This Is Still Happening is a feature in which Slate will attempt to offer an update on Cabinet-level corruption, what could be done to bring the officials to account, and what Democrats are doing in response (generally, nothing). The sixth installment is about the man responsible for our nation’s health care system, Alex Azar.
The Official: Secretary of Health and Human Services Alex Azar
What Is Still Happening: The catastrophic lack of public information surrounding the spread of the novel coronavirus has led to tanking financial markets and possible economic meltdown, but the greater concern is how many Americans might get seriously sick or even die from the outbreak who need not have. For the past month, the United States has been flying blind into the deadly new pandemic due to a lack of available testing, and Alex Azar is the official most responsible for that failure.
Is it fair to blame Azar and the Trump administration generally for a global disease that apparently started with bats in Wuhan, China? No. It is fair, though, to blame him for the woeful federal response that has resulted in a horrifying under-identification of cases, the actions of public health officials that may have actually exacerbated the crisis, and the many lies and misleading statements he has told to the public as the disaster has unfolded.
How have Azar and HHS failed in this crisis? Let us count the ways.
• The most critical failure is America’s tragic testing regime. While testing has been widespread in other countries, it has been tightly restricted in the United States due to a broken health care system; terrible, unexplained decisions not to use available resources; and the use of faulty tests. Dr. Anthony Fauci, a member of Trump’s coronavirus task force, acknowledged as much on Thursday. “It is a failing. Let’s admit it,” he told the House Oversight Committee. “The idea of anybody getting it easily the way people in other countries are doing it—we’re not set up for that. Do I think we should be? Yes, but we’re not.”
How did this happen? Federal officials still haven’t offered any explanation as to why the United States refused to use tests shipped by the World Health Organization, which distributed tests to almost 60 countries, when the contagion was in its early phase, a move which could have helped with detection and slowed community spread. Instead, the Centers for Disease Control and Prevention opted to design and use its own tests, which turned out to be faulty and resulted in many inconclusive results. As the New York Times has reported, researchers in Seattle who had the capacity to step in and help fill the shortage as cases exploded in the region were instructed not to test.
The shortages, incomprehensibly, continue to this day. On Tuesday, Politico reported that even as test availability has increased—not up to need, but beyond the initial low numbers—a shortage of necessary lab equipment has continued to hamper testing and led to further undercounts. On Thursday, it was reported that only about 11,000 tests had been conducted in the United States, as compared with more than 10,000 per day in South Korea. Public health officials also confirmed that just 77 people were tested by the CDC between Sunday and Wednesday morning. All of these failures belong to Azar and his department.
• HHS leadership repeated an early mistake of quarantining cruise ship passengers on ships where the disease was likelier to spread, rather than disembarking and quarantining infected passengers on land.
• Last month, a whistleblower reported that federal health officials did not have the protective gear or infection training they needed when working with American evacuees from Wuhan who had been exposed to the virus and were quarantined at March Air Reserve Base in Riverside, California. These federal workers then took commercial flights to return to their communities without being tested. CNN further reported on Wednesday that workers at Travis Air Force Base in Solano County, California, were similarly ill-equipped and also returned to their communities without testing. “They’re spraying down streets with bleach in China,” one of CNN’s sources said. “We would go straight from quarantine to Starbucks.” As CNN further reported: “In an after-action report filed with the U.S. Department of Health and Human Services one of the workers stated that when he complained about the lack of proper protective equipment, a supervisor told him: ‘If you don’t feel comfortable, we’ll find another job for you.’ ”
Azar’s HHS department responded to the whistleblower complaint by saying that workers were asymptomatic and “therefore, testing for the virus is not medically necessary.” Health experts say that some people who contract the coronavirus may be asymptomatic or presymptomatic and still spread the disease. Azar himself has stated, without proof, “Even if these allegations prove to be true, there was no spreading of the disease from this.”
• Reuters, meanwhile, reported on Thursday that Azar kept dozens of coronavirus threat meetings classified at the White House’s insistence, restricting access from public health officials who needed information about the outbreak. “We had some very critical people who did not have security clearances who could not go,” one official said. “These should not be classified meetings. It was unnecessary.” As Reuters reported, the move was apparently part of a White House media strategy of keeping information from the public: “One of the administration officials suggested the security clearances for meetings at HHS were imposed not to protect national security but to keep the information within a tight circle, to prevent leaks.”
• The Associated Press reported last week that Azar gave in to White House demands not to publish guidance by the CDC recommending that older Americans not fly.
• President Donald Trump has added to the harm of the lack of testing by lying to the public constantly about it. The secretary of Health and Human Services, whose job in a public health crisis is to make sure the public is as informed as possible, has excused or amplified the president’s deceit and misinformation. For instance, after Trump said last week that “anyone who wants a test can get a test,” Azar said the president was just speaking in “shorthand.” “What he meant to say is we’re not in the way of that,” Azar said. And when Trump said, “A lot of people think it goes away in April with the heat,” Azar validated these comments, claiming, “He said he hopes it will go away with warmer weather.” In that same interview, Azar also claimed the virus was “contained.”
Overall, Azar has backed Trump’s administration line of downplaying the effects of the virus that other public health officials have acknowledged is at least 10 times as deadly as the flu. “The risk to any average American is low from the novel coronavirus,” Azar said on Feb. 29. “The risk remains low. Thanks to the unprecedented actions President Trump has taken and the actions he’s announcing today, that risk remains low. But this can change rapidly.”
