20 Years of Failing to Prepare

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S1: Thank you very much.

S2: Earlier this week, President Trump got up in front of the cameras for one of his daily press briefings, flanked by two huge flat-screen televisions.

S3: Now, with that, I have a couple of interesting we have a few clips that we’re just going to put up a few minutes in.

S4: The president asked to dim the lights. Then he teed up video snippets that put a positive spin on his administration’s response to the Corona virus, a pandemic that has cost tens of thousands of American lives.

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S5: Well, we’ve asked them to accelerate. Someone had even scored this video with a kind of West Wing soundtrack.

S3: We could give you hundreds of clips just like that. We have them. We didn’t want this to go on too long.

S4: But I just want to say, for members of the press watching this spectacle unfold, you could sense this disbelief settle over them. One reporter asked who made this video? Other reporters jumped in to say, hold it. Are you saying you couldn’t have acted sooner to prevent people from getting sick? You couldn’t have done more.

S6: Back in like February, on January 30, this time, your travel ban lost a lot.

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S7: And in fact, we’ll give you a list. What we did, in fact, he said at some point we’ll give you a list of everything we did. And you actually you saw that list, right?

S8: I did see that list. I saw it circulating on Twitter by one of his campaign staff.

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S2: Dan Dimond is a reporter over at Politico.

S8: He was watching this press conference play out, waiting for that list, the the list of things that the Trump campaign was touting, the list of items across February. I counted it up. There were 20 distinct achievements as they saw it. But when I actually looked at those 20 things, seven of them were announcements. One was vowing in the State of the Union to protect us from coronavirus.

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S9: And then a couple of the others were things that had failed. The CDC was going to roll out tests in February. That that was one of the action items on the West. We know that those tests didn’t work.

S10: I wanted to talk to Dan because he knows how Washington deals with health care better than almost anyone. The last secretary of health and Human Services resigned after Dan’s reporting made him look bad. But the thing about Dan is that when things go wrong the way they have with this Corona virus, he doesn’t just wonder who’s to blame.

S2: He wonders, how did this mess start here? Reporters at this press briefing asking about the administration’s response back in February. And he wanted to go back even further is the beginning of the story.

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S8: January 2020, when the United States realizes that this virus is starting to make landfall in the United States is the beginning of a story. Last year, when the virus is exploding across, one in China is the beginning of the story. Four years ago, when Donald Trump is running for president and there are questions about his his interest in funding a public health system, and when he gets into office, did he take the right steps to set us up for this?

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S7: I mean, there’s been so much reporting, sort of highlighting the incompetence of the federal response in the last few months. I guess my question is whether you think it’s worth separating out that incompetence from something else, which is more of a structural problem.

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S8: I think there can never be enough reporting about what happened and what went wrong with the current response. But it’s it’s impossible to look at. A crisis like this and and not see the roots in the past.

S9: The programs that were supposed to come into place to help us for this moment. Some of those programs were funded or defunded years ago. And any crisis is not just in that moment, it’s all the moments that led up to it.

S11: And Dan Diamond. He’s looked back at twenty years of these moments, decisions made by the Bush administration. President Obama and how they led us here. I’m Mary Harris. You’re listening to what next. Stick with us.

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S7: So, Dan, you start the story of pandemic preparedness with 9/11. Why?

S8: Because I think that’s where the story of pandemic preparedness really starts in the United States.

S12: That was the moment where the United States realized how unprepared this country was for a major crisis, not just a terror attack, but the potential of a follow up bio attack. And within a week, the health department was pivoting to try and prepare for a smallpox attack and anthrax attack. And those fears were hammered home in the coming weeks and months. We forget this now, but lawmakers were getting letters in the mail that that raised concerns of a bigger anthrax scare. So it was a moment where the Bush administration and the health department in particular was forced to confront the lack of readiness for a bio event.

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S2: At first, the Bush administration was laser focused on a biological weapon, not a naturally occurring pandemic. Vice President Dick Cheney advocated for vaccinating the entire country against smallpox, fearing Americans were sitting ducks. Health experts caution against that plan, worried about unintentional side effects. In the end, President Bush quashed the idea.

S13: Not everyone was happy that that Bush didn’t pursue national vaccination and said the Bush administration pursued a much more targeted vaccination campaign for. For some health workers and military. But even that wasn’t enough for some observers who said that Bush wasn’t preparing the United States and that he would regret it by not vaccinating everyone.

