Midterm Take-Home Examination
PSCI 24733: Global Disaster Politics
Spring 2021
Answer ONE essay from EACH GROUP (for a total of two). Each essay should be 3-4 pages, typed,
double-spaced, and rigorously apply a standard academic source citation style. Be sure to address all
aspects of the questions, to relate your answers carefully to course material and any other supporting
evidence. You should submit this as a single Word document, and you can used a combined
Bibliography or Works Cited at the end of the two essays. Please note: Your answers should not
overlap significantly with previous written work for the class (e.g., past Response Papers).
These midterm essays are due in the Moodle submission portal by Wednesday, March 17, by 12:00
noon (Wooster time).
Group I: Answer ONE of the following questions (worth 50 points):
1. What is a disaster, and how should governments respond to them? Develop a detailed essay that first
defines disasters and draws strong connections to course readings and theories. Next, critically analyze
the political and moral implications to respond to disasters that flow from such a definition. For the last
third of your essay, apply these arguments to analyze developments in the Iceland-Z crisis simulation.
2. What does the theory of bureaucratic politics tell us about disaster response? What are the implications of
Schneider’s arguments about bureaucratic and emergent norms in this context? For the last third of your
essay, apply Schneider’s framework to analyze developments in the Iceland-Z crisis simulation.
3. Critically analyze all dimensions of the following claim: “Democracies provide the most effective
responses to disasters.” Develop a detailed essay incorporates arguments from Tilly, Hannigan, Fenner,
Kleinfeld, and others to speak to this question. Finally, relate these arguments to our experiences in the
Iceland-Z crisis simulation.
4. Which is more essential to effective disaster response—leadership or public trust—and why? Develop an
essay in which you champion one of these dimensions over the other based on your studies of
comparative public policy, and draw in detailed examples and arguments from course material. How did
these perspectives inform your experiences in the Iceland-Z crisis simulation?
Group II: Answer ONE of the following questions (50 points):
5. Develop an essay that compares and contrasts the following two comparative public policy theories:
Punctuated Equilibrium Theory and the Advocacy Coalition Framework theory. What are the primary
arguments or assumptions of these theories? Who are the most important actors that they study? How are
they similar or different? Finally, describe how one of these theories works to provide sound analysis in a
mini-case study.
6. Which is a more serious disaster: COVID-19 or climate change—and why? Develop a carefully
constructed comparative public policy analysis of this question by drawing on arguments from Dodds,
Hannigan, Harrison, and other readings.
The Iceland-Z Viru
s
:
National Security Council Disaster
Management Simulation Handbook
Global Disaster Politics:
Comparative Public Policy, Emergency Management, and Problem-Solving
Political Science 24733: Special Topics in Comparative Politics
Simulation Designed by Professor Jeffrey S. Lantis
The College of Wooster
2020-2021
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Part I: Simulation Overview
Welcome to a role-playing simulation of crisis meetings of the National Security Council
dealing with a global pandemic. The theme of this crisis decision-making simulation is: What
should the United States do to respond to an increasingly severe outbreak of a deadly
virus? This is a perennial and highly relevant theme for national security, human security, and
global public health. You will be assigned to work in teams to represent roles as national
security “principals,” including the President of the United States, the Director of the Centers
for Disease Control (CDC), Secretary of State, the Secretary of Defense, the Director of
Central Intelligence, the Secretary of Homeland Security, etc. Participants will engage in a
series of deliberations on the best response to a hypothetical policy crisis scenario. Your goal is
twofold: to faithfully represent your assigned role and to try to develop strategies and
interagency agreements that you believe will most keep the U.S. population safe. You will
make decisions about how to proceed in the face of an emergency, how to prepare and protect
the community, and how to ensure such a crisis can never happen again.
The simulation will run for approximately one week of the term. This handbook provides you
with the necessary tools to begin your research and preparation, including background
information on the crisis, web resources, rules of procedure and suggestions for further
readings. The handbook also includes information about your role groups and directions and
themes for further investigation during the exercise. There are three major “rounds” of the
simulation, divided between intra-group and inter-group deliberations and negotiations. The
simulation is structured to fit the class meeting schedule, building to an effort to develop a
working consensus on the third day of the simulation. We will also follow a set of rules of
procedure, designed to facilitate negotiations and allow for simulation time to be divided
between informal deliberations and formal presentations. During informal periods, players
meet with each other to debate and design policy solutions. In our formal presentations,
bureaucratic representatives make speeches, respond to questions, and introduce and debate
resolutions to these problems.
Role-playing simulations are popular active teaching and learning approaches, and their
effectiveness in promoting engagement and critical thinking is well documented in the
scholarship on teaching and learning. The simulation is also designed to promote knowledge of
important contemporary issues and different bureaucratic perspectives. As you work with other
students to attempt to influence policy, you will gain important insights about decision-making
and experience the process of problem solving first-hand.
Pandemics and Global Health: Background Information
Pandemics, defined as the spread of infectious diseases over wide regions of the world and in
high concentrations in the population, have been responsible for the greatest human death tolls
in history. For example, the bubonic plague killed approximately 25% of the entire European
population in the 14th century. The A/H1N1 pandemic of Spanish influenza (or “Spanish flu”)
pandemic in 1918-1919 led to the deaths of 50 to 100 million people. More American soldiers
in World War I died from the flu than were killed in combat. In the 1950s, societies struggled
to overcome the polio epidemic, a disabling and life-threatening disease. Polio was eventually
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eradicated in the western world with the development of a vaccine. Over the past few decades,
sporadic cases of avian influenza have threatened the globe, including the H5N1 virus in the
late 1990s. Severe acute respiratory syndrome (SARS) was a viral respiratory illness caused by
a coronavirus, called SARS-associated coronavirus (SARS-CoV), that emerged in Asia in
February 2003. The illness spread to more than two dozen countries and killed nearly 800
people before the outbreak was contained through isolation, contact-tracing, and quarantine.
The H1N1 swine influenza virus epidemic first emerged in the United States in 2009 and
quickly traveled around the world. It is estimated to have killed more than 12,000 people in the
United States, and as many as 600,000 worldwide.1
Developing Responses and COVID-19
Over time, these episodes of the spread of infectious diseases have been both tragic and
informative. Scientists learned that epidemics of infectious diseases are caused by the spread of
microbes. They have constructed hypotheses about diseases, tested them, and reported the
results widely. These findings have enabled our society to grow almost used to seeing the
spread of some of these diseases, such as the common cold, flu, strep throat, and chicken pox.
Science shows that these illnesses are often passed from person-to-person through touching or
aerosol droplets (through speaking, coughing, or sneezing, for example). Most of these are
survivable and manageable, though severe influenza is responsible for an average of 30,000 to
60,000 deaths annually in the United States. In some of these cases, exposure can equal life-
long immunity from repeat infections. Careful observation and analyses of these patterns can
promote greater knowledge of the threat and potential responses.2
The study of the spread of diseases through groups of people at the population level requires
detective work. When an outbreak occurs, policy-makers and medical epidemiologists try to
discover how they are distributed in a population in terms of person, place, and time. They seek
to know the nature and scope of the threat (e.g., Is it local? How does it spread? Is it global?
How fast can it spread? How long with the threat last?). These clues help to form a hypothesis
for how and why a disease is transmitted. They study patterns of disease acquisition and
transmission, and develop hypotheses for how and why viruses are spread.3 They then work to
isolate the virus, replicate it in the lab, and begin studying treatments or cures. Along the way,
policy-makers must reckon with critical questions related to the implications of science for
regulation, especially questions of what types of behaviors remain permissible and how to
maintain mission-critical functions of government and society.
All of these issues, and more, arose in the COVID-19 pandemic of 2019-2021, a widespread,
lethal global health crisis. In December 2019, a new coronavirus (SARS-CoV-2) emerged first
in Wuhan, China, and quickly spread around the world. The acute respiratory syndrome caused
hundreds of thousands of deaths across more than 100 different countries within the first four
months. The World Health Organization declared COVID-19 to be a global pandemic in
March 2020. Not only did scientists find that the disease was highly contagious and easily
transmissible, but its infection fatality rate (IFR), estimated between 1-2 percent of those
infected, raised alarm bells for the public health community. This was compared to the
seasonal influenza IFR of 0.1 percent. By December 2020, the global death toll of the COVID
pandemic was 1.75 million people, and rapidly growing.
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Various governments, nongovernmental organizations, and international governmental
organizations have sprung into action in response. Their first step was to trace and study the
disease. Scientists in the People’s Republic of China successfully sequenced the genetic code
of the novel coronavirus and shared this information with the world in January 2020. Western
nations were somewhat slow to respond to growing crisis, however, and it took time for them
to better understand the nature and depth of the problem. Once they recognized its severity,
though, responses to the pandemic applied an all-of-government response in many countries.
Not only did governments formulate potential responses, they worked closely with all sectors
of societies in attempts to regulate or encourage changes in citizens’ behaviors.
Epidemiologists and public health experts scrambled to try to respond, and they had to balance
their scientific studies with policy concerns. Here we discuss evidence from a selection of
research topics relevant to pandemics, including work on navigating threats, social and cultural
influences on behavior, science communication, moral decision-making, leadership, and stress
and coping. In each section, we note the nature and quality of prior research, including
uncertainty and unsettled issues. Seeking effective response to the COVID-19 pandemic and
highlight important gaps researchers should move quickly to fill in the coming weeks and
months. The pandemic has led to a massive global public health campaign to slow the spread
of the virus by increasing hand washing, reducing face touching, wearing masks in public and
physical distancing.4
Figure 1. Phases of COVID-19 Pandemic Response 5
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Schedule Synopsis
Participants will be assigned to groups representing key executive branch players and other
actors engaged in policy-making. Each role group is provided with background worksheets
which include directions and themes for further investigation during the exercise. The goal of
this exercise is to develop strategies and interagency agreements that will keep U.S. citizens
safe! You will make decisions about how to proceed in the face of an emergency, how to
prepare and protect the community, and how to ensure such a crisis can never happen again.
