How Trump Threw Out the Pandemic Playbook

The Atlantic

20 hours ago

As of last month, there is no one left in the White House whose sole job is to keep the nation safe from biological threats. The leader of the National Security Council's biosecurity directorate recently resigned. His staff had been pushed out, and his unit is now defunct. The Office of Pandemic Preparedness and Response Policy, established by Congress in 2022, has dwindled from a staff of about 20 under President Joe Biden to a staff of zero.
The Trump administration has said that it's just reorganizing the bureaucracy and is prepared to handle biothreats. But our experience suggests otherwise. Without a leader from the NSC embedded in the White House and ready to coordinate other agencies, more people—including Americans—will get sick and die.
We have spent years helping lead the U.S. government's efforts to contain the deadliest biological threats. One of us, Beth Cameron, helped found the NSC's biosecurity office, in 2016—created as a response to a deadly Ebola outbreak in West Africa that had begun a couple of years earlier. Ebola is a gruesome, highly contagious disease that causes its victims' organs, blood vessels, and immune cells to fail. The average lethality rate is about 50 percent. That outbreak killed more than 11,000 people across West Africa and cost the U.S. government billions of dollars to help contain. Despite our government's best efforts, 11 cases ultimately reached the U.S., and two were fatal.
President Donald Trump terminated the NSC's biosecurity office during his first term, but Biden reestablished it—and just in time. In early February 2021, an ominous email came to the White House from federal health officials: reports of Ebola outbreaks in Guinea and the Democratic Republic of the Congo. The cases were close to the borders of Uganda and Rwanda, major travel hubs for the region.
The White House was already managing the coronavirus pandemic and resulting economic crisis. But leaving Guinea and Congo to handle the Ebola outbreaks on their own was risky. So we activated a system developed through hard-learned lessons from past deadly outbreaks, designed to help contain them at their sources and to prepare for the worst at home.
We sent public-health professionals to advise the affected countries. We took inventory of vaccines and other supplies so we would be ready to deploy them. We relied on a painstaking system of testing, vaccinations, and predeparture screenings in Congo and Guinea. We ensured that anyone who had been to an affected country and was seeking to come to the U.S. was funneled to one of a handful of American airports. The CDC and the Department of Homeland Security activated a program for tracing and contacting passengers after their arrival. One of us, Jon Finer—the principal deputy national security adviser at the time—led a team of senior health and national-security officials from across the government; it met every day to coordinate all of the moving parts, and to keep the president and other senior officials informed.
It worked. The disease was entirely contained within the two source countries—no cases reached the U.S.—and 18 people died, a number that could have been exponentially higher.
To strengthen our responses to future pandemics, lawmakers soon established the position of a U.S. coordinator for global health security; one of us, Stephanie Psaki, was the first person to hold that job. They also created the Office of Pandemic Preparedness and Response Policy in the White House. The Trump administration, tasked with upholding the law, is supposed to be staffing these offices. Not only has it failed to do that, but in just six months, it also has dismantled many of the early-warning-and-response systems that were built over decades.
In Trump's second term, his team has fired thousands of public-health experts at the CDC, the FDA, and other agencies. It has canceled investments in safeguards against pandemic influenza, undermined confidence in vaccines, and cut funding for potential future outbreaks. It killed USAID and is scaling down the CDC's global role, canceling many of the programs that maintained ties to countries where disease outbreaks occur. It has withdrawn the U.S. from the World Health Organization. And it has created confusion about who in the U.S. government is in charge of the system for tracking deadly biothreats, whether naturally occurring, accidental, or deliberate.
Put another way: The second Trump administration inherited a playbook, and then pushed out the people who knew how to run the plays.
The United States is dealing with many biological threats at home and abroad, such as the bird flu and measles—with the latter, America is already facing the worst outbreak in decades. Scientists estimate about a 50–50 chance of another pandemic as severe as the coronavirus occurring in the next 25 years. The probability is even higher for smaller-scale threats, such as periodic Ebola outbreaks. Deadly biothreats are more and more likely to emerge for a range of reasons, including increased interaction between humans and animals, labs without sufficient biosecurity systems, easier public access to the information and technology needed to create or manipulate a bioagent, and continued concerns about the development of biological weapons by nefarious actors. The risk of death and economic disruption is only growing.
America rebuilt the system of disease detection and response after the first Trump administration damaged it. That will be harder to do this time around. Far more officials have left the government. Will they be willing to come back, given the degree to which their work has been disparaged and their job security eviscerated?
Stopping deadly diseases from reaching the United States is challenging at the best of times. Absent trusting relationships and, truth be told, a fair amount of pressure, affected countries aren't always forthcoming with information. (We dealt with one case that required resorting to threats to withhold U.S. support if the other government didn't share more data about an emerging outbreak.) Health imperatives can collide with political ones, such as when a country has to consider restricting travel. Questions can arise about how much of a vaccine or treatment should be shared with other countries, and how much should be kept at home (if a vaccine or treatment exists at all).
But these are all reasonable policy debates that assume the system is basically functioning. In a worst-case scenario, we might not even know about a disease until it has started spreading in a major city with an international airport. With no warning, we will have less ability to stop the disease at its source, and less power, if it reaches our shores, to save American lives. The odds of us facing that scenario have now gone way up. This would be a terrible tragedy, and all the more so because it would be self-inflicted.