President Donald Trump held a press conference on Wednesday night in an effort to calm Americans’ fears about the coronavirus outbreak after the Centers for Disease Control and Prevention (CDC) confirmed the first U.S. case not directly linked to overseas travel. Instead of putting an outside expert in charge of the country’s response to this impending epidemic, as many had hoped, Trump named Vice President Mike Pence as leader of the task force. The president said that Pence’s record of handling health crises as Indiana governor qualified him for the position. Those of us who remember how Gov. Pence responded to an HIV outbreak in rural Indiana, however, do not agree.
Scott County, in southern Indiana near the Kentucky border, has about 24,000 residents. In 2014, when the outbreak began to be identified, 19% of its residents lived below the poverty line, and opioid abuse was rampant. The outbreak appears to have begun with people sharing needles to inject Opana (oxymorphone), a pain medication similar to, but stronger than, OxyContin (oxycodone). In a normal year, the health department would see five new HIV diagnoses, but between December 2014 and March 2015, 79 people tested positive for HIV. By the time the outbreak was contained, over 215 people had contracted HIV.
Criticism of Gov. Pence’s response to this outbreak usually focuses on his ideological opposition to needle-exchange programs, with good reason. Sharing needles is the most efficient way to transmit HIV. Researchers estimate that for every 10,000 times a woman has penile-vaginal intercourse with an HIV-positive male partner, eight would end in HIV transmission. In contrast, for every 10,000 times an HIV-negative person shares needles with an HIV-positive person, 63 would likely end up in HIV transmission. The county’s public health nurse told The New York Times in 2015 that people were using the same needle up to 300 times “until it broke off in their arms,” because needles were so hard to come by. Needle-exchange programs—which provide clean needles to injection-drug users—are considered an important part of public health harm-reduction efforts. Research shows that these programs do not result in increased drug use but do substantially reduce the risk of infection with HIV and hepatitis C.
Pence, a social conservative, believed that such programs were immoral because they promoted or enabled drug use. And he held tight to this belief well into the HIV outbreak in Scott County, despite pleas from his health department advisors and experts from the CDC. Ed Clere, a Republican state representative, was poised to introduce legislation clearing the way for syringe exchange in the state but was essentially told not to bother. According to The New York Times, after a March 2015 meeting with CDC officials who told him this was a crisis and needle exchange was imperative, Gov. Pence went home to “pray on it.” Ultimately, Pence decided to issue a temporary order allowing needle exchange in Scott County.
We will never know what came to Mike Pence during that prayer, but the program that resulted was too little and too late. Using computer modeling, epidemiologists at Yale University found that the outbreak had probably been building for years and had peaked in January 2015, two months before Pence prayed his way to needle exchange. Moreover, the exchange program itself was not run according to best practices. In order to participate, individuals needed to register using their birthdate and some letters of their name and were given a laminated registration card. Anyone found with a needle but no registration card was automatically arrested. Experts said these rules impeded participation.
The Yale review, published in the British medical journal, The Lancet, suggested that if public health officials had responded in 2013, they could have limited infections to 56 or fewer (averting at least 127 infections), and if they had responded in 2011 (admittedly, before Pence was elected governor), they could have averted at least 173 infections and contained the outbreak to just 10 or fewer individuals.
Interestingly, Pence’s vehement anti-abortion stance may have played a bigger role in the HIV outbreak than his moral opposition to needle exchange. One of the major factors at play in Scott County was the lack of available HIV testing. The only HIV testing center in the area—a Planned Parenthood affiliate—shut down in 2013 because of funding cuts. Planned Parenthood has always been a target of Pence’s. In 2011, when he was in the U.S. House of Representatives, Pence authored an amendment to defund the organization that passed in a contentious vote. Federal money is not allowed to be used to provide abortion, and Pence did not suggest that Planned Parenthood was doing that. Instead, he made a “starve the beast” argument: “What’s clear to me, if you follow the money, you can actually take the funding supports out of abortion. We then have a much better opportunity to move forward to be a society that says yes to life.” Not surprisingly, he did not acknowledge the importance of all of the other health services that Planned Parenthood clinics provide, including HIV testing.
The war on Planned Parenthood has continued under the Trump administration, with cuts to Title X and new rules that stifle clinics’ ability to provide both contraceptive care and abortion to their clients. Even more disturbing, as we face the coming of a new coronavirus, the administration has cut funding for public health efforts across the board, including funding for pandemic preparedness. In 2018, Trump eliminated funding for disease security programs developed after the most recent Ebola outbreak. This forced the CDC to cut back the program by 80% and focus on emerging pathogens in just 10 priority countries (China did not make that list). In addition, the administration did not replace the head of the pandemic support team when he left, instead disbanding the entire team.
Trump recently asked Congress for $2.5 billion in funding for the new coronavirus, which some argue he wouldn’t have needed to do if these cuts hadn’t been made. And, on Thursday, Sen. Elizabeth Warren, one of the Democrats running for president, introduced legislation that would result in approximately $10 billion being diverted from Trump’s Mexico border wall project for coronavirus response. She said in a statement: “Rather than use taxpayer dollars to pay for a monument to hate and division, my bill will help ensure that the federal government has the resources it needs to adequately respond to this emergency.”
The United States has been protected from many pandemics by our geographic distance from so much of the world, but oceans do not make us immune to new contagions, especially in an era of easy world travel. Slashing the preparedness programs and funding suggests the Trump administration does not truly understand our risk. Putting anyone other than a medical professional and/or public health expert in charge of the response shows that it does not take its role in protecting the health of its citizens seriously. And, choosing an ideologue like Mike Pence to run our response proves, yet again, that politics is more important to this White House than American lives.
Of particular concern is an announcement on Thursday that Pence’s office would be controlling the public messages about the new coronavirus. Officials claim that the goal isn’t to direct the content of what experts say, but to coordinate statements and television appearances. Still, with this administration, it’s hard not to be concerned that this will end in the public getting less information and/or less accurate information. In his press conference, Trump himself said that a vaccine was “coming along well,” which is misleading at best. Anthony Fauci, M.D., who heads the National Institute of Allergy and Infectious Disease, said that between testing, development, production, and distribution, the vaccine wouldn’t be applicable to the epidemic for at least a year or 18 months. Fauci has apparently been instructed not to say anything else without clearance.
It is possible that Pence will be able to leave ideology out of the response. Unlike HIV, no one blames the new coronavirus on the supposedly immoral behavior of its victims. In fact, on Thursday, Pence appointed Deborah Birx, M.D., a physician who has served as the U.S. global AIDS coordinator since 2014, to coordinate the White House response to the new coronavirus, in a possible acknowledgement of what he doesn’t know. Still, the vice president has a track record of ignoring science and experts in favor of his own belief system—he has said that daycare is damaging to kids, favors harmful conversion therapy practices, suggested that condoms are poor protection against STIs, and argued that smoking doesn’t kill people. If, in his new role, Pence puts prayer over public health, like he did in Indiana, many lives could be lost.