There are three major “rounds” or days of the simulation, divided between intra-group and
inter-group deliberations and negotiations. The simulation is structured to fit the class meeting
schedule, often building to an effort to develop a working consensus on the third day of the
simulation. We will also follow a set of rules of procedure, designed to facilitate negotiations
and allow for simulation time to be divided between informal deliberations and formal
presentations. During informal periods, players meet with each other to debate and design
policy solutions. In our formal presentations, bureaucratic representatives make speeches,
respond to questions, and introduce and debate resolutions to these problems.
Schedule Synopsis
Schedule
Day 1: This involves introductions, providing a rules briefing, directing preliminary intra-
group meetings on their bureaucratic perspective and potential policy solutions. The session
continues with brief presentations by groups outlining their preferred policy solution to the
crisis scenario. As a foundation for the in-class presentation, groups are required to draft a one-
page written draft policy statement outlining the themes they believe are most important, with
a detailed policy rationale. Each group is allowed three minutes to present their perspectives in
the group meeting.
Day 2: This day begins with an update on the crisis at hand. We will then initiate a period for
informal, inter-agency deliberations with the goal of building policy consensus. Players should
focus on development of draft policy directives through informal, inter-agency deliberations.
Ultimately, the National Security Advisor (read: Professor Lantis) will moderate the discussion
and promote the goal of policy resolution. Remember that for a policy directive to be an
effective solution, an oversized majority (two-thirds) of bureaucratic agents present have to
agree on and vote for the proposed solution by the end of the final session.
Day 3: We will continue to track breaking news and allow inter-agency deliberations. We will
share drafts of policy directives both informally and formally, with the goal of working toward
final resolutions. Day 3 also includes a round of voting, where each team will get to decide
whether they view the policy directives to be an optimal solution. The final phase of Day 3
involves presidential deliberation and announcement of final policy decisions.
Debriefing: The end of the simulation should focus on debriefing, providing an opportunity to
discuss individual and group experiences. This type of analysis is especially important because
experiential learning frequently occurs after, rather than during, an exercise.6
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Part II: Step-by-Step Simulation Guide
Day 1: Breaking News, Draft Policy Statements, Interagency Forum
Synopsis
Today’s session includes introductions, a rules briefing, directing preliminary intra-group
meetings on their bureaucratic perspective and potential policy solutions. The session
continues with brief presentations by groups outlining their preferred policy solution to the
crisis scenario. As a foundation for the in-class presentation, groups are required to draft a
one-page written draft policy statement outlining the themes they believe are most important,
with a detailed policy rationale. Each group is allowed three minutes to present their
perspectives in the group meeting. Thus, the briefing needs to be concise and creative in order
to gain the attention of other bureaucratic actors and the president.
Day 1 Schedule Details
For the first 20 minutes, your assignments are:
• Review your role assignment and profile sheet carefully.
• Review and consider background information, including the briefing handbook
and web resources. Then begin to process the current case through the ‘lens’ of
your role assignment, and prepare a brief presentation to the president based on
talking points. Remember that your briefing needs to be concise and creative to
catch the attention of the president.
• Consider answers to the following questions:
-What is your assessment of the severity and legitimacy of the threat?
-What are possible responses, and their pros and cons?
-What are your policy recommendations?
-Do you recommend a complete and immediate shutdown of society?
-Do you recommend everyone shelter in place where they are located?
-Do you close schools and stores?
-How to guarantee public service and food needs are met in this crisis?
-How to guarantee order and lawful behavior?
• Prepare your policy recommendation form and discuss who will present and key
points
Next 30 Minutes:
• First interagency policy forum—presentations by each role group.
• The President will decide on the order and timing of presentations, as well as
moderate debate, discussion, and questions as time permits.
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Rules of Procedure
• Students will participate in rounds of the simulation across class meeting days, and
they may communicate individually or in groups between sessions, as well.
• Students will follow guidance and complete worksheets and develop interagency
response proposals in sequence during the simulation.
• Delegates will address one another respectfully, and we will maintain decorum
throughout the process.
• Guidance and information about each phase of the simulation will be shared with the
class group as a whole, and the professor will be on hand to advise and support any
individuals or groups with questions.
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Day 1: Breaking News Report [To Be Accompanied by Video]
By: Matilda Overweather
WASHINGTON, DC–U.S. intelligence sources report that a new lethal virus has begun to
circulate across Europe. The virus appears to have originated in the town of
Zjornökierkegaard, Iceland, famous for its natural hotsprings and tourist resorts. Experts have
taken to calling it simply the “Iceland-Z” virus. The virus appears to have already been
transmitted to continental Europe, and rumors of some symptoms associated with the virus—
fever, cough, and itchiness—have begun to emerge in the United States. It has also already
proven to be lethal: Of the 100 known infections in Iceland, 20 people have already died.
Investigations have begun among EU emergency management personnel over the question of
how deadly and dangerous the virus might be and possible additional measures.
Background
European concerns about the transmission of a deadly virus are understandably linked to
wider public health worries in the post-COVID era. That disease, along with others like SARS
and H5N1, have been devastating to health and well-being of societies. According to Johns
Hopkins University data on COVID-19, the pandemic killed over 1.4 million people
worldwide, including 410,000 in the United States in 2020-2021. The disease was highly
contagious and easily transmissible, with an infection fatality rate (IFR), estimated between 1-
2 percent of those infected. Pandemics like COVID-19 also have devastating economic
effects. We have also learned that pandemics also require whole-of-government responses to
be most effective. The history of U.S. and global pandemic preparedness includes roles for
governments, nongovernmental organizations, and international governmental organizations.
Not only do governments formulate potential responses, they must work closely with all
sectors of societies in attempts to regulate or encourage changes in citizens’ behaviors.
What is Known about Iceland-Z?
So far, there is only scant evidence about the depth of this potential threat. Scientists have
learned that it is lethal, easily transmissible, and on the move. Common symptoms like coughs
and fever seem to appear quickly in patients, raising the possibility that carriers of the virus
are asymptomatic for some time before feeling ill. Like with COVID-19, this raises the silent
threat that the virus could be transmitted unknowingly.
Where is it? So far, about 100 cases in Iceland present these symptoms, but there may be
many more infected persons. The European Union Pandemic Preparedness Group based in
Geneva is currently trying to sample the virus in order to develop an effective test, and they
suspect that as many as 100 more people are infected across several European countries.
Finally, strange things are occurring in the United States, including a commuter plane crash
outside Albany, New York, and an unusual number of people calling off work due to sickness
along the eastern seaboard section of the U.S. Beyond that, much is speculation at this point.
The world anxiously awaits word of a plan or response from your presidential administration,
as dawn brings news of this virus and social media platforms begin to light up with rumors….
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Day 2: Breaking News, Interagency Policy Directive Negotiations
Synopsis
This day begins with breaking news and an update by groups on their positions on the matter
of solutions to the crisis at hand, as well as the development of draft policy directives.
Remember that it is critical for players to try to represent their assigned roles but also find
areas for agreement with other players. For an NSCS policy directive to be an effective
solution, an oversized majority (two-thirds) of bureaucratic agents present have to agree on
and vote for the proposed solution by the end of the final session. The role of the President
remains moderating and facilitating inter-agency dialogue in an effort to build a policy
resolution.
Schedule Details
For the first 10 minutes, your assignments are:
• Meet in groups to review and consider new information presented at the start of
today’s session. Then begin to process the current case through the ‘lens’ of your
role assignment, and reconsider any policy statements and directives that you
have developed so far.
• Consider answers to the following questions:
-What is your assessment of the severity and legitimacy of the evolving
threat?
-What are possible responses, and their pros and cons?
-How might your policy recommendations have changed?
Next 40 Minutes:
• Begin a period for informal, inter-agency deliberations is allowed with the goal of
building policy consensus through sharing clauses of draft policy statements. This
could involve large or small groups and plenty of discussion and draft writing. The
role of the President remains moderating and facilitating inter-agency dialogue in an
effort to build to a policy resolution.
• Develop draft policy directives: Groups that begin to establish consensus work
together to write draft policy directives using templates available in class. Students
should plan to meet outside of class to continue to develop policy directives for
presentations on Day 3.
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Day 2: Breaking News Report [To Be Accompanied by Video]
By Matilda Overweather
There have been concerning new developments with the Iceland-Z virus in recent hours. The
latest reports tell us that the virus continues to rapidly spread across the EU and we now have
more than 1,000,000 confirmed cases here in the United States.
Tragically, the disease is proving extremely deadly, and scientists have confirmed that the
IFR is at 20%.
This virus is something the likes of which we’ve never seen, and the response has been the
same. All of Europe has shut down and put shelter in place orders into effect—all except the
UK, that is. Hospitals in Europe are overwhelmed, and are refusing patients at the doors in
many countries.
Social media has gone into a frenzy and store shelves are emptying as Americans remember
the challenges with getting essentials in March of 2020. Take a look at this clip from popular
TikTok user @erwinandco’s account, in an attempt to make light of the situation…A number
of Tik Tok users have also drawn associations between Gen Z and the Z virus, and have
created a popular dance routine that is usually accompanied by the line, “Make the Z virus
dance go viral!” I’m glad the youth of America can still create artistic, though somewhat
disturbing, content in such a challenging time.
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Day 3: Interagency Negotiations, Final Policy Forum, Presidential Announcement
This is the final day of our simulation dealing with a global pandemic. The theme of this crisis
decision-making simulation is: What should the United States do to respond to an
increasingly severe outbreak of a deadly virus? You are engaging in a series of
deliberations on the best response to a hypothetical policy crisis scenario, with the goal to
represent your assigned role and to develop strategies and interagency agreements that will
keep the U.S. population safe. You will make decisions about how to proceed in the face of an
emergency, how to prepare and protect the community, and how to ensure such a crisis can
never happen again.
Synopsis
This day begins with more breaking news and an update by groups on their positions on the
matter of solutions to the crisis at hand, as well as the development of draft policy directives.
