https://www.vox.com/policy-and-politics ... c-response
President Donald Trump’s failure to respond to the coronavirus pandemic didn’t begin with the administration’s inability to send out the millions of test kits and the protective medical gear for health care workers that experts say are needed to tackle the crisis. It didn’t start with Trump’s bungled messaging downplaying the crisis even as it’s worsened, nor with his mid-March insistence that social distancing measures could be lifted by Easter (he later backpedaled).
It began in April 2018 — more than a year and a half before the SARS-CoV-2 virus and the disease it causes, Covid-19, sickened enough people in China that authorities realized they were dealing with a new disease.
The Trump administration, with John Bolton newly at the helm of the White House National Security Council, began dismantling the team in charge of pandemic response, firing its leadership and disbanding the team in spring 2018.
The cuts, coupled with the administration’s repeated calls to cut the budget for the Centers for Disease Control and Prevention (CDC) and other public health agencies, made it clear that the Trump administration wasn’t prioritizing the federal government’s ability to respond to disease outbreaks.
But experts say a lot of the damage has been done: The federal government is still only playing catch-up, as thousands of new cases of coronavirus are confirmed and the death toll steadily increases every day.
The first sign of a massive failure came with testing. South Korea, which has been widely praised for its response to coronavirus, tested more than 66,000 people within a week of the first community transmission within its borders. By comparison, the US took roughly three weeks to complete that many tests — in a country that is much more populous and, now, is on track to have a much worse outbreak than South Korea and other nations.
Testing is crucial to slowing epidemics. First, it lets public health officials identify sick people and subsequently isolate them. Second, they can trace that sick person’s recent contacts to make sure those people aren’t sick and to get them into quarantine as well. It’s one of the best tools we have for an outbreak like this.
But it’s the kind of thing that the Trump administration has screwed up, while instead trying to downplay the threat of Covid-19. Trump himself has tweeted comparisons of Covid-19 to the common flu — which Jha describes as “really unhelpful,” because the novel coronavirus appears to be much worse. Trump also called concerns about the virus a “hoax.” He said on national television that, based on nothing more than a self-admitted “hunch,” the death rate of the disease is much lower than public health officials projected.
Trump’s failures began years ago
When Bolton became Trump’s national security adviser in 2018, he quickly moved to disband the White House National Security Council’s Directorate for Global Health Security and Biodefense, which President Barack Obama set up after the 2014-2016 Ebola outbreak to lead federal coordination and preparation for disease outbreaks.
In April 2018, Bolton fired Tom Bossert, then the homeland security adviser, who, the Washington Post reported, “had called for a comprehensive biodefense strategy against pandemics and biological attacks.” Then, that May, Bolton let go the head of pandemic response, Rear Adm. Timothy Ziemer, and his global health security team. The team, the Directorate for Global Health Security and Biodefense, was never replaced.
At the time, the Trump administration and Bolton argued the cuts were needed to streamline the National Security Council.
But, according to experts, the work of a global health security team, or something like it, is crucial to responding to any disease outbreak. Since the federal government is sprawling and large, it helps to have centralized leadership in case of a crisis. That leadership could ensure all federal agencies are doing the most they can and working toward a single set of goals.
But it’s important to have this kind of agency set up before an outbreak. Setting up an agency takes time; it requires hiring staff, handing out tasks and expected workloads, creating internal policies, and so on. A preexisting agency is also going to have plans worked out before an outbreak, with likely contingencies in place for what to do. That’s why it was so important to have this agency in place even during years, like 2018, when disease pandemics didn’t seem like a nearby threat to everyone.
“The basic systems need to be in place for global, state, and local responses,” Jen Kates, a senior vice president and director of global health and HIV policy at the Kaiser Family Foundation, told me. “When you don’t shore those up, you’re not starting from scratch, but you’re catching up every single time.”
By repeatedly undercutting outbreak preparedness, Jha said, the Trump administration signaled “to the government and all the agencies this is not a priority. And that means that even other agencies end up not putting as much attention and energy on it. So I think this has been a longstanding problem of the White House.”
Trump, for his part, has defended his record, arguing, “I’m a businessperson. I don’t like having thousands of people around when you don’t need them. When we need them, we can get them back very quickly.”
But experts argue that’s not how pandemic preparedness should work. “You build a fire department ahead of time,” Tom Inglesby, director of the Johns Hopkins Center for Health Security, told the Washington Post. “You don’t wait for a fire.