responses to pandemics. Administration officials, meanwhile, have hosted workshops for CEOs, started a Google doc for stakeholders to connect and created an open forum Skype group to encourage collaboration.

It is a frantic rush to catch up with a disease that caught political and medical professionals off-guard. Slow at first to react to the situation in West Africa, the White House dispensed of any pride of ownership when it came to finding solutions.

Administration aides say it was the president who had the idea to crowdsource the effort to unlock the PPE problem. Those aides didn't point to a "eureka" moment. Instead, they said that "stories from the field," made it to his office, convincing him of the need. The effectiveness of prior "Grand Challenges" also played a role. In one celebrated occasion, an Argentinian car mechanic produced a potentially remarkable breakthrough for easing child labor in impoverished countries.

On Sept. 26, Obama officially unveiled the PPE challenge in remarks at a Global Health Security Agenda Summit. At the time, the country wasn't nearly as panicked about the virus. It would be another four days before the first Ebola patient diagnosed in the U.S., a Liberian man named Thomas Duncan, would be admitted to a hospital in Texas.

Simply announcing the challenge didn't ensure its viability, however. The president's staff had to spread the word to prospective applicants. The Office of Science and Technology Policy and USAID were asked to lead the effort. They put together dual tracks. The first was a platform that gave applicants the opportunity to earn a grant up to $1 million for their idea. The second was an open innovation platform on the site openIDEO, where anyone could brainstorm on proposals.

They also broadened the ask. Instead of just focusing on PPEs, officials suggested people reconceptualize the larger medical experience, from influencing behavioral patterns to improving disease diagnostics.

"When we looked at this problem, we could have just said, ‘Alright, we need a PPE that meets these specs,’ and just put that idea out there," said Taylor. "But there are other ways that you can solve this problem. So by saying, ‘One of our challenges is that health care workers need to be able to spend longer time with their patients,’ then you can have people say, ‘Alright, well one way to fix that is by improving the suit. Another way to fix that might be by improving the care setting in some way. Maybe there are creative ways we can cool the environment so that the existing suits we have work better.'"

Entries ran the gamut: Ideas included installing carbon dioxide cooling vests under the hazmat suits, putting strong scents on surgical gloves so that doctors will be alerted before touching their faces with possibly infected material, refiguring faucets so that medical workers could turn them on and off with their feet, installing cooling decontamination showers for people to take in full PPE gear, and refiguring the hospital floor so that dysentery from patients could fall through grates below and flow down towards a hazard waste storage unit.

In addition to online forums, the administration also quietly asked industry officials to come to Washington to help. On the weekend of Oct. 10, 15 or so gathered at the Kaiser Permanente Center for Health in D.C. to discuss rapid-prototyped options for simpler PPEs.

Jay Buckalew, president of Coolshirt Systems, was part of the group. He said he was contacted out of the blue by the White House, and paid his own way to participate in the strategy session with fellow CEOs.

"It was basically, lets put the guys in the room who do this for a living," he said. "It was a good environment to be in."

Over two days, Buckalew recalled, the group brainstormed ideas and then split into smaller settings to tackle specific problems, from caregiver comfort to medical unit mobilization. As someone who already makes cooling gear for surgeons, race car drivers and other officials who operate in hot facilities, Buckalew had a simple solution: Use his product.

But so far, the administration hasn't gone for it.

"We have been in communication with those folks," he said. "The response we had was there was a process to go through with openIDEO, and then we will move rapidly."

To date, no money has been rewarded as part of the challenge.

Though the White House is trying to experiment beyond the usual government platforms in finding a breakthrough for PPEs, they have retained some basic bureaucratic restraints. People who are submitting proposals must collaborate on a "concept paper" with USAID. Those concept papers must be reviewed by an "Ebola Scientific Review Board." A contracting/agreement officer must review the board's recommendations. USAID must then work to help find collaborators and supplemental technology for meritorious proposals. After which, officials there enter a final review period where they negotiate over cost, effectiveness and instrument types. If the two sides can't reach an agreement, the project is canceled "at no cost to the Government," according to outlines of the proposal and procurement process.

This may seem like an awful lot of hoops through which an applicant must jump when trying to help tackle an infectious disease ravaging three separate countries. But administration officials say they are operating with both care and urgency. Any proposal has to be shown to actually work in the field before it can be deployed, administration officials noted. And even then, the global procurement process must run its course. You can build all the cooling backpacks for PPEs you want. But if the World Health Organization or Doctors Without Borders isn't trained on how to use them, they will remain packaged in a storage facility.

"We are putting in place clear and rigorous pathways that can rapidly test and deploy the best ideas," said an administration official.

The emphasis currently is on finding solutions that are deployable in six months time -- if not shorter -- though officials aren't writing off submissions that could have longer-term application. While the open-innovation platform at openIDEO will close on Nov. 15, the platform that includes financial incentives will continue to collect ideas. The first round of review for submissions from that platform is on Nov. 7.

Buckalew and others are trying to move the process along more quickly. On Wednesday, a group of companies including Coolshirt Systems announced that they were creating a joint venture to "produce a new hazardous material suit with built-in cooling" designed specifically to help health care workers treating Ebola patients in West Africa.

"We have been doing this for 17 years," Buckalew said. "We were more of the opinion we already have it, we can ship it today, how many do you want?"



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