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The Politics of the U.S. Response to COVID-19

The coronavirus pandemic is President Donald Trump’s 9/11 — but rather than identifiable terrorists to target, there is an invisible virus threatening global stability. This crisis will test the president’s ability to rely on his experts and to acknowledge and rectify his errors. 

The U.S. intelligence community sounded the alarms in January 2020, urging the design of a rapid response to contain the pandemic, but Trump did not react. When the Office of Director of National Intelligence reported the increasing number of deaths in Taiwan, South Korea, Hong Kong, Iran, Italy, and other European countries, several high-level officials – including  Health and Human Services Secretary Alex Azar and Director Robert Redfield of the Centers for Disease Control and Prevention – pressed for an urgent meeting with the president. The meeting did not transpire until Jan. 18. Trump first denied the seriousness of the outbreak, then delayed an adequate response to the public health crisis. 

Senior-level officials’ inability to obtain Trump’s attention, ineffective relationships between the White House and the intelligence community and the National Intelligence director, and the president’s own downplaying the severity of the coronavirus outbreak were a perfect mixture for a public health disaster.

In Search of the Office on Global Pandemics

The Global Health Security and Biodefense (GHSB) team on the National Security Council (NSC) was created in 2014-2015 to address coordination problems during the Ebola virus outbreak. In the early phases of that outbreak, the response and preparedness strategy was disjointed; different parts of the NSC managed specific lines of efforts of the strategy, but no single part could see the grander picture.  

In 2018, NSC’s senior director for GHSB, Dr. Luciana Borio, said that “a pandemic flu was the number one threat to the U.S.,” but the NSC leadership did not appreciate this statement. Borio left the GHSB and the interim director, Rear Adm. Tim Ziemer, continued to raise the profile of  GHSB in midst of budget cuts. In 2019, Trump’s budget slashed 19% of the CDC budget and dealt Public Health Services a 10% cut. When John Bolton arrived at the NSC as the advisor in March 2018, he dismantled the GHSB office.   

The first architect and director of GHSB, Beth Cameron, wrote a disparaging Washington Post opinion essay stating, it was “impossible to assess the full impact of the decision to shutter the global health security team,” but argued it was “clear that scrapping the office had contributed to a sluggish domestic response.” By not having the biodefense directorate in the White House, Trump did not have the supportive structure in place to act swiftly during a crisis.  

The White House Blues

In January 2020, in the absence of the GHSB, Trump’s NSC Advisor Robert C. O’Brien and deputy Matthew Pottinger led the White House pandemic response. They advocated shutting out flights from China and Europe and ensuring the cruise ship with confirmed coronavirus passengers would not be docked in California. Pottinger, a former Wall Street Journal reporter in China, personally saw how the Chinese government botched the SARS virus breakout. Both O’Brien and Pottinger understood this was the NSC’s moment to repair its damaged reputation by serving as the central body for interagency coordination to confront the pandemic. Both O’Brien and Pottinger insisted that the NSC be the focus point for designing a pandemic response by convening daily meetings, ensuring the inter-agencies collaborated cohesively, and retaining sole supervision of the process.

On Jan. 31 this changed when Vice President Mike Pence became the head of the White House Task Force for the Coronavirus, effectively eclipsing the NSC. Pence supervised the task force with the Secretary of Health and Human Services (HHS), U.S. Surgeon General, U.S. Deputy of Secretary of State, Director of the U.S. Office of Science and Technology, Director of the National Institute of Allergy and Infectious Diseases, Director of CDC, FEMA, and 15 more directors from other inter-agency offices.

Other internal factors contributed to missteps, delayed responses, and poor decisions on containing COVID-19. The departure of acting Chief of Staff Mick Mulvaney on March 6 rearranged the hierarchy of who has access to the president. Then, there was the lingering, confusing role of Jared Kushner, the president’s senior advisor and son-in-law. Kushner created his own team of government allies and business leaders which some dubbed the “shadow task force.” Kushner misadvised Trump that Google had 1,700 engineers working all night to roll out a website on the coronavirus, but Google denied any involvement. Recent reports indicated that Kushner’s company, Oscar Health, was hired to create a public website to identify COVID-19 testing centers, which would violate the conflict of interest measures in federal procurement laws.