S7: It just shows how complicated this decision making is. Like, it’s usually very expensive to prepare for something that hasn’t happened yet. And that’s one barrier. But the other the other thing that stood out to me reading this sort of 20 year history of pandemic preparedness that you put together was just the fact that every administration seemed to have this moment where they thought, we don’t need to prepare for this. Like every every president came in and was like, what what is this office on global health threats? Do we really need that? We just get rid of it.

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S12: President Donald Trump has gotten slagged. He’s gotten so much heat for the decision to disband the pandemic office in the White House. The National Security Office on Pandemic Preparedness. He was just following the script that that other White Houses did to Barack Obama. His team initially disbanded. The White House Health Security Office, George W. Bush did the same thing, inheriting from the Clinton ministration. So, yeah, there there are new White Houses that come in. And despite being warned by their predecessors that you will need these tools, you will need these teams. They almost always opt to scale back until there is a crisis that reminds them. This is why that team was there in the first place.

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S2: If President Bush learned his lesson after 9/11, President Obama learned it after H1N1 swine flu hit during his first year of his presidency. Then he learned it again when Ebola struck in 2016.

S13: H1N1, the swine flu, confronted the administration from from the first year of Obama’s term. And what the Obama administration tried to take from H1N1 was a sense of readiness and preparedness for the next fight. And I took a look at the lengthy review commissioned by the Obama administration and an improvement plan that was drawn up. Many of the lessons are things that would feel familiar to someone following the Cauvin 19 response. Like what? There was an emphasis on developing non-pharmaceutical interventions. NPI is where there would be shutdowns of schools, of businesses, of community events to avoid spreading H1N1 or whatever respiratory illness came came next. Another takeaway was the need to quickly spool up treatment and vaccines as soon as possible. And then I think a third thing that would be constant between the H1N1 crisis and future crises was the focus on widespread testing, the need to have testing up and running as soon as possible, just so public health experts could get a handle on where the problems were, who’s actually sick and how to channel resources to fight the emerging threat.

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S14: Someone who has been thinking about pandemics for nearly all of the last 20 years is President Trump’s Health and Human Services Secretary, Alex Azar. Back in the Bush administration, he was a lawyer at the agency, had a front row seat as Washington began ticking biological hazards much more seriously at Politico.

S13: We think about our beats very much like a White House reporter thinks about the White House. So my job is to cover the health department. That means in some ways that Alex Azar is like my president and his his team is like my cabinet. So all the energy and effort that goes into covering White House escapades by by some reporters. For me, it’s a health department, which means I watch almost every Alix’s ah press appearance and speech. And I knew that he had done pandemic work in the Bush administration. But before working on this story, Mary. I didn’t realize just how much he had done. Alex Azar arrived at the Health Department in 2001. He had been one of the lawyers fighting in Bush v. Gore on behalf of Bush. He’d been this Republican Party legal superstar. He was known really not for any any health care expertise, just for being one of the guys that the Republican Party went to to get things done. So he arrives at the health department in 2001 and from all understanding, wasn’t necessarily keen on the job, had to be talked into being the top lawyer at the health department, but came to really like the work. Loved the work. And as general counsel, e.r.’s fingerprints were on basically everything that came out of the health department for the first four years. And because there was not a major preparedness effort, there was not a big preparedness shop. Initially after September 11th, the general counsel’s office, the lawyers shaped a lot of the early preparedness work. So Azar himself. Yes. Azar Azar himself was either working on these projects, writing some of the the plans. So Azar was very closely involved out of the legal shop. And then in 2005, he became the number two official overall at the health department, which meant he played a major role in what would become the Bush administration’s pandemic flu plan in 2018 is I would come back and assume his current role as secretary of health and Human Services.

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S2: His time there has been fraught, though, through the winter of twenty nineteen. He got caught up in feuds with one of his subordinates, Sima Samar, the head of Medicare and Medicaid that left Azar are in a pretty weak position.

S13: Entering 20:20, where the White House had months and months of grievances against him, he had fights inside his own health department. And here he is trying to convince Donald Trump to take dramatic action to shut down the economy, to lock down travel and hurt our relationship with China. He was not coming in with a strong hand as he was trying to make those cases.