These directives will be shared through a round of presentations, and the president will
moderate an inter-agency dialogue in an effort to build a policy resolution.
Schedule Details
For the first 10 minutes, your assignments are:
• Review and consider new information presented at the start of today’s session.
Then begin to process the current case through the ‘lens’ of your role assignment,
and reconsider any policy statements and directives that you have developed so
far.
Next 30 Minutes:
• Final interagency policy review meeting and presidential decision. The President
will moderate discussion and promote the goal of policy resolution.
• For a policy directive to be implemented, an oversized majority (two-thirds) of
bureaucratic agents present have to agree on and vote for the proposed solution by
the end of the session.
• The President then deliberates and announces a ruling on final policy decisions.
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Part III: Role Assignments
Role Assignment: Attorney General
Iceland-Z may represent a threat to U.S. security, but you have a number of concerns
related to your professional role and responsibilities.
• First, you believe this is a problem for states, not the federal government. And
you have a legal responsibility to dissuade the president from taking federal
actions that would violate states’ rights in these circumstances.
• Second, you believe that a strong federal response could open the government up
to legal jeopardy if treatments or cures are not proven to be safe.
• Third, you believe that a national mask mandate is unconstitutional and illegal,
and would open the administration up to a huge legal debacle.
• Fourth, you believe the president may not fully understand the legal complexities
in this situation. Their plans to issue emergency orders could be fraught with legal
landmines.
These positions are further complicated by the fact that your tenure in office so far has
not been easy. It has been plagued by legal and political challenges associated with
politics. In some ways, given your knowledge of the law and the Constitution, you bear
the heaviest responsibility of all in terms of deliberating on policy routes.
There are important legal, ethical, and societal issues to consider when it comes to any
action involving responses to the pandemic. And caution is the word.
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Role Assignment: Chairman of the Joint Chiefs of Staff
You represent the highest-ranking military officer in the United States. You are an old
‘war horse.’ Your position enables you to work with the chiefs of all military branches.
Even as the pandemic rises, you are keeping your eyes on the horizon. The world has
become a much more dangerous place. Terrorists that we had thought were vanquished
are now back with a vengeance and even threating the American homeland. Not only is
the threat of global terrorism on the rise, it is metastasizing into strains that are more
violent, better armed, better funded and more difficult to counter. You have seen credible
evidence recently, for example, of the potential for non-state actors to carry out crippling
cyber-terrorist attacks on the U.S. power grid.
You and your fellow ‘chiefs’ have also discussed scattered evidence that the Iceland-Z
virus actually did not originate from Iceland, but rather is a Chinese-inspired plot to sew
instability in the western world. China watched the United States and its western allies
nearly crumble during the COVID-19 pandemic, and they have expansionist plans that
would benefit from a weakened United States.
You believe that the intelligence is strong. Develop a convincing set of arguments that
the president must take immediate action in the interest of international and national
security.
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Role Assignment: Director of Central Intelligence Agency
All of the lights are ‘blinking red’ when it comes to Iceland-Z. This will become a global
pandemic, and allied intelligence agencies are gearing up to share information about how
to fight it.
At the same time, you have some very convincing new information about the origins of
Iceland-Z. You believe that the virus may have been intentionally released by the Chinese
government in Iceland, a country that they knew had huge volumes of trade and travel
with both North America and the European Union. The intelligence on Iceland-Z
whereabouts comes directly from your own clandestine operatives and satellite
reconnaissance. You believe it is rock-solid, actionable information. Thus, you will need
to convince the U.S. president that the United States should take concerted action against
the Chinese regime.
Given recent criticisms of U.S. foreign policy as “feckless”, the president desperately
needs a ‘win’. The president’s statement last Thursday that the United States does not yet
fully understand the nature of the virus was politically damaging, not to mention a
dangerous signal to the world of indecision.
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Role Assignment: The President of the United States
You are the most powerful leader in the free world, with a mandate to protect and defend
the Constitution of the United States. You believe that the Iceland-Z pandemic represents
a clear challenge to U.S. national security. You are also concerned about the instability
associated with pandemic rioting and societal unrest, and you must act to ensure the
future security of our nation.
Among your considerations should be short-term and long-term policy decisions,
communication with the public, and the issuing of emergency orders. You must also
coordinate with state and local authorities.
Your assigned role is special, though. You should listen carefully to the presentations and
take notes when needed. Following each presentation you will have an opportunity to ask
one challenging question of each presenter.
In the end, though, you have to do something! The media and members of Congress are
criticizing your policies as “feckless” in recent months. You may consider any
diplomatic, economic, political, or military actions to address this developing situation.
Your final policy choice should be well reasoned and insightful. Good luck!
PS: You should play the part as you see fit…you are not required to portray the current
president (or a recent one).
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Role Assignment: Secretary of Health and Human Services
You have many years of experience inside HHS, and you are relieved that the president
seems to be a moderate and thoughtful leader.
You are considered the leading expert in the government on pandemic preparedness and
response. You are not a scientist like Dr. Fenster at the National Institutes of Health, but
you are an expert on policy. You believe that the U.S. government should act quickly
with a central/federal government response to decisively to launch a massive pandemic
response program. Your organization, along with others focused on health and welfare,
have long considered pandemic preparedness an important priority, and you have
personally led dozens of meetings over the years, including after-action reports on
COVID-19 and studies of SARS, and potentially dangerous tropical diseases.
Your experience with interagency programs is also very valuable in this situation. Some
of your counterparts who lead government bureaucracies have other priorities and may be
less willing to find common ground. But you are committed to promote open discussion
and even compromise—so long as it helps you to get where you intend to go with a
massive response.
You should advocate for indirect and creative policy solutions to this crisis.
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Role Assignment: Director of the National Institutes of Health
Dr. Fenster, you are a legend in the fight against infectious diseases! You have served as
the director of NIH for seventeen years, and in this capacity you have helped prior
administrations battle pandemics and other serious public health challenges. You have
written three books on pandemic response and conducted probably a thousand interviews
over the years.
The one thing you know from your research, including time in the field researching
infectious disease transmission, is that the only way to respond to this crisis is a total,
immediate lockdown of government and society. The data on the possible infection-
mortality rate for this disease is off the charts—worse than any of the major influenza and
coronavirus pandemics that have struck the globe before. Worse than COVID.
You know the answer to this situation: we need an immediate lockdown or millions of
Americans will die. And we need it now.
Remember, you have a great deal of credibility, and it is possible that you might be able
to actually dissuade all the entrenched bureaucrats and military advisors from reckless
actions.
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Role Assignment: Secretary of the Treasury
Well, here we go again. Scientists and advisors to the president are concerned about the
spread of the Iceland-Z virus to a broad population and are considering drastic actions
like shutting down the economy. You cannot let this happen!
There are several major reasons for your opposition to any concerted government
response. First, you are painfully aware that the last pandemic of COVID-19 caused a
worldwide, deep recession that crippled the American economy for years. The costs of
the shutdown and then subsequent retrenchment by the population and the government
are still being felt. In many ways, you believe that COVID-19 will have a long-term
economic and psychological impact similar to the Great Depression a century before.
Generations will be scarred for life. Second, the U.S. government officials really have no
idea yet of the severity of the new threat and are hinting at rash actions that may
undermine the prospects for U.S. economic dominance. Third, we are losing to China.
Their authoritarian regime and state-controlled economy was the only one in the world to
rise up through the ashes of COVID-19 to take dominant control of the global economy.
Their immediate response to the pandemic last time allowed them to move on fully a year
before other governments could. If we take drastic actions in the United States, we will
likely end up with an economy as powerful as…Italy.
Your mission is to convince the president that the United States should adopt a slow and
cautious attitude and that we should keep the economy open (with some precautions) at
all costs.
19
Role Assignment: Secretary of Defense
Your mission is to convince the president that the military has a primary role in
defending against the spread of the Iceland-Z virus.
You know that the world is a more dangerous place today. There are threats on every
horizon. And only the military has the capabilities to respond to them effectively. You
should recommend decisive and strong action. This includes the use of the military to
restore order in unrest, to patrol the streets in cities that have experienced pandemic-
related problems, and to deliver needed food and medical aid.
You support a military operation to fix this problem, and you should think creatively
about military options that have a good chance of success. At the same time, you and
some other agency heads also have deep concerns about the reliability of this new
intelligence on the actual origins of Iceland-Z. You believe that the virus may have been
intentionally released by the Chinese government.
Consider military options, strategies, resources, and objectives carefully in light of these
circumstances.
20
Role Assignment: Director, Centers for Disease Control (CDC)
The U.S. Centers for Disease Control and Prevention (CDC) is the federal agency
mandated with protecting the health of Americans. It used to be among the world’s
preeminent health agencies, playing a crucial role in fighting disease globally and acting
as a first responder in outbreaks in the past.
However, your agency has faced sharp criticism, particular due to is failures during the
COVID-19 pandemic. The agency that you’ve known and loved for twenty years there is
actually on the precipice of being disbanded. In other words, this crisis response may be
your last chance—and you cannot afford to get this one wrong.
Here’s what you know, shared exclusively with you by your experts in the field:
• Iceland-Z is more contagious and more deadly than anyone seems to be reporting.
Hospitals in Europe will be overrun in a matter of days, and this has the potential
to sicken millions in the United States.
• Containment of this virus may be impossible, but your experts have begun to try
to promote radically different thinking: starving the virus! Given the fact that the
CDC failed to respond effectively to the early spread of COVID, your scientists
have a new plan: Mass evacuation and isolation versus lockdowns in place.
• Scientists predict that Iceland-Z will reach the east coast of the United States
quickly, so you should recommend:
-immediate closure of air and maritime travel on the eastern seaboard;
-mass evacuation of populations from urban areas in the northeast to temporary
quarters for one month in the Midwest.
This approach may sound radical, but isolation to starve the virus of victims has
effectively helped end the Ebola virus outbreak in Liberia in 2015 and a similar outbreak
of smallpox in rural India in 1997. Be bold, and good luck!