Competing interests within the White House ultimately led to a multidimensional, chaotic, farcical response. Several of Trump’s inner circle of confidants are jockeying to prove their skillful relevance; another group acts as the West Wing’s vanguard, furiously working to filter information that will flow (or not) to the president; and influential public relations spin masters capitalize the news cycle. This environment was not conducive to the creation of a thoughtful response to COVID-19

Is Bureaucracy the Answer?

The 9/11 attacks defined George W. Bush’s presidency. He worked with Congress to pass the Homeland Security Act, which made the Department of Homeland Security (DHS) a standalone, Cabinet-level department to coordinate the prevention of attacks on America. When DHS opened its doors in March 2003, it consolidated the Secret Service, U.S. Citizenship and Immigration Services, U.S. Customs and Border Protection, U.S. Coast Guard, FEMA, U.S. Immigration and Customs Enforcement, and the Transportation Security Administration under one authority. 

The collective experience of watching terrorists attack America unified the country. With COVID-19, there is no live broadcast of an attack. Astonishingly, COVID-19 has caused three times more deaths (over 10,800) from COVID-19 than the Sept. 11 attacks, yet the White House has no strategic plan or long-term solution to the pandemic. 

The White House Task Force on the Coronavirus is a temporary fix. To effectively mitigate the pandemic and future epidemics, Washington will need to respond with a post-9/11 expediency by realigning bureaucratic structures. Just as DHS evolved out of a security necessity, a similar department is critical because it would be dedicated to securing and protecting the public health and economy. It would consist of existing government entities, like the CDC, National Institute of Health, and HHS. Distinct offices would be dedicated to securing the supply and distribution of food, medical resources, and public health personnel, and the non-disruption of  communications and transportation. 

This new department would cover broader health security issues such as pandemics, HIV/AIDS programs, and vaccine programs, and establish a strategy for different kinds of outbreaks. Centrally important is attention to biological warfare – “germ warfare” – where infectious agents are used to incapacitate or kill a population. The U.S. military has expertise at the Defense Threat Reduction Agency, and the Department of Defense has as deputy assistant to the Secretary for Counterproliferation/Chemical and Biological Defense. However, these military efforts are not under one umbrella with CDC, FEMA, or HHS.   

A basic rule of bureaucracy is that your institutions and structures reflect, reinforce, and implement your priorities. Dismantling the White House GHSB Office was an egregious error and an example of misjudging the importance of global health, biodefense, and biological warfare. The creation of an adequate, comprehensive bureaucratic structure will need expertise from a combination of science, technology, and epidemics control, national security, economy, banking, intelligence analysis, and policy makers.

Reality is Painful

The Institute for Health Metrics and Evaluation, based at the University of Washington School of Medicine, has the best data projections when it comes to predicting where the COVID-19 situation is headed. As of April 1, their predictions – which assume that whatever protective measures states are taking right now remain the same – show that the U.S. will a hit peak hospital overload on April 16. On that day, over 260,000 people will be hospitalized, which means a shortage of 85,000 hospital beds and 19,000 ICU beds in the United States. Due to this shortage and how widespread the virus will be, over 2,600 people will die of COVID-19 on April 16. To put that in perspective, in the United States approximately 10,800 people have died of COVID-19 as of this writing, but on April 16 alone there will be more than 2,600 deaths.

If predictions are correct, COVID-19 will have three waves. This means the pandemic will last until May 2021. A task force cannot sustain the energy or leverage professional expertise and necessary bureaucratic streamlining of services for that long. Pence has repeatedly spoken of an “all government approach,” but such an approach will lead to waste and duplicated efforts. Political appointees just do not have the expertise to supervise pandemics. 

Washington, like Beijing and Rome, made multiple mistakes before realizing the seriousness of the coronavirus pandemic. Trump is under immense scrutiny as he deals with the challenges of designing and implementing a comprehensive long-term solution to COVID-19. This crisis is an opportunity for Trump to demonstrate, by putting forth a new department initiative, that he can transcend partisan politics and place the safety and security of the public in the center.

Dr. Qamar-ul Huda was a Senior Policy Advisor to the U.S. Department of State Secretary’s Office of Religion and Global Affairs. He tweets at @qbhuda.

The views expressed herein are the author’s and do not necessarily reflect those of CGP.