The solution to an HIV outbreak in southern Indiana five years ago was straightforward. The virus was being spread by intravenous drug users sharing dirty needles; providing clean needles would bring a halt to new cases. A later study found that an early response to the crisis could have resulted in one-quarter the number of infections that eventually resulted. But the response instead came late.

At the time, Indiana’s governor was Mike Pence, now vice president. As The Post’s Meryl Kornfield reports, Pence announced a state of emergency focused on the outbreak in late March 2015, two months after it began. He opposed needle-exchange programs, arguing that “effective anti-drug policy [doesn’t] involve handing out drug paraphernalia.”

Even while approving a program in Scott County, the epicenter of the outbreak, his administration made clear that this was “a surgical strike for the areas affected” and not a new embrace of needle exchanges. Doctors warned that the problem was broader than the one county and, in response, the state panel approved a measure allowing counties to establish their own exchanges.

Criticism of Pence’s handling of the HIV outbreak has reemerged following President Trump’s announcement Wednesday that Pence would lead the federal government’s response to the threat of a coronavirus pandemic. Speaking to reporters at a briefing, Pence explained the role he would play.

“As a former governor from the state where the first MERS case emerged in 2014,” Pence said, referring to Middle East respiratory syndrome, a form of coronavirus that spread that year, “I know full well the importance of presidential leadership, the importance of administration leadership, and the vital role of partnerships of state and local governments and health authorities in responding to the potential threat of dangerous infectious diseases.”

The question that looms over the Pence appointment is a simple one: Has the former governor, whose skepticism of government intervention in health emergencies was manifested in the HIV outbreak, actually come to appreciate the importance of a government response?

When he first ran for Congress, he wrote a series of blog posts that presented similar skepticism about having the government address public health crises. The most famous was an article opposing a settlement between tobacco companies and the government — a deal that he warned was actually about “big government.”

Pence conceded that cigarettes were harmful, although he argued that “smoking doesn’t kill,” since most smokers don’t die from tobacco-related illnesses. He continued: “The relevant question is, what is more harmful to the nation, second hand smoke or back handed big government disguised in do-gooder healthcare rhetoric.”

“Even a conservative like me would support government big enough to protect us from foreign threats and threats to our domestic tranquility,” he said, “but the tobacco deal goes to the next level. Government big enough to protect us from our own stubborn wills. And a government of such plenary power, once conceived will hardly stop at tobacco. Surely the scourge of fatty foods and their attendant cost to the health care economy bears some consideration. How about the role of caffeine in fomenting greater stress in the lives of working Americans? Don't get me started about the dangers of sports utility vehicles!"

This is mostly just political rhetoric of the government-is-bad-and-oppressive variety, which was popular at the time of Pence’s immersion into federal politics. But it’s nonetheless a perspective that should raise concerns in the current moment: Does Pence similarly think that recommendations to wash one’s hands are too Big Brother-y? What about mandatory quarantines, should it come to that? Mandates to wear protective masks in public?

If for two months he put protecting Indianans from HIV behind his personal opposition to needle exchanges, what happens if there’s tension between his political beliefs (and ambitions) and recommendations from experts centered on coronavirus?

Or will he simply dismiss the experts, as he did when he wrote about climate change when running for Congress?

“Environmentalists claim that certain 'greenhouse gases' like carbon dioxide are mucking up the atmosphere and causing the earth to gradually warm,” he wrote. “Despite the fact that CO2 is a naturally occurring phenomenon in nature” — increases in carbon dioxide emissions, he later wrote, were “mostly the result of volcanoes, hurricanes and underwater geologic displacements” — “the [Greenpeace] folks want to blame it all on coal (another natural mineral) and certain (evil) coal burning power plants."

The warming climate is, in fact, a function of increased greenhouse gas emissions driven by the combustion of fossil fuels, something that is now broadly accepted but which was also clear in the late 1990s at the time Pence wrote.

The tension here is between the available facts and the politics of responding to them. Pence in 2015 was a Christian conservative Republican who understood that needle-exchange programs were politically toxic. When he lambasted the tobacco settlement, the politics demanded rejection of government overreach. When he criticized the Kyoto Protocol to reduce carbon dioxide emissions, opposition to action on climate change was a default political position for his party, as it remains today.

In the current moment, though, there's another complicating factor for Pence, one demonstrated in his remarks accepting his new position on Wednesday. He began with effusive praise for his boss's approach to the new threat.

“From the first word of outbreak of the coronavirus,” he said, “the president took unprecedented steps to protect the American people from the spread of this disease” — one line in a flurry of defenses of Trump's response.

Pence is accountable to a president who has made clear that he wants to assure Americans that coronavirus is not a big deal. A president who consistently subjugates science to politics. Pence will be leading an effort that Trump wants to keep as constrained and quiet as possible. For Pence, who understands that his own political ambitions are tightly tied to staying in Trump’s good graces, that presents a political tension that didn’t exist when he was simply trying to navigate between political ideals and the public health of Indiana. Now, he has to figure out the same balance while also making sure that Trump doesn’t get mad about what he’s doing.

There’s a reason that past health crises have been led by nonpolitical actors: It helps keep the politics of a response at a distance. This may, in fact, be why Trump specifically wanted someone political leading the charge, so that Trump has a hand in shaping where things go. In appointing Pence, he gets a twofer, handing over leadership to someone who has already demonstrated a willingness to give politics primacy on public health issues.

“Mike is going to be in charge, and Mike will report back to me,” Trump said when naming Pence as the lead administration official on the issue. “He’s got a certain talent for this.”

We have to ask: To what does “this” refer?