Former federal officials and public-health experts argue that an effective response to a epidemiological crisis demands sustained planning and investment. While the administration’s response to coronavirus has been criticized in recent weeks as slow and disjointed, people in and outside the White House have warned for years that the nation is ill prepared for a dangerous pandemic.
“You build a fire department ahead of time. You don’t wait for a fire,” said Tom Inglesby, director of the Johns Hopkins Center for Health Security. “There is an underappreciation for the amount of time and resources required to build a prepared system.”
Officials at the White House and the Centers for Disease Control and Prevention did not respond to interview requests.
Under pressure to step up the U.S. response to Ebola, President Barack Obama in 2014 appointed Ronald Klain, a veteran Democratic operative, to serve as an “Ebola czar.” The Obama administration also set up a special National Security Council team to oversee epidemic preparedness on a permanent basis.
The global health security team continued to operate during Trump’s first year in office, before John Bolton dismantled the unit when he took over as national security adviser in 2018. That led to the abrupt departure of its leader, Rear Adm. Timothy Ziemer, who had led the White House’s anti-malaria efforts under Obama and President George W. Bush. Ziemer is the senior deputy assistant administrator for the Bureau for Democracy, Conflict, and Humanitarian Assistance at USAID.
White House Homeland Security adviser Tom Bossert, who had advocated a comprehensive biodefense strategy against pandemics and biological attacks, left the White House the same day Bolton arrived. Bossert is chief strategy officer at Trinity Cyber, a cybersecurity firm.
“It was a clear loss, and now we are behind the ball,” said a former White House official familiar with Ziemer’s team, who spoke on the condition of anonymity to discuss a personnel matter. “They had the contacts and the relationships and knew who to talk to. Now they are trying to re-create a lot of those relationships and knowledge within the executive branch.”
As the virus infected hundreds of people in China in late January, Trump announced the formation of a coronavirus task force led by Health and Human Services Secretary Alex Azar. At a news conference Wednesday, Trump declared Vice President Pence would steer the White House’s response to the pandemic — a decision Azar had learned about only moments earlier, according to five people familiar with the situation.
At the news conference, Trump played down the risks of a widespread pandemic and said the government was ready to handle the virus even if it spreads in the United States.
The president said he would be willing to accept more emergency funding than the $2.5 billion requested by his administration after lawmakers pushed for a more robust federal response.
“We can get money and we can increase staff. We know all the people,” he said. “We can build up very very quickly.”
On Thursday, Pence announced that Deborah L. Birx, who leads U.S. efforts to fight HIV/AIDS around the world, would serve as “White House Coronavirus Response Coordinator,” making her the third person the White House has put in charge of grappling with the response to the disease outbreak.
The recent conflict between officials at the State Department and the CDC over how to transport 14 American cruise ship passengers infected with the virus demonstrates the consequences of not having permanent leadership over global health security, Klain said. He also said a permanent White House team focused on infectious diseases might have staved off the backlash that came from local officials in Costa Mesa, Calif., and Anniston, Ala., over tentative proposals to quarantine coronavirus patients.
“What you’re seeing play out is that this response is starting from a standing start instead of a running start,” said Klain, an adviser to former vice president Joe Biden’s presidential campaign. “We all knew it was inevitable — no one knew it would be this virus at this time — but we knew it would be a virus at some time.”
Klain also noted that Pence and Azar each has a full-time job. “Running this response is not like driving Uber,” he said. “You don’t do it a couple hours a day.”
Former USAID official Jeremy Konyndyk, who helped lead the U.S. response to the Ebola outbreak and other international disasters during the Obama administration, said recruiting people with the specialized skills to handle an infectious-disease crisis is difficult. Public health has suffered for years from inconsistent funding and attention until a crisis emerges, he said.
“What we see with financing for outbreak preparedness is this cycle of panic and neglect,” Konyndyk said. “What the president seemed to say is that’s fine. It's not fine.”
Concerns among public health leaders have accelerated as Trump has sought to shrink the federal bureaucracy he scorns as the “deep state.”
In early 2018, a coalition of global health organizations protested plans to scale back the CDC's operations in 39 of 49 countries where it was helping to quickly identify and control disease outbreaks. “These programs are essential to our national defense,” the coalition wrote in a letter to Azar.
More recently, in November 2019, a commission on health security that included Republican and Democratic members of Congress warned that “the American people are far from safe.” The commission created by the Center for Strategic and International Studies called for the White House to reestablish “strong, coherent, senior-level leadership” on health security at the NSC and to invest more on improving health security in foreign countries.
Trump’s budget blueprint for 2021 proposes a series of cuts to the nation’s health agencies, including a nearly 16 percent cut to the CDC and a 10 percent cut to the Department of Health and Human Services, which houses the CDC and the National Institutes of Health.
In hearings on Capitol Hill this week, Democrats lambasted Azar over the proposed cuts, which Congress has largely rejected in the past. Rep. Brendan Boyle (D-Pa.) asked Azar Thursday how he could defend “draconian cuts” in the CDC budget “at the same time we are facing a unique worldwide health crisis.”
Azar insisted that even as the overall CDC budget is being cut, programs devoted to “infectious disease, global health security, and preparedness” were increasing by more than $100 million. However, CDC budget documents show this spending increase reflects at least some activities unrelated to coronavirus, while the majority of CDC programs face large reductions.
The uncertainty over funding for public health has discouraged some skilled professionals from staying in the federal government, according to Cyrus Shahpar, a physician who served at the CDC under Obama and worked on the agency’s global rapid-response team during the first year of the Trump administration.
Shahpar said that rapid-response team shrank while he was at the agency as proposed CDC cuts drove some people away and a federal hiring freeze barred filling positions. The number of permanent CDC employees declined about 5 percent between December 2016 and March 2019, according to the most recent data published by the Office of Personnel Management.
It is not easy to persuade a lot of people with specialized skills to suddenly shift to federal service to help respond to a threat, said Shahpar, who now works at Resolve to Save Lives, a global nonprofit that aims to prevent epidemics and deaths from cardiovascular disease.
“They have stable jobs with retirement plans,” he said. “They are not going to quit their job at the university or quit their job in the local government to go join the U.S. federal government for six months because of coronavirus. It doesn't work like that.”
Yasmeen Abutaleb, Erica Werner, Andrew Ba Tran and Toluse Olorunnipa contributed to this story.