Early in the crisis, Azar flatly lied about the number of people who had been tested and said that “there is no testing kit shortage, nor has there ever been.” As recently as Tuesday, Azar gave the misleading statement that “there are millions of tests out there now,” when in reality, testing numbers have remained in the thousands.
How Long It Has Been Going On: Azar trained for his role as the Baghdad Bob of the coronavirus as a senior health official in the George W. Bush administration. During Azar’s time as HHS general counsel, the department implemented a policy that sought to keep congressional investigators from interviewing HHS staff, granted a waiver to allow one of the architects of Bush’s Medicare prescription drug bill to interview for jobs with drug companies while crafting that bill, helped suppress internal cost estimates of that bill, and helped promote abstinence-only sex education programs to the detriment of public health.
After leaving the administration, Azar became one of the top executives at the drug manufacturer Eli Lilly at a time it was sued for, and repeatedly accused of, price gouging and fixing. In just the most disturbing instance, the company more than tripled the price of insulin, participating in an industry price spike that is killing people.
Rejoining the government as Trump’s HHS secretary in 2017, Azar resumed his support of Republican ideological crusades: backing Medicaid work requirements, lecturing the international community with anti-abortion rhetoric, and going so far as to rebrand HHS as the “Department of Life.”
The biggest previous indication of how Azar would put Trump administration propaganda ahead of the lives and health of Americans was seen in his department’s treatment of undocumented immigrant children during the family separation crisis. Earlier this month, the HHS Office of Inspector General released a report describing in excruciating detail how top officials reporting to Azar had ignored warnings that families were being separated en masse, that children were being traumatized, and that the Office of Refugee Resettlement had inadequate capacity to actually care for these kids.
As the report described: “ORR staff believed that the [Unaccompanied Alien Children] Program lacked the bed capacity to accommodate a large increase in separated children and were also concerned about the trauma such a policy would inflict on children. At several points before the zero-tolerance policy was implemented, ORR staff shared these concerns with the ORR Director, the Acting Assistant Secretary for ACF, and the Counselor to the Secretary for Human Services Policy. OIG found no evidence that these three senior HHS officials took action to protect children’s interests in response to the information and concerns raised by ORR staff.” HHS leadership, for instance, ignored specific warnings, such as “We had a shortage last night of beds for babies.” One of Azar’s top lieutenants said he believed family separation would have a positive “deterrent” effect. Another said “I do not know what the moral right thing to do is in this situation.”
Azar’s department ultimately wholeheartedly backed family separation, putting out a statement as the crisis was exploding that “if parents do not wish to be separated from their children, they should not violate the laws of the United States or endanger minors through criminal smuggling.” Azar himself repeated that talking point and claimed falsely that his department was tracking all separated children and communicating regularly with separated parents—statements ultimately disproven by the OIG.
The OIG further reported that Azar’s department actively tried to suppress and hide internal criticism of the policy proposal before it was fully enacted. From the report:
Some ORR staff described an organizational culture that discouraged putting potentially controversial information in writing, including but not limited to information about separated children. … For example, ORR staff recalled receiving repeated, general reminders to be cautious about putting information in writing, as well as being instructed to provide verbal-only briefings and offer verbal-only comments on certain matters. Some ORR staff also reported that they were criticized for documenting certain topics. For example, one ORR employee recalled that immediately after sending an email that included concerns about family separation, a superior within ORR verbally advised the employee that those concerns should not have been put in an email.
Collectively, these repeated reminders to limit written information may have had a chilling effect on frank discussion about the possibility that larger-scale family separation would occur, impeding the UAC Program’s ability to prepare. The lack of documentation may also have contributed to senior HHS officials’ ability to dismiss staffs’ concerns about capacity and children’s well-being rather than squarely address them. Additionally, the lack of written records on these topics hampers subsequent efforts to determine what occurred and how HHS could better respond to similar challenges in the future.
Now the entire country will experience that culture of misinformation and unpreparedness that was beta-tested on migrant babies.
What Would Normally Happen: Family separation was one of the most shameful, unlawful, and brutal policies the federal government has enacted in its history. That abuse alone in a normal world would result in removal from office for any official involved.
As for the pandemic that is currently spreading across the country, this is such a rare event that there’s not great precedent for how such a tragically botched response would be treated. Perhaps the closest point of comparison is George W. Bush’s Federal Emergency Management Agency director Michael D. Brown, who resigned in disgrace after his mishandling of the response to Hurricane Katrina likely cost hundreds, if not thousands, of lives.
What Democrats Have Done: Some Democrats have gone the standard and ineffectual route of calling for Azar to resign over his department’s mishandling of the coronavirus crisis, without any organized or sustained pressure campaign. Aside from a few scattered resignation calls, there was no such campaign for Azar to vacate following his department’s horrific family separation work.
What Is Likely to Be Done: Democrats will continue to hold oversight hearings on the coronavirus, but the efforts to prevent a complete collapse of our financial and health care systems may distract them from holding anyone accountable for these horrific failures, even if they were inclined to do so.
How Impeachable This Stuff Is: Azar claimed that his department’s work during family separation was “one of the great acts of American generosity and charity.” In a more just world, he and others involved would be brought before the Hague. 9 out of 10.