S7: Yeah, I’m wondering in all of your reporting, kind of how you came out feeling about Alex are because you’re reporting others reporting has really painted him as someone who was early on warning of the dangers here, but then at the same time bickering with other people in the administration. And of course, he was one of the people involved in, you know, the idea of approving tests. And so the CDC has at times pointed to HHS and Alex Azar and said part of the reason we don’t have a test is because of actions that were taken or not taken by those folks. So I wonder, he just seems like such a complicated guy, because you also found, you know, a transcript from 2019 where Azar specifically said the thing that keeps me up at night is the idea of a pandemic flu. So he clearly knew the risks and was clearly concerned about them and was deeply knowledgeable because he’d been in HHS for so long. But at the same time, it’s almost like tripping over your shoelaces a little bit.

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S13: We like simple narratives. The simple narrative of Trump failed on pandemics, a simple narrative of Obama would have done better. I think the truth is always more complicated, and whether it’s Trump and his handling of this pandemic can’t be totally separated from all the years that led up to this moment or in this case, Alix’s R, who was right on. So many things with pandemics, but maybe when. About running his health department in a way that made it weaker for this moment. Sima Burma wasn’t the only deputy on the outs with Alex Azar. Former FDA commissioner Scott Gottlieb had his own battles with Health Secretary Azar and the new commissioner, Steve Hahn, who took office just a few weeks before the Corona virus threat wasn’t initially looped in on on a lot of the key decisions that he has earned his team were making. So he was walking into this crisis with only part of a team that he really trusted. And while these are absolutely recognized, the risk of pandemic, it’s not clear that all of his department was activated in a way that we now realize it needed to be. So I think I think the report card on Alex’s are is still incomplete. It’s still TBD. We won’t know for sure until this crisis is over. But he certainly was a loud and vocal voice inside the administration on the pandemic threat. Did he do everything? Did he have his team ready to go? That’s a separate question and one that I’m still working to answer.

S10: Dan knows there are certainly things this administration could have done better if they’d followed suggestions from previous administrations. They would have ordered protective gear for doctors three months earlier. And that’s just one example.

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S7: It’s interesting because you also said that there are even things that the administration could be doing now, like a disease surveillance tool that was built within Health and Human Services that would allow the federal government to flip a switch and kind of gather data that local municipalities have really wanted, which is no racial and ethnic breakdowns of infections and things like that. Can you explain a little bit more like what are some of the things that could be done now?

S13: No one knows yet how significantly Cauvin, 19, is hitting minority populations. We have some regional data. We we have some city data. Public health experts want to see the national data on this.

S12: Now that we’re weeks into the outbreak, again, trying to figure out how to structure a response where resources should go. The Trump administration has not released national data on the racial and ethnic disparities here. And a point that came up in my conversations for for my preparedness story was the health department had prepared a tool exactly for this moment. It was used in H1N1 to offer Real-Time pictures of who had H1N1 by slicing that by race, by ethnicity, by gender. Drilling down in two different regions or areas. That tool was built 10 years ago. It’s not being used now. And there are other initiatives that were begun forgotton started unfunded.

S2: I’m picturing this like basement at Health and Human Services with just like records and, you know, things stacked up from years. And now no one flips through them.

S12: If you’ve seen Health and Human Services, it looks like a giant bunker. It is one of the ugliest buildings in Washington, D.C. And it’s quite possible that wedged into the walls, they have all kinds of secret plans and preparedness strategies that that folks aren’t aware of. I actually am thinking, Mary, not just about health and human services, though. The White House had its own plan, its own playbook that my colleague Nall Tusa and I scooped a few weeks ago. And that was the Obama era pandemic playbook designed exactly for this moment, a step by step guide on what to do when a threat like Koven, 19, shows up. That plan was ignored. So even when these plans are found, when they are. Aware of these preparedness strategies, there’s no guarantee that current officials are going to use them because they think that they’ve got a better plan now or there’s there’s animus toward who came up with the plan four years ago. It’s unfortunately an imperfect response in the middle of a perfect storm of crisis.

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S7: Is that new? Like I heard that I was just thinking, like, is this how it’s always been that every four, eight years an administration comes in and just wipes the slate clean?

