In April 2015, an Ohio doctor made an urgent call to the Centers for Disease Control and Prevention describing a possible life-threatening botulism outbreak that posed a risk to as many as 50 people who attended a church potluck dinner.
Within hours, CDC experts who were coordinating with the Ohio Department of Health and a local hospital determined that botulism antitoxin was needed to treat the food-borne illness. They made an immediate request to the only U.S. source for the life-sustaining countermeasure—the Strategic National Stockpile.
William Greg Burel, the director of the stockpile, got the request just after 2 p.m. that day. He quickly issued his approval and set in motion a process that got the medication delivered to Ohio just after midnight to help save the lives of 18 people who had become seriously ill.
This was all in a day’s work for Burel who, during his almost 10 years of managing the Strategic National Stockpile, has made sure drugs and medical supplies are always ready, and personnel are equipped to respond to major health threats such as an influenza pandemic and the Ebola virus, as well as illnesses arising from natural disasters such as Hurricane Sandy and possible chemical, biological or nuclear terrorist attacks.
“Under Greg’s leadership, the performance of the Strategic National Stockpile has gotten increasingly better. Distribution is more rapid than ever before,” said Lisa Kaplowitz, senior medical advisor for the Substance Abuse and Mental Health Services Administration.
The $7 billion stockpile is the national repository of critical medication and supplies that are available to supplement state and local resources during a public health emergency. It includes antibiotics, antidotes, antitoxins, life-support medications, airway maintenance supplies and medical and surgical items.
The CDC’s crisis-response program must be ready to spring into action at a moment’s notice. Managing the medical countermeasures of that response—and anticipating future problems—is Burel’s responsibility.
During his tenure, Burel has led 10 large-scale and more than 30 smaller emergency deployments for the treatment of individuals with life-threatening conditions. He oversees the work of more than 200 multi-disciplinary personnel and is responsible for more than $500 million in annual appropriations.
Edward Gabriel, the Department of Health and Human Services principal deputy assistant secretary for preparedness and response, said Burel has developed strategic partnerships with the private sector, consulted with the states on preparedness and managed to build and expand the stockpile while operating under serious budget constraints.
“Without the strategic procurement partnerships that Greg has arranged and nourished, the strategic national stockpile would not be as relevant as it currently is,” said Gabriel. “Greg’s unique ability to work with the private sector has made him one of the best in the medical supply chain business. He’s a forward thinker with excellent judgment.”
Among the challenges he faces are the efficient acquisition, storage, management and distribution of drugs and medical supplies for public health emergencies while preparing for emerging threats. During Burel’s tenure, the national stockpile has steadily expanded its focus so that it is capable of responding to all the global hazards of the 21st century.
“Greg has done a stellar job for nearly 10 years. He constantly has to rethink his business model,” said Sally Phillips, the HHS deputy assistant secretary for preparedness and response.
During the Ebola crisis, for example, Burel’s staff quickly facilitated delivery of protective equipment to hospitals that were treating patients who were exposed to the deadly virus.
One of his current challenges has been dealing with the Zika virus. Together with the CDC Foundation, a nonprofit organization that assists the agency, Burel has been involved in providing prevention kits for pregnant women in the U.S. territories of Puerto Rico, the U.S. Virgin Islands and American Samoa.
These kits are designed to inform pregnant women about Zika virus and its serious risks to newborns, and how to avoid infection. They also provide an initial supply of prevention tools such as topical insect repellent, pesticides and condoms to avoid potential sexual transmission. The CDC anticipates distributing thousands of these kits containing products purchased by national stockpile or provided by philanthropic or corporate donors.
“Government can’t go it alone,” Burel said. “It needs to involve the right partners in every sector, which also helps to build accountability.”
Burel also has cultivated relationships with Congress to protect the agency’s mission.
“The stockpile is always in flux,” explained Fran Harrell, the chief for the CDC’s Program Planning and Analysis Branch. Harrell said Burel has worked with Congress to explain the rationale behind the destruction of outdated or expired medications and the stockpile’s budget.
Burel also works closely with the senior leadership across government to “explain what the forecast for the future entails and what the best balance in the national stockpile should be,” Harrell said.
His biggest challenge as a manager, Burel said, is “persuading others to think more broadly outside of their areas of expertise. Once you overcome this resistance, great things are possible.”