21
Role Assignment: Governor of California
You are a former Hollywood movie star and now serve as governor of the largest state in
the union, California, with a population of 40 million. Iceland-Z may represent a threat to
U.S. security, but you have more pressing concerns related to your own state and
immediate interests.
• First, you believe this is a problem for states, not the federal government. You
have a political and legal responsibility to dissuade the president from taking
federal actions that would violate states’ rights in these circumstances.
• Second, you believe that a state mask mandate and curfew laws are legal, but that
a federal plan would be unconstitutional and illegal.
• Third, you are convinced that the president doesn’t fully understand the health
complexities in this situation—that they are misguided and misinformed. Some of
the most serious research on Iceland-Z is underway at top California labs, and you
will have more information soon to make the most informed policy choices.
To further complicate this picture, you also have personal political ambitions that may
someday include a run for the presidency. You need to tread carefully, defend California’s
interests, and watch out for state’s rights. Good luck!
22
Additional Readings and Resources
Josh Wingrove, Susan Warren, and John Tozzi, “Virus Exposes U.S. Unreadiness, Testing
Trump’s Grip on Crisis,” Bloomberg News, March 20, 2020, pp.1-8.
Michael D. Shear, Shri Fink, and Noah Weiland, “Inside Trump Administration, Debate Raged
Over What to Tell Public,” New York Times, March 8, 2020, pp.1-5.
Laura Barron-Lopez, Holly Otterbein, and Maya King, “Health Professionals Warn of ‘Explosion’
of Coronavirus Cases in Minority Communities,” Politico.com, April 6, 2020, pp.1-9.
Melissa Healy, “Could a ‘Controlled Avalanche’ Stop the Coronavirus Faster, and with Fewer
Deaths?” Los Angeles Times, April 25, 2020, pp.1-13.
John F. Harris, “Admit It, You Are Willing to Let People Die to End the Shutdown,”
Politico.com, April 30, 2020, pp.1-11.
Kim Hjelmgaard, Eric J. Lyman and Deirdre Shesgreen, “This is What China Did to Beat the
Coronavirus; Experts Say America Couldn’t Handle It,” USA Today, April 1, 2020,
https://www.usatoday.com/story/news/world/2020/04/01/coronavirus-covid-19-china-radical-
measures-lockdowns-mass-quarantines/2938374001/.
Victor Asal, “Playing Games with International Relations,” International Studies Perspectives,
vol.6, no.3 (August 2005), pp.359–373.
Emre Hatipoglu, Meltem Müftüler-Baç, Teri Murphy, “Simulation Games in Teaching
International Relations: Insights from a Multi-Day, Multi-Stage, Multi-Issue Simulation on
Cyprus,” International Studies Perspectives, vol.15, no.4 (November 2014), pp.394–406.
Laura Horn, Olivier Rubin, Laust Schouenborg, Undead Pedagogy: How a Zombie Simulation
Can Contribute to Teaching International Relations , International Studies Perspectives, vol.17.
no.2 (2016), pp.187–201.
Stephen M. Shellman and Kursad Turan, “Do Simulations Enhance Student Learning? An
Empirical Evaluation of an IR Simulation,” Journal of Political Science and Education, vol.2, no.1
(2007), pp.19–32.
Brigid A. Starkey and Elizabeth L. Black, “Simulation in International Relations Education,”
Simulation and Gaming, vol.32, no.4 (2001), pp.537–551.
Kirsten Taylor, “Simulations Inside and Outside the IR Classroom: A Comparative Analysis,”
International Studies Perspectives, vol.14, no.2 (2013), pp.134–149.
Priya Dixit, “Relating to Difference: Aliens and Alien-ness in Doctor Who and International
Relations,” International Studies Perspectives, vol.13, no.3 (2012), pp.289–306.
Jutta Weldes, To Seek Out New Worlds: Exploring Links between Science Fiction and World
Politics (Basingstoke: Palgrave Macmillan, 2003).
23
Endnotes
1 “The 2009 H1N1 Pandemic,” CDC.gov, https://www.cdc.gov/flu/pandemic-resources/2009-
h1n1-pandemic.html.
2 Associated Press, “CDC: 80,000 People Died of Flu Last Winter in the United States,”
September 26, 2018, https://www.statnews.com/2018/09/26/cdc-us-flu-deaths-winter/.
3 Paul E. Waggoner and Donald E. Aylor, “Epidemeology: A Science of Patterns,” Annual
Review of Phytopathology, vol.38, no.1 (2000), pp.71-94.
4 Congressional Research Service, “COVID 19: Global Implications and Responses,” CRS In
Focus Report, June 12, 2020, https://crsreports.congress.gov/product/pdf/IF/IF11421.
5 Figure adapted by Lilia Eisenstein; graphic inspired by Regina Phelps, “COVID-19 Pandemic
Planning Phases—Where are We? and Where are we Going?” Risk and Resilience Hub, April 1,
2001, https://www.riskandresiliencehub.com/covid-19-pandemic-planning-phases-where-are-we-
and-where-are-we-going/.
6 Brent E. Sasley, “Teaching Students How to Fail: Simulations as Tools of Explanation,”
International Studies Perspectives, vol.11, no.1 (February 2010), pp.61-74; Michael Prince,
“Does Active Learning Work? A Review of the Research,” Journal of Engineering Education,
vol.93, no.3 (2004), pp.223-231.
S Y M P O S I U M
Leadership Tasks in Crisis Management
Crises and disasters put leaders, and their leadership,
to the test. In extreme circumstances marked by col-
lective stress and extensive damage, leaders are expected
to mount an eff ective response, protecting citizens and
minimizing consequences. Leaders must organize a set
of activities that includes sensemaking (understanding
the crisis), critical decision making, vertical and hori-
zontal coordination, meaning-making (formulating an
authoritative defi nition of the situation), and commu-
nication (Boin, ‘t Hart, Stern, & Sundelius, 2005; Boin,
Kuipers, & Overdijk, 2013). Th ese executive tasks are
hard to accomplish in the best of circumstances. Th e
dynamics of crises and disasters make it even harder.
Joint sensemaking is particularly important to
eff ective crisis management: if decision makers do not
have a shared and accurate picture of the situation, they
cannot make informed decisions and communicate
eff ectively with partners, politicians, and the public.
Many crises—ranging from 9/11 to Katrina, from
ORCHESTRATING JOINT SENSEMAKING
ACROSS GOVERNMENT LEVELS: CHALLENGES
AND REQUIREMENTS FOR CRISIS LEADERSHIP
ARJEN BOIN AND CYNTHIA RENAUD
Making sense of a crisis is an important task for leaders at both the operational and strategic level.
In the current article, we argue that there is a difference between sensemaking at the strategic and
operational levels of a disaster response. An “appreciative gap” may emerge between the two levels
as a result. Such a gap can cause stress and strife between the operational and strategic layers work-
ing on the same crisis event. Bridging the gap poses very specifi c demands on leadership at both
the strategic and operational level.
Sandy to Boston—have shown how hard it is to make
sense of a fast-moving threat that defi es plans and
eludes collective experience.
To develop a quick understanding of a new and
inconceivable threat typically requires a large number
of actors, operating at diff erent levels of the system, to
share and compare their picture of the situation. Th e
more actors and the more variety in organizational
stripes and feathers, however, the harder it becomes to
establish a shared picture of a dynamic situation.
In the response to large-scale disasters, we should
distinguish between the strategic and the operational
level. Th e strategic layer of decision makers is normally
comprised of the top echelons of response organizations:
police and fi re chiefs, city managers, Federal Bureau
of Investigation and Federal Emergency Management
Agency (FEMA) leaders, elected offi cials, and chief
executive offi cers of private businesses. Th ey typically
gather at an emergency operation center (EOC) and
manage a crisis from that location. Th is level of decision
makers will bear the scrutiny of after-incident reviews.
View this article online at wileyonlinelibrary.com • DOI:10.1002/jls.21296 41
823787949@qq.com
823787949@qq.com
S Y M P O S I U M
42 JOURNAL OF LEADERSHIP STUDIES • Volume 7 • Number 3 • DOI:10.1002/jls
Second, most people fi nd it very hard to cope with
stress and uncertainty (Kahneman, 2011). Th e brain
likes to eliminate uncertainties by suggesting a variety of
shortcuts or what psychologists call “heuristics.” Th ese
heuristics work quite well in normal times, as they help
us to make sense of situations we do not understand
right away. Unfortunately, these heuristics do not
necessarily lead to a correct picture of the situation.
Moreover, the brain’s sensemaking capacities quickly
deteriorate under stress. All this may lead individuals to
cling to the fi rst available (and convincing) explanation
of what is happening.
Th ird, group interaction often introduces additional
barriers to a correct and shared picture of the situation.
Th e particular way in which a group shares and
discusses pieces of information (even the order in which
it is presented), the relations between group members
(trust, dislike, etc.), the setting in which a group
convenes, and the behavior of the group leader all aff ect
the outcome of group deliberations. Seemingly small
factors may have disproportionate eff ects on a group’s
sensemaking abilities.
Fourth, organization theorists have pointed out that
many barriers within and between organizations often
prevent the necessary fl ow of information and the
sharing of perceptions. In his classic Man-Made Disasters,
Barry Turner (1978) explains how specialization and
division of labor in modern organizations create
and institutionalize diff erent ways of seeing, which, in
turn, can create collective “blind corners” (ways of not
seeing). Th is may lead to situations where some people
in the response network do not understand what others
in that network take for granted.
In normal times, institutional mechanisms such
as deliberation, specifi cation, and verifi cation
(characteristic of the bureaucratic process) compensate
for sensemaking shortcomings. But in crisis, such
institutionalized information-processing mechanisms
no longer suffi ce, as they are geared toward routine
processes.1 In the absence of such mechanisms, an
“appreciative gap” can rapidly emerge and divide the
strategic from the operational level.
