WASHINGTON — When Ebola was spreading in West Africa in 2014, Donald Trump took to Twitter.
“STOP THE FLIGHTS!,” he blasted in all capital letters. “NO VISAS FROM EBOLA STRICKEN COUNTRIES.”
He even cast doubt on the honesty of the Centers for Disease Control and Prevention, tweeting: “Ebola is much easier to transmit than the CDC and government representatives are admitting. Spreading all over Africa — and fast.”
It wasn’t true, of course, and common wisdom among public health authorities holds that blocking flights does nothing to stop the spread of disease. It can, in some cases, make things worse.
Now Trump is president, and leading an administration that is chaotic and fractious. The outbreak of a new coronavirus could be his biggest public health challenge, and veterans of other disease outbreaks and epidemics are worried about how he’ll handle it.
“We are likely to see trade bans, quarantines and other overreactions that are very harmful,” said Lawrence Gostin, a senior professor at Georgetown University and an expert in global health law who has advised several administrations. “With the Ebola epidemic, it was urging quarantines, travel bans, overreacting in all the ways that would be counterproductive. I would hate to see that now.”
Thus far, Trump has been almost silent about the coronavirus on social media, sending out a rather innocuous tweet Monday that praised his health officials. “We are in very close communication with China concerning the virus. Very few cases reported in USA, but strongly on watch. We have offered China and President Xi any help that is necessary. Our experts are extraordinary!” he tweeted.
He has also been silent about an ongoing epidemic of Ebola virus in the Democratic Republic of the Congo that has infected more than 3,400 people and killed more than 2,200 of them.
But as this outbreak spreads, Trump is not surrounded by seasoned advisers on public health. Trump’s onetime public health adviser, Rear Adm. Timothy Ziemer, left the National Security Council in 2018 and returned to the U.S. Agency for International Development (USAID). His team was taken apart. Another adviser who advocated for strong defenses against disease and biological attacks, former homeland security adviser Tom Bossert, also resigned in 2018.
In addition, noted Asha George, executive director of the Bipartisan Commission on Biodefense, the White House is distracted by impeachment proceedings, disputes with Iran, North Korea, and China, and the election.
“The administration is facing a number of challenges,” George said. “You have those kinds of national security issues going on at the same time that we have this novel coronavirus moving around the world, and we are still in the middle of flu season,” she added.
“It’s a lot to be trying to address at once, and the question of whether the administration can handle it is a good one.”
Not everyone sounds so concerned.
Dr. Anthony Fauci, who heads the National Institute for Allergy and Infectious Diseases, said the agency is collaborating with industry to get started on potential vaccines and one could be ready for the first Phase 1 stage of safety testing in three months or so.
Fauci said that despite the lack of a designated White House coordinator, the National Security Council is paying close attention to the coronavirus outbreak. “I am very impressed with the response here to this outbreak,” said Fauci told STAT.
“Right now we have people running the NSC meetings who are very deeply involved, who are smart and intelligent people,” he added. “I have been in on every single one of those meetings at HHS level and at the NSC level and I can tell you that the U.S. government response is all over this.”
Fauci has headed NIAID since 1984, surviving six administrations including those of former presidents Ronald Reagan, both Bushes, Bill Clinton, Barack Obama, and now Trump. He has helped handle the response to AIDS, the 2001 anthrax attacks, SARS, MERS, Ebola, H1N1 flu, and Zika.
Gostin also offered a more positive take — but for a different reason.
“In many ways I am actually delighted that our political leaders are too busy to interfere in this,” he said. “I mean that seriously, because first of all the administration doesn’t have seasoned, experienced people in global health in the White House. It’s not like under the Obama administration, where there were really experienced people who were advising the president.”
Gostin added: “All things being equal, I would rather see CDC and the Health and Human Services Department handle this from a public health perspective, a scientific perspective, rather than mucking it up with politics,” Gostin said.
“The CDC are highly competent and I think they have done exactly the right thing.”
Among the moves by the CDC thus far: airport screening of travelers from Wuhan, where the outbreak is believed to have originated; advisories to hospitals on how to handle potential coronavirus patients; travel advisories recommending that Americans postpone nonessential travel to all of China; and regular public briefings.
Several public health officials noted that the federal government bureaucracy is designed to keep working despite political tumult and across administrations.