S2: Did any of the administration officials you spoke to who had maybe been around for a while? Say things have changed or was this just status quo?

S12: Great question, and one that I definitely tried to answer. The handoff between administrations can be fraught. You’ve got one administration leaving, another one coming in that the past number of transitions has been opposed to what that administration did, that the Trump campaign and Trump himself railed against Obama. Obama ran against Bush. Bush was refuting Clinton. So it’s it’s not the warmest handoff, but there were efforts between the administrations to try and prepare the next one. I think what was different this time is just how much animus the Trump team brought to the transition. We reported a few weeks ago about the tabletop exercise where the Trump team was warned a few days before the inauguration on what it meant to respond to a pandemic. They were warned basically on a scenario just like the one we’re living through now. Most of those officials have now left the government just because the Trump administration is so tumultuous that some of the officials who were there and continued to be in the government per our sources, weren’t all that interested in the exercise. Betsy De Vos, the education secretary, was there. Wilbur Ross, the commerce secretary. Couple of our sources told us that he fell asleep during that preparedness exercise. That said, there are reasons for a new administration to come in and think we will do it better, we’ll do it differently than the last team. But to do things better requires having those conversations and understanding what the last team did. And the Trump team didn’t do that the same way that previous administrations paid more attention to it.

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S7: You know, I keep thinking back to Mike Leavitt, the former secretary of health and Human Services that you interviewed. Who who is one of your sources for this article? Because you began your story with him just getting reamed by Jay Leno for telling people to prepare for some kind of pandemic. You know, keep powdered milk and tuna fish. And it seems so crazy in 2005 when he said those things out loud. And of course, now it doesn’t seem crazy at all. And I just wonder when you talk to him where he was, that because, like, I don’t know how I’d feel if I was that guy. Like, he’s the guy who told you so like 15 years ago. And now what he warned about is happening.

S13: He could be the kind of guy who would say, I told you so. And now listen to me. He is not like that. Mike Leavitt had been health secretary for Bush. He’d been the governor of Utah. He’s he’s a delightful interview. I got to say, in all my interviews for the story, we we had a long conversation and he walked me through so many things that didn’t make it into the piece. But one thing that did stick with me, Mary, was his remarkable predictive ability. And to be that guy in 2005 who’s stomping around the country warning of a pet pandemic, going or holding events in every state and federal territory. He told me that he did about two thirds of those events himself. Alex Azar, his deputy, did the other third or so.

S12: Levitt was right. He was totally right. He just had the year wrong and the efforts that the Bush administration made, a lot of them informed, the strategies were were following through on how the Bush administration came up with a social distancing plan. And some of the same officials beyond Levitt and Azar are also are involved in now rolling out plans today.

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S2: I mean, one of the things he said to you was that the current pandemic is going to change the world in fundamental ways. And it made me wonder if Mike Leavitt gave you any clues for how. For what he thinks that might look like.

S13: It’s clear that our world will change. I think it’s too early to know how much some will depend on how long all of us are in our homes and what that means for the economy and new forms of how our society works. Some of it will depend on how long this sticks with us. Without a vaccine, without treatment, because the world looks very different in 2021 if we’re vaccinated against Vess versus if we’re not. It was interesting conversation because we talked about the high level pressures on decision makers like him versus the personal decisions that someone at his age and I believe his in his late 60s or early 70s, the personal decisions that he’s making to keep safe from this and how he’s walled himself out from a lot of the world. Mike, Mike Leavitt said to me, I’m thinking about all these things in the near term. I’m thinking about how do I stay safe for my family? How do I help them stay safe? And I think that was the key concern that I got from our conversation, not where are we going in 20 years, but where are we going in 20 days. And and until we have answers on how long, Koven 19 will be with us, I think it’s really hard to say how much society will change to accommodate a.

S15: Dan Diamond, thank you so much for joining me.

S13: I’m always glad to be here. Be well and be safe.

S15: Dan Diamond is a health care reporter at Politico. He’s got a newsletter called The Political Pulse. Go subscribe. And that’s the show. What Next is produced by Mara Silvers, Daniel Hewett, Jason De Leon and Mary Wilson. I’m Mary Harris. If you follow me on Twitter at Mary’s desk, you can see the view from my backyard, which is just steps away from where I’m recording this right now. I’ll catch you back here tomorrow.