An important factor is that both worlds operate on
diff erent time scales. First responders, as their name
implies, simply get there fi rst. It usually takes more
time for executives to arrive either at the command
Th e operational level is at the heart of the crisis: where
the explosion occurs, the shooting happens, or the levees
break. It is where ranking offi cers from all involved
disciplines fi rst respond to the scene. It is where operational
commanders (perhaps a sergeant or lieutenant) attempt
to make some sense of the situation so they can begin to
articulate orders and give direction to responding resources
in an attempt to get a handle on the situation.
Operational and strategic leaders operate in diff erent
worlds that are often separated by an “appreciative
gap”—deep diff erences in perspectives, aims, and
actions. In the current article, we explore how the
diff erent dynamics of both response levels aff ect joint
sensemaking. First, we conceptualize the idea of an
“appreciative gap” separating the operational and
strategic levels. We then probe these dynamics at both
levels, after which we briefl y consider strategies that
may help to bridge this gap.
Joint Sensemaking Across a n
Appreciative Gap
A crisis combines three elements that together pose deep
challenges to crisis managers: there is a collective per-
ception of threat, which must be immediately addressed
under conditions of pervasive uncertainty (Rosenthal,
Charles, & ‘t Hart, 1989). Sensemaking is the set of
activities aimed at coping with that uncertainty.
When a situation is new and baffl ing, crisis managers
must try to get information, analyze it, establish a
picture of the situation, share that picture, and update
it as new information becomes available (Weick, 1995).
As simple as this may sound, joint sensemaking in crisis
often fails. Th e literature off ers at least four types of
explanation for this failure.
First, the chaos of crisis is not conducive to rapid
sensemaking. Normal processes of information and
communication often fall apart, organizational chains
fragment, and key information (What’s the cause?
How many people died? How many wounded?) is
simply hard to come by. It takes precious time and
trained offi cers to survey a disaster site, collect critical
information, summarize it in an understandable way,
and get that information to the right person in the
chain. For fi rst responders, however, the collection of
this information is rarely a priority.
JOURNAL OF LEADERSHIP STUDIES • Volume 7 • Number 3 • DOI:10.1002/jls 43
S Y M P O S I U M
post or the emergency operations center after they have
been notifi ed of the event. As a result, both levels of
leadership exist for a time in diff erent “time zones.” Th e
operational level has been on scene and operating for
a period of time before the strategic level gets its act
together.
Th ese diff erent time scales can deepen the appreciative
gap in at least two ways. Initial sensemaking at the
strategic level may simply adopt and build on the fi rst
crystallized sensemaking eff orts emanating from the
operational level without questioning that defi nition of
the situation. Th e gap may also be deepened by strategic
crisis managers looking for confi rmation in operational
reports of their own initial impressions of the situation.
One might think that the Incident Command System
(ICS), which off ers a platform for cooperation between
large numbers of actors, is critical to joint sensemaking.
Although the ICS system has been successful in
facilitating joint coordination, it does not address the
sensemaking challenges noted previously (Renaud,
2012).2 It provides for horizontal connections but
is less eff ective in bridging the appreciative gap that
separates the fi eld from the crisis center.
To accomplish joint sensemaking requires leadership.
Leadership is understood here in terms of orchestrating
the implementation of executive tasks in order to
channel the eff orts of many toward a defi ned aim
(Barnard, 1938). As the dynamics are very diff erent at
the strategic and operational levels, joint sensemaking
requires diff erent forms of leadership. It is to these
diff erent dynamics that we turn next.
Crisis Sensemaking at the Operational
Level
For an operational leader, sensemaking begins from the
moment he or she hears about the crisis. While getting
to the scene, the operational leader seeks to make sense
of the fi rst, often bewildering if not inconceivable, mes-
sages. Driving to the scene, the leader will listen to the
radio traffi c, trying to separate the real information
from all the noise. Radio traffi c is loud and confused;
people are yelling, sometimes crying. He or she might
call the dispatch supervisor who is in the hub of the
communication center and may know more than any-
one else at this point. Somebody will be on the phone
wanting to know what is going on: it could be a boss,
an elected offi cial, a media representative, or a family
member. People will be asking for decisions before the
leader even arrives on scene. All of this is likely to raise
the responding leader’s stress level immediately.
A picture, however incomplete, begins to form and
will shape the leader’s fi rst information needs: Are
people hurt? Are there suspects outstanding? Are guns
still blazing? What is the physical scope of the event? He
or she will mentally revisit similar situations, recalling
what went wrong and what went right. Th e initial
sensemaking will steer fi rst observations on scene: as
psychologists tell us, people often see what they expect
to see.
Upon arrival, the operational leader will get out of
the car and walk to the heart of the event. Th at walk
is the last moment of peace the operational leader will
have before getting completely overwhelmed by people,
environment, questions, and demands. Th e fi rst visual
clues emerge. Colleagues and complete strangers will
share their situational assessment, typically mixed with
requests for action or direction.
One of the (many) tasks of operational leadership is
to create situation reports (“sitraps”) for the strategic
level. Th is means that operational leaders must survey
the disaster site and translate visual impressions and
fragmentary information into an understandable and
accurate report. As the report will set the tone for
discussions and strategizing at the strategic level, it is
extremely important to get it right.
Experienced fi rst responders make sense of a crisis
situation by matching their fi rst observations with
situational vignettes that are stored in memory (Flin,
1996; Klein, 2009). Th ey “feel” and “act” their way
into a response, by testing their initial perceptions
against subsequent observations (Weick, 1995).
Such a process can be surprisingly eff ective: quick
and accurate sensemaking informs self-organization,
improvisation, and life-saving activities. But it critically
depends on the level of expertise and the “knowability”
of a crisis. Experience can make a huge diff erence,
especially when the threat has “knowable” components
(Flin, 1996; Kahneman & Klein, 2009; Klein, 2009).
In that case, experienced operational commanders
will have a more accurate picture of an emerging crisis
than their inexperienced counterparts in the EOC
44 JOURNAL OF LEADERSHIP STUDIES • Volume 7 • Number 3 • DOI:10.1002/jls
S Y M P O S I U M
(Kahneman & Klein, 2009). But in unique situations,
when experience off ers no guidance (or misguidance),
strategic leaders may even have a better view of the
situation than operational leaders.
Crisis Sensemaking at the Strategic Level
Th e world of strategic crisis management is a diff erent
one from the world in which fi rst responders do their
job. As fi rst responders organize themselves at or near
the disaster site, political and administrative executives
rush to the crisis center or EOC. Th ese executives will
spend most of their time in a conference room, with
whiteboards, telephones, and computer screens, from
which they will direct and oversee the crisis response.
Th eir eff orts to make sense of the situation diff er from
those at the operational level along several dimensions:
Time: In the operational world, every second
counts. At the strategic level, split-second decisions
are extremely rare. Th e strategic level therefore has
more time to think, especially in the initial phase
of a crisis. But there is not much to “do”: there usu-
ally are few truly strategic decisions that demand
attention. Searching for something to manage, they
tend to focus on operational issues. Th e subsequent
search for operational detail may then come to
shape the sensemaking process.
Information: First responders see, hear, and smell
the crisis; strategic leaders have to imagine it. Th is
opens the door for various heuristics such as ana-
logue reasoning (comparing the new threat to simi-
lar threats that happened before). Strategic leaders
crave information; fi rst responders often drown in
it. Th is creates what we may term a “sensemaking
void” in which strategic leaders struggle to grasp
the immensity of the crisis.
Information partners: Whereas the operational site
is crawling with fi rst responders who all carry bits
of information (and disinformation), the EOC is
fi lled with people who all have information that
has reached them through a chain of command.
Th us, lots of vital information got lost in the chain
or may have gotten embellished and explains why
fatality numbers often appear higher in the early
phase of a disaster. It also means that verifi cation
and any search for new information will require
time and eff ort. Th is becomes even harder when
key information providers are not represented at
the EOC (think of businesses or “unknown” agen-
cies that were not included in the disaster plan).
Media: Crises and disasters are media events.
Media provide both a source of frustration and a
rare opportunity for strategic leaders to portray
leadership. Media moments (interviews, press
conferences) often drive the organization of the
sensemaking process in the EOC: “We need this
information quick, because the governor needs to
say something!” But media can also help to make
sense of the situation as they bring their sensemak-
ing results to the attention of the strategic level
through the questions they pose. Strategic leaders
do not always make full use of the media as an
information source. In fact, they often view the
media in adversarial terms. Detailed questions typi-
cally fuel a new information search, which takes
up critical resources (attention) and may have a
paralyzing eff ect on sensemaking eff orts.
Politicization: Crises and disasters are also deeply
political at heart (‘t Hart, 2013). Th ey provide an
opportunity to demonstrate leadership and per-
formance capacity; they also provide a stage for
critics to launch or strengthen a narrative about
how the incompetence, lack of caring, or political
agenda is exposed by the crisis. Facts matter less
than argumentation here. It means that “meaning-
making”—off ering a credible and evocative narrative
to the public—will be as important as “sensemak-
ing.” Political leaders may thus be tempted to inter-
pret a crisis in a certain way, which, in turn, will
shape their sensemaking. In this respect, it is always
interesting to witness the shadow line of command,
made up of political advisors, that emerges in an
EOC.
Overcoming the Gap: Cues for
Leadership
We have argued that an appreciative gap between stra-
tegic and operational levels is likely to emerge in the
initial phase of a complex crisis or disaster. Th e gap is
JOURNAL OF LEADERSHIP STUDIES • Volume 7 • Number 3 • DOI:10.1002/jls 45
S Y M P O S I U M
created by the diff erent sensemaking dynamics that play
out at both levels. It is further enlarged by the time and
distance that separates the EOC from Ground Zero.
Moreover, certain distractions typically occur in the
EOC, ranging from demanding politicians to aggres-
sive media inquests. All in all, we should not be too
surprised that strategic leaders (think of FEMA leader
Michael Brown immediately after hurricane Katrina)
do not seem to be aware of “clear facts” on the ground
(the number and locations of stranded survivors in New
Orleans).