“The core agencies that help to find, stop, and prevent health threats are still functioning,” said Dr. Tom Frieden, a former CDC director who now heads Resolve to Save Lives, dedicated to fighting heart disease and epidemics.
Dr. Suzet McKinney, CEO and executive director of the Illinois Medical District and a board member of the Bulletin of the Atomic Scientists, the group that sets the Doomsday Clock, also believes that federal agencies can pick up any White House slack.
“I have great faith in the public health officials at the CDC and the Department of Health and Human Services,” McKinney said.
“You can’t just say CDC has got this,” she said.
“When you look at how our federal government is organized, we have CDC, FDA, everybody doing their thing. Each has its own emergency response arm that swings into action wherever we have an outbreak. The question becomes what happens when you have an event that goes beyond the usual situation, the usual emergency,” George added.
“It’s a lot to try and manage.” That means a coordinator at the White House level, she said. Former President Barack Obama appointed Ron Klain as his “Ebola czar” during the 2014-2016 Ebola epidemic.
In a letter to Trump Monday, Sen. Ed Markey (D-Mass.) noted: “Unfortunately, under your leadership, this position was eliminated in 2018 and you have provided no clarity on who would be the lead voice and coordinator of the U.S. response to an infectious disease threat. Having a person with expertise leading the whole government response is of utmost importance.”
There are many prospects for such a person because there’s a large cadre of public health experts who have fought pandemics and advised on how to prepare for the next one, including former CDC directors.
But George worries that the churn at Trump’s White House might frighten off some of the choicer candidates.
“Are the experts throughout the country that used to be in an administration, are they going to be willing to come back to help the White House?” she asked. “I think the answer is no. These people are not going to come back into the administration.”
Many may help from private industry or state health departments, she said. But at the top levels of government, it’s not clear who may be whispering in Trump’s ear on behalf of public health.
Rep. Tom Cole (R-Okla.) has framed a robust biodefense policy as a way for the White House to look strong and evenhanded. “There is nothing like a crisis to make people realize that there are things that are more important,” he said. “I think there would be bipartisan support for anything the executive branch thought it needed to respond to this particular pandemic, if it turns into a pandemic.”
Cole said Congress has managed to disregard repeated White House recommendations to slash funding to NIH, CDC, and other public health agencies. For example, the latest appropriations bill Congress passed in December provided $41.7 billion for the NIH, a nearly 7% increase.
“We are not without input here. If they go wildly off the tracks on something, that will come out and we will be in a position to put some pressure on,” said Cole, who is former chairman of the House Appropriations subcommittee that oversees biomedical research.
“I have a lot of faith in [CDC Director Robert] Redfield,” Cole added. “I have a lot of faith, obviously, in [National Institutes of Health Director] Francis Collins.”
Cole, who has pressed for increases in biomedical funding, said it’s a win for all sides in politics. “This is bipartisan and it’s bicameral,” he said. “I think we are in better shape than we were two years ago.”
Nonetheless, no one in public health believes the U.S. is well-prepared to fight an epidemic. It’s something they have been complaining about for years, even decades.
“The decrease in funding to protect Americans through global health security means there is less protection for Americans,” Frieden said.
The 2020 budget includes $2.6 billion for the public health emergency fund, with just $620 million for the Strategic National Stockpile, which is a repository of drugs, vaccines, and equipment to be mobilized in a health emergency, and $258 million to prepare hospitals to handle something big.
Funding for state health departments, hospitals, and public health in general has fallen for years under a number of administrations, including the Obama and Trump years. While funding has gone up at some agencies, it’s not nearly enough, said George.
“We need billions and billions of dollars,” she said.
As public health experts keep an eye on Trump, they should also be aware that despite his frenetic take on Ebola in 2014, he can be gentled.
In 2014, he repeated some of the disproven claims about vaccines. “Healthy young child goes to doctor, gets pumped with massive shot of many vaccines, doesn’t feel good and changes – AUTISM. Many such cases,” he tweeted.
Then measles started spreading in 2018, fueled by sustained campaigns by vaccine skeptics to persuade some communities not to vaccinate their children. Measles cases surged, with 1,282 cases in 2019, according to the CDC. That’s the highest number since 1992. It was the biggest public health emergency Trump had faced as president.
And as a result, he seemed to change his tune on vaccines. “They have to get the shots. The vaccinations are so important,” he told reporters as he left the White House last April. And he didn’t say much else.