Sometimes the gap is bridged by the imposition of
one picture over the other. Strong operational leaders
can easily impose their assessment on inexperienced
strategic leaders; sensemaking at the operational level
will then drive the response. Th e opposite can also
happen, if a strong political mandate trumps a search
for facts. Each one of those situations means a diff erent
path for the response.
In the ideal situation, strategic and operational
sensemaking processes are synergetic: they become
iterative processes working off each other through
effi cient deliberation and corrective feedback loops.
Synergy can happen only when leaders at both levels
organize sensemaking processes to be complementary.
To accomplish this, strategic leaders will have to:
• spend time solely on sensemaking (without imme-
diately considering strategies and decisions);
• explain to operational commanders what type of
information they need and why;
• monitor changes in the situation;
• understand how hard it is for operational leaders to
produce the information they seek;
• listen carefully to operational commanders and be
alert to small clues of impending problems; and
• be prepared to adapt their picture of the situation.
Operational leaders are crucial gatekeepers and play
a critical role in the joint sensemaking process. At
the same time, they do not always fully understand the
responsibilities of the strategic level and the demands
imposed on it. To avoid the unavoidable appreciate gap
from widening, they should:
• separate sensemaking efforts from formulating
needs (“I need more people”);
• not simplify (chaos is normal and diff erent assess-
ments of the situation will exist);
• not be afraid to say “I don’t know”;
• explain how hard it is to get certain information;
• explain how they will try to get it anyway; and
• respect that strategic leaders have diff erent concerns
(political, organizational).
We argue that the strategic and operational levels of a
complex response operation require diff erent forms of
leadership. To be truly synergetic, leaders at both levels
must concentrate on the tasks that are pertinent to that
level (Boin et al., 2005). Not only should they perform
their tasks well, but they should also be aware of the
tasks that leaders at the other side of the “appreciative
gap” try to fulfi ll. Such shared awareness of the various
leadership challenges at each level is critical to developing
a joint picture of the situation. Most important, what
is required is a form of meta-leadership: preparing
strategic and operational leaders for the challenges they
will face before the next crisis occurs.
Notes
1Media are the exception: their routine processes are particu-
larly well geared toward crisis sensemaking.
2For critical assessments of ICS, see Buck, Trainor, and
Aguirre (2006).
References
Barnard, C. (1938). Th e functions of the executive. Cambridge, MA:
Harvard University Press.
Boin, A., ‘t Hart, P., Stern, E., & Sundelius, B. (2005). Th e politics of
crisis management: Public leadership under pressure. Cambridge, UK:
Cambridge University Press.
Boin, A., Kuipers, S., & Overdijk, W. (2013). Leadership in times
of crisis: A framework for assessment. International Review of Public
Administration, 18, 79–91.
Buck, D., Trainor, J., & Aguirre, B. (2006). A critical evaluation
of the incident command system and NIMS. Journal of Homeland
Security and Emergency Management, 3(3), 1–27.
Flin, R. (Ed.) (1996). Sitting in the hot seat. London, UK: John
Wiley and Sons.
Kahneman, D. (2011). Th inking fast and slow. London, UK: Allen
Lane.
Kahneman, D., & Klein, G. (2009). Conditions for intuitive exper-
tise: A failure to disagree. American Psychologist, 64, 515–526.
46 JOURNAL OF LEADERSHIP STUDIES • Volume 7 • Number 3 • DOI:10.1002/jls
S Y M P O S I U M
Klein, G. (2009). Streetlights and shadows: Searching for the keys to
adaptive decision making. Cambridge, MA: Th e MIT Press.
Renaud, C. (2012, June). Th e missing piece of NIMS: Teaching
incident commanders how to function in the edge of chaos. Home-
land Security Aff airs, 8, Article 8.
Rosenthal, U., Charles, M., & ‘t Hart, P. (Eds.). (1989). Coping
with crises. Springfi eld, IL: Charles C. Th omas.
‘t Hart, P. (2013). After Fukushima: Refl ections on risk and insti-
tutional learning in an era of mega-crises. Public Administration,
91, 101–113.
Turner, B. A. (1978). Man-made disasters. London, UK: Wykeham.
Weick, K. E. (1995). Sensemaking in organizations. Th ousand Oaks,
CA: Sage.
Arjen Boin is a professor of public governance and crisis
management at the Utrecht School of Governance and an
adjunct professor at the Public Administration Institute,
Louisiana State University. He received his PhD from
Leiden University, Th e Netherlands, where he taught at the
Department of Public Administration. Boin has published
widely on topics of crisis and disaster management, leader-
ship, institutional design, and correctional administration.
His books include Th e Politics of Crisis Management
(Cambridge University Press, winner of American Political
Science Association’s Herbert A. Simon book award),
Governing after Crisis (Cambridge University Press,
2008), Crisis Management: A Three Volume Set of
Essential Readings (Sage, 2008), Designing Resilience
(Pittsburgh University Press, 2010), MegaCrises (Charles
C. Thomas, 2012), and The EU as Crisis Manager:
Patterns and Prospects (Cambridge University Press,
2013). He is the editor for Public Administration and a
managing partner of Crisisplan BV.
Cynthia Renaud currently serves as Chief of Police for the
Folsom Police Department. Prior to her tenure with the
city of Folsom, she spent twenty years with the Long Beach
Police Department where she worked a variety of assign-
ments including patrol, detectives, internal aff airs, and
the training division. She holds a Master of Arts degree
in English Literature from California State University,
Long Beach, as well as a Master of Arts degree in Security
Studies (Homeland Security and Defense) from the Naval
Postgraduate School. Her thesis submissions in both pro-
grams earned the Best Master of Arts Thesis and the
Outstanding Th esis Award, respectively. Cynthia writes
on a variety of law enforcement topics. Her published
works include “High Risk Vehicle Stops: the Long Beach
Police Department’s Method” (Tactical Edge Magazine,
2005), “Community Oriented Public Safety, the Long
Beach Experience” (FBI Law Enforcement Bulletin,
January 2006), and “ The Missing Piece of NIMS:
Teaching Incident Commanders How to Function in the
Edge of Chaos” (Homeland Security Affairs Journal,
2012). Cynthia also teaches critical incident manage-
ment classes for California’s Commission on Peace Offi cer
Standards and Training (POST) and has presented at con-
ferences both nationally and internationally on the topic
of initial response eff orts to large-scale, critical incidents.
4/23/20, 9)17 AMThe Cold Calculations Americaʼs Leaders Will Have to Make Before Reopening – The New York Times
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With no vaccine or cure, the president, governors, mayors and county executives will have to
decide how many deaths would be acceptable to restore a shattered economy.
By Peter Baker
April 22, 2020
WASHINGTON — How many deaths are acceptable to reopen the country before the
coronavirus is completely eradicated? “One is too many,” President Trump insists, a politically
safe formulation that any leader would instinctively articulate.
But that is not the reality of Mr. Trump’s reopen-soon approach. Nor for that matter will it be the
bottom line for even those governors who want to go slower. Until there is a vaccine or a cure for
the coronavirus, the macabre truth is that any plan to begin restoring public life invariably
means trading away some lives. The question is how far will leaders go to keep it to a minimum.
Some of the more provocative voices on the political right say that with tens of millions of
Americans out of work and businesses collapsing, some people must be sacrificed for the greater
good of restoring the economy quickly. To many, that sounds unthinkable, but less inflammatory
experts and policymakers also acknowledge that there are enormous costs to keeping so much of
the work force idle, with many of the unemployed struggling to pay for food, shelter or medical
care for other health challenges.
And so the nation’s leaders are left with the excruciating dilemma of figuring out how to balance
life and livelihood on a scale unseen in generations. “Every governor in the nation is asking that,”
Gov. Gretchen Whitmer of Michigan, where 2,700 have died and more than 1 million have lost
The Cold Calculations America’s Leaders Will Have to
4/23/20, 9)17 AMThe Cold Calculations Americaʼs Leaders Will Have to Make Before Reopening – The New York Times
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jobs, said this week. “There’s no such thing as zero risk in the world in which we’re living. But we
know that not taking measures to control the spread means that’s going to translate into lives
lost.”
With no cure available for the coronavirus and no vaccine likely for another year or more,
governors in hard-hit states are seeking ways to minimize the number of additional deaths by
staging and structuring any reopening. Time and testing are key, according to public health
experts. The longer a quarantine can be extended the better, they say, and the more testing made
available, the easier it would be to properly calibrate a reopening and respond to any new
outbreak.
Pushing to restore business sooner rather than later, Mr. Trump has dismissed waiting until
comprehensive testing provides a better map of where the infection has spread. Instead, the
federal government’s guidelines envision “sentinel surveillance” testing of vulnerable places like
nursing homes and inner-city health centers, while gradually reopening businesses, schools and
other venues in stages with precautions like masks, gloves and social distancing.
All of which could mitigate future infections but would not halt them. The reason the death toll
projection may be closer to 60,000 rather than the 2 million of one estimate was because society
largely shut down. One recent study said that the 60,000 deaths would have been 6,000 had
quarantine measures been imposed just two weeks earlier. So easing measures means the death
toll will go up even with safeguards.
But remaining closed is not without a cost either. In just four weeks, a staggering 22 million
Americans have lost their jobs, the equivalent of the entire labor force of 23 states.
https://www.whitehouse.gov/openingamerica/
4/23/20, 9)17 AMThe Cold Calculations Americaʼs Leaders Will Have to Make Before Reopening – The New York Times
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The question divides not only the nation but even families. Rahm Emanuel, the former mayor of
Chicago and White House chief of staff, and his brother, Dr. Ezekiel J. Emanuel, a prominent
medical ethicist and vice provost of global initiatives at the University of Pennsylvania, have
engaged in a running quarrel about how soon society should reopen.
Rahm Emanuel considers it untenable to keep most of the country closed until the virus is
completely under control, while Ezekiel Emanuel maintains that the pandemic is too much of a
threat to rush back to life as usual.
Latest Updates: Coronavirus Outbreak in the U.S.
4.4 million more workers file for unemployment.
House will vote on a $484 billion relief plan, and McConnell suggests states declare bankruptcy.
The coronavirus and seasonal flu could collide in the fall.
See more updates Updated 2m ago
More live coverage: Global Markets New York
President Trump has dismissed the idea of waiting until comprehensive testing allows
communities to better understand how far the virus has spread. Anna Moneymaker/The
New York Times
•
•
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4/23/20, 9)17 AMThe Cold Calculations Americaʼs Leaders Will Have to Make Before Reopening – The New York Times
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“There’s nothing you can do risk free. Nothing,” Rahm Emanuel said last week. “And the missing
ingredient is what do you think the public can accept and what will you do to be forthright and
honest?” The public, he said, understands that life comes with peril as long as measures are
taken to minimize it. “If you reduce the speed limit dramatically, you’d have less deaths,” Mr.
Emanuel said. “But we allow it to go to a certain level.”
In a separate call, Ezekiel Emanuel said: “I think Rahm is wrong on how bad it could be by
letting it run around the population. I’m not for keeping the economy closed forever. Sometimes
my brother paints me in a picture. But you have to do it safely. Safely doesn’t mean no deaths. I
never said no Covid deaths. But you have to do it in a way that is measured, not irresponsible
where you’re going to get to 2 million deaths.”
The trade-offs have stirred angry exchanges since the start of the lockdowns. Lt. Gov. Dan
Patrick of Texas, who is 70, said last month that older people like himself should be ready to risk
death to save the economy for their grandchildren, comments he defended on Fox News on
Monday night. In a separate appearance on Fox last week, Dr. Mehmet Oz, the television host,
cited a study to argue that reopening schools “may only cost us 2 to 3 percent in terms of total
mortality,” calling it “a trade-off some folks would consider.” After a backlash, he said he
“misspoke” and expressed regret that he “confused and upset people.”
Some of those charged with making these decisions said far more information is required to
reopen with enough confidence to constrain further spread of the virus and avoid a deadly
second wave. Gov. Philip D. Murphy of New Jersey said his state would need to double the
number of tests.
“You have to crack the back of the personal health piece before you can crack the back of the
economic piece,” he said this week. Noting that 177 people in his state died the day before, he
added: “The house is still on fire and the fire brigade is still out there trying to put the fire out.”
The situation, not surprisingly, looks different in different parts of the country. The trade-offs in
Wyoming, where there have been six deaths, or in Hawaii, with 12 deaths, hardly compare to
those in New Jersey, where more than 5,000 have died, or in New York, where more than 15,000
have died.
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coronavirus outbreak.
I’ve realized my comments on risks around opening schools have confused and upset people, which was never my intention. I misspoke. pic.twitter.com/Kq1utwiCjR
4/23/20, 9)17 AMThe Cold Calculations Americaʼs Leaders Will Have to Make Before Reopening – The New York Times
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READ MORE
Updated April 11, 2020
When will this end?
This is a difficult question, because a lot depends on how well the virus is
contained. A better question might be: “How will we know when to reopen
the country?” In an American Enterprise Institute report, Scott Gottlieb,
Caitlin Rivers, Mark B. McClellan, Lauren Silvis and Crystal Watson staked
out four goal posts for recovery: Hospitals in the state must be able to
safely treat all patients requiring hospitalization, without resorting to crisis
standards of care; the state needs to be able to at least test everyone who
3/8/20, 11)22 AMInside Trump Administration, Debate Raged Over What to Tell Public – The New York Times
Page 5 of 5https://www.nytimes.com/2020/03/07/us/politics/trump-coronavirus.html
Last week, Vice President Mike Pence was given control of the public messaging, and although Mr. Pence has had some
mixed messages of his own — he promised more tests before they were available — the White House has since displayed
more discipline. Mr. Pence holds twice daily conference calls with officials from across the country, and a virus task force
he leads issues daily talking points, with comment from the health professionals, to make sure the message is consistent.
But the president still has his bullhorn. During his visit to the C.D.C., Mr. Trump told reporters that he was not inclined to
let 21 people who tested positive for the virus on a cruise ship off the coast of California onto American soil.
“They would like to have the people come off,” he said. “I would like to have the people stay.” The president said he would
allow health experts to make the final decision, but he made clear again where he stood.
His concern? It would increase the tally for the number of people infected in the United States. “Because I like the
numbers being where they are,” the president said.
Michael D. Shear and Noah Weiland reported from Washington, and Sheri Fink from New York. Reporting was contributed by Mike Baker from Seattle; Nicholas
Bogel-Burroughs and Emma Fitzsimmons from New York; Katie Thomas from Chicago; and Emily Cochrane, Zolan Kanno-Youngs, Lara Jakes and Abby
Goodnough from Washington.
READ MORE
The Coronavirus Outbreak
How Is the U.S. Being Affected?
Updated March 5, 2020
So far, 17 deaths have been linked to the virus with more than 350
confirmed cases across the country. We are tracking every case.
•
Cut off from their relatives inside the virus-stricken nursing center in
Kirkland, Wash., families are frantically searching for help and basic
information.
•
A cruise ship with thousands of people on board was being held off the
coast of California.
•
Many health care workers say they lack protective gear and protocols to•
Who’s on the U.S. Coronavirus Task Force
Published Feb. 29, 2020Updated May 7, 2020
Several of the nation’s top health officials are among those sitting on an advisory panel formed by
President Trump.
Administration health officials gave the House Energy and Commerce committee an update on
preparedness for the potential spread of the coronavirus in the U.S.Credit…T.J. Kirkpatrick for The New
York Times
President Trump formed a coronavirus task force in late January, and members have been meeting
regularly. But as the virus began to spread around the globe and infections were confirmed in the
United States, Mr. Trump named Vice President Mike Pence as his point person at the end of February,
and more administration officials were added to the panel. Among them are internationally known AIDS
experts; a former drug executive; infectious disease doctors; and the former attorney general of
Virginia.
The new coronavirus response coordinator for the White House, Dr. Deborah L. Birx, also holds the rank
of ambassador as the State Department’s global AIDS director.
An experienced scientist and physician, Dr. Birx will report to Vice President Pence, though White House
officials did not specify how her duties will differ from those of Mr. Pence or Alex M. Azar II, the
secretary of health and human services who is the chairman of the nation’s coronavirus task force.
Nominated by President Obama in 2014 to the State post, Dr. Birx has spent more than three decades
working on HIV/AIDS immunology, vaccine research and global health. For the past six years, Dr. Birx, a
former Army colonel, has been in charge of the President’s Emergency Plan for AIDS Relief and
America’s participation in the Global Fund to Fight AIDS, Tuberculosis and Malaria. From 2005 to 2014,
she also was director of the division for Global HIV/AIDS at the Centers for Disease Control and
Prevention.
A biography distributed by the White House said she had “developed and patented vaccines, including
leading one of the most influential HIV vaccine trials in history.”
During her confirmation hearing in 2014, Dr. Birx spoke with admiration of the government’s ability to
come together to confront a deadly disease that threatened the health and welfare of people around
the globe.
“The history of the end of the 20th century will be forever recorded with the emergence of a new and
deadly viral plague that challenged us scientifically, socially and politically,” she told members of the
Senate Foreign Relations Committee. “Fortunately, that history will also record that — eventually — we
faced our own fears of the disease and embraced those infected and affected with the open arms of
compassion, creative research and determined solutions.”
Dr. Birx majored in chemistry at Houghton College and received her medical degree from Penn State
University’s Hershey School of Medicine.
— Michael Shear
ALEX M. AZAR II
Credit…T.J. Kirkpatrick for The New York Times
Alex M. Azar II became secretary of health and human services in January 2018, arriving with a
background in government and industry and presenting himself as a problem-solving pragmatist.
He replaced Mr. Trump’s initial pick for the job, Tom Price, who had resigned in September 2017 in the
face of multiple federal inquiries into his use of private and government planes for travel.
Mr. Azar, a former top executive at Eli Lilly, has navigated a series of high-profile issues since taking the
job, from attempting to scale back the Affordable Care Act to overseeing the shelters that have housed
the thousands of unaccompanied minors separated from their parents during border crossings or who
entered the United States alone. He has also sought to address rising drug prices and public health
initiatives such as improving the care of people with chronic kidney disease, although many of those
policies have not come to fruition.
And he has clashed with top health officials, including with Seema Verma, the administrator of the
Centers for Medicare and Medicaid Services, in a power struggle that required the intervention of the
White House.
From 2012 to early 2017, Mr. Azar was president of Lilly USA, a unit of Eli Lilly and Company, a major
producer of insulin. That history as a drug company executive came under criticism during his
Senate confirmation, when Democrats questioned whether he would take the industry’s side on the
issue of rising drug prices. Republicans cited that experience as an asset, arguing that it would help him
better understand the problems.
Mr. Azar, 52, was a law clerk for Supreme Court Justice Antonin Scalia. He joined the administration of
President George W. Bush as general counsel of H.H.S. in 2001 and became deputy secretary four years
later. While there, he helped carry out a 2003 law that added a prescription drug benefit to Medicare,
one of the most significant changes in the history of the program.
Mr. Azar graduated from Yale Law School and grew up in Maryland, where his father was an
ophthalmologist and his mother a registered nurse.
A longtime AIDS researcher, Dr. Robert R. Redfield has served since March 2018 as the director of the
Centers for Disease Control and Prevention and administrator of the Agency for Toxic Substances and
Disease Registry.
As such, he is the nation’s chief public health officer, overseeing government response to crises like the
opioid epidemic or Ebola, and has had primary responsibility for supervising the federal response to the
coronavirus cases in the United States, reporting to Mr. Azar.
Dr. Redfield has already been the target of criticism for some of the C.D.C.’s decisions — including
testing protocols that may have missed infections, flawed testing kits for the virus and the repatriation
of infected patients from the Diamond Princess cruise ship — although it is not clear whether his was
the final word on these and related actions.
Before taking his post, Dr. Redfield was a professor at the University of Maryland School of Medicine,
where he co-founded the Institute of Human Virology, and served as chief of infectious diseases. The
institute provided treatment for H.I.V., the human immunodeficiency virus, to more than 6,000 patients
in the Baltimore-Washington area and more than 1 million people in Africa and the Caribbean. Earlier in
his research career, Dr. Redfield advocated broad testing for H.I.V. and the screening of military
personnel for the virus — and faced renewed criticism for those views when he was nominated to the
C.D.C. post.
A native of Chicago, Dr. Redfield grew up in Bethesda, Md., where both of his parents worked at the
National Institutes of Health. He graduated from Georgetown University and its School of Medicine, and
did his residency at Walter Reed Army Medical Center, then continued as a researcher there, focusing
on AIDS. He launched the virology institute with Dr. Robert C. Gallo, who developed the blood test for
H.I.V. in 1996.
— Sheila Kaplan
DR. ANTHONY S. FAUCI
Credit…T.J. Kirkpatrick for The New York Times
As head of the National Institute of Allergy and Infectious Diseases at the National Institutes of Health
since 1984, Dr. Anthony S. Fauci has played a central role in research of disease outbreaks, and the
search for cures, since the emergence of HIV/AIDs — as he is doing now with the coronavirus.
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He testifies regularly to Congress about the threat of emerging diseases and has been one of the most
prominent leaders of the government’s front line on public health.
Behind the scenes, though, is where Dr. Fauci is considered most influential: He helps shape the
decisions about where research should be directed in search of a response or cure. Overall, Dr. Fauci
oversees an agency with a budget of $5.9 billion for 2020.
Dr. Fauci grew up in Brooklyn. His father was a pharmacist. attended Holy Cross College and graduated
from Cornell University Medical College in 1966. His life shifted significantly in 1981, when he was
working at the N.I.H. and gay men began showing up with devastated immune systems.
Dr. Fauci, while certainly not known in popular culture circles, carries a kind of celebrity status among
scientists. That might stem in part from the amount of research money he controls but also because of
his ease with communicating deep science both with nuance and accessibility, making him a translator
of sorts during times of crisis.
KENNETH T. CUCCINELLI II
Credit…Samuel Corum/Getty Images
Kenneth T. Cuccinelli II, one of the top immigration officials in the United States, has brought his
firebrand approach to Mr. Trump’s coronavirus task force.
He leads the United States Citizenship and Immigration Services, the agency overseeing legal
immigration, while simultaneously working as acting deputy secretary of the Department of Homeland
Security. In nine months, the former attorney general of Virginia has gone from defending Mr. Trump’s
aggressive immigration policies on Fox News to representing the Homeland Security Department on
virus response.
Mr. Cuccinelli coordinates the screening of travelers at airports, and land and maritime ports, and has
overseen the monitoring of people who have recently traveled to China or shown signs of illness.
In his short time with the Homeland Security department, Mr. Cuccinelli has irked other agency leaders
with his aggressive communication to the public — including when he said the sonnet on the Statue of
Liberty poem referred to “people coming from Europe.”
Mr. Cuccinelli was similarly criticized on Monday afternoon when he complained on Twitter that he
could not gain access to a Johns Hopkins University map of the spreading coronavirus outbreak.
“I’m sure it’s jarring to the public to see a very high ranking federal official sending out an S.O.S. on
Twitter,” said January Contreras, who was a senior adviser to Janet Napolitano, his predecessor at the
homeland security agency.
After Senator Chuck Schumer, the Democratic leader from New York, said Mr. Cuccinelli’s appointment
to the task force showed how “hollowed out” federal agencies are, Mr. Cuccinelli pointed the finger at
Mr. Schumer for not attending a briefing on the virus.
In an interview with The New York Times earlier this month, Mr. Cuccinelli said he spent much of his
time since being appointed to the task force calling hundreds of local politicians to coordinate their
responses to the virus.
Born in Edison, N.J., Mr. Cuccinelli was raised in Virginia. He graduated from the University of Virginia
with an engineering degree and from George Mason University with a law degree.
Dr. Adams became the U.S. surgeon general in 2017, after serving for three years as the health
commissioner for Indiana. He holds the rank of vice admiral in the U.S. Public Health Service, and
oversees about 6,500 public health officers, many of whom work in underserved areas around the
world.
Dr. Adams, 45, trained as an anesthesiologist. He is a strong advocate of needle exchanges to stop the
spread of diseases, and in Indiana, helped establish one that is credited with contributing to the end of
an unusual H.I.V. outbreak among people in a rural community who were injecting a prescription
painkiller.
He made news early in his tenure by talking about the toll that drug addiction has taken on his own
family.
In recent weeks, as concern over the coronavirus has grown, he has taken to Twitter and to television,
advising the public to keep calm. He has also asked the public to stop buying masks, so that there will be
enough for health care providers.
In a rare surgeon general advisory in 2018 — the first since 2005 — he urged Americans to carry
naloxone, a medication that can save the lives of people overdosing on opioids.
Earlier this year, Dr. Adams warned that too many smokers are not being advised by their doctors to
quit. In a report issued in January, the surgeon general advised smokers to choose from a variety of
cessation methods that have been proven effective — and cautioned that e-cigarettes have not.
“The biggest take-home from this report is that far too many people who want to quit aren’t getting
access to the cessation treatments that we know work,” he said at the time.
Dr. Adams grew up on his family’s farm in Mechanicsville, Md. He earned his bachelor’s degrees in
biochemistry and psychology from the University of Maryland, Baltimore County; a master of public
health degree from the University of California, Berkeley; and a medical degree from Indiana University
School of Medicine.
Before becoming health commissioner Dr. Adams was an assistant professor of anesthesiology at
Indiana University Health. — Sheila Kaplan
SEEMA VERMA
Credit…Manuel Balce Ceneta/Associated Press
Seema Verma became the administrator of the Centers for Medicare and Medicaid Services in March
2017, after serving as a top health policy adviser to Vice President Mike Pence when he was the
governor of Indiana.
Her agency, which spends more than $1 trillion a year on programs providing health care to more than
one-third of all Americans is the biggest within the Department of Health and Human Services. Since Ms.
Verma took the helm, she has advocated repealing the Affordable Care Act and, short of that, reining in
the law’s expansion of Medicaid to millions of low-income adults.
Working with Mr. Pence in Indiana, she was an architect of that state’s conservative approach to
Medicaid expansion, which emphasized “personal responsibility” by requiring many beneficiaries to pay
premiums or risk being locked out of coverage for six months.
At C.M.S., Ms. Verma has encouraged states to require many of the adults who became eligible for
Medicaid through the Affordable Care Act to work, volunteer or train for a job, and prove to their state
that they are doing so, or lose coverage. Those “work requirements” have been struck down by several
courts for failing to comport with the objective of Medicaid as defined under federal law — providing
health coverage to the poor.
Her relationship with Alex M. Azar II, the health and human services secretary, has been rocky, to the
point that the White House stepped in to mediate late last year. She also came under fire from
Democrats for spending several million dollars on public relations contracts that were partly meant to
raise her public profile; the contracts are now under review by the department’s inspector general.
Ms. Verma, 49, founded a health policy consulting firm, SVC Inc., in 2001, which also advised Kentucky
and Ohio on how to shape their Medicaid expansion programs and worked with a number of other
states. After her confirmation as administrator of C.M.S., she sold the company to Health Management
Associates.
A first-generation American whose parents immigrated from India, Ms. Verma was born in Virginia and
has listed Missouri, the Washington, D.C. suburbs and Taiwan as places she lived earlier in life. She
graduated from the University of Maryland and has a masters in public health from Johns Hopkins
University. — Abby Goodnough
Keywords:
Punctuated! equilibrium! theory
Sewol! Ferry! Disaster
Three! Sewol! Acts
Policy! process
Google! Trends
a ! b ! s ! t ! r ! a ! c ! t
The ! Sewol ! Ferry ! Disaster ! undermined ! the ! South ! Korean ! government’s ! efforts ! to ! establish
the! country ! as! a ! crisis-free ! region. ! Considering ! the ! number ! of ! fatalities ! and ! the ! immensity
of! the ! disaster, ! the ! South ! Korean ! legislators ! passed ! three ! acts ! concerning ! the ! Sewol ! Ferry
Disaster:! the ! Sewol ! Special ! Act,! the ! Government ! Organization ! Act, ! and ! the ! Yoo ! Byung-
eun ! Act.! The ! strength ! of! this ! study ! is! that ! it! illuminates ! the ! Sewol ! Ferry ! Disaster ! using! the
institutional ! model ! of ! the ! punctuated ! equilibrium ! theory ! (PET), ! applied ! in ! a! Korean ! setting.
Moreover, ! it! elucidates ! the ! concept ! of ! punctuated ! events ! and ! their ! impact ! on ! budgets ! and
public! attention, ! primarily ! using ! Google ! Trends, ! as! it! examines ! policy ! changes ! following ! the
disaster ! and! demonstrates ! inconsistencies ! in! the ! PET. ! The! authors ! conducted ! a! case ! study ! on
the ! Sewol ! Ferry ! Disaster ! and ! the ! three ! subsequent ! Sewol ! Acts ! to! illuminate ! the! effect ! of ! the
disaster! on ! policy ! processes. ! Using ! the ! prior ! history ! of ! punctuated ! events ! in! South ! Korea, ! we
demonstrated ! a! higher ! propensity ! for! punctuation ! and ! the ! functions ! of ! positive ! feedback
after ! the ! policy ! monopoly ! collapse ! that ! followed ! the ! Sewol ! Ferry ! Disaster ! in ! South ! Korea.
We! also! demonstrated ! that ! fewer ! instances ! of! negative ! feedback ! are ! observed ! in! South
Korea ! than! in! the ! United ! States. ! Based ! on ! these ! findings, ! PET ! can ! be ! applied ! and ! developed
a ! larger ! number ! of! different ! settings ! by ! future ! studies.
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Active communication to understand requirements.
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