White House preparedness for pandemic threat has faltered across four presidencies

Blame for coronavirus crisis shouldn't fall squarely on Trump, experts say.

While much criticism has been heaped on President Donald Trump and his administration’s handling of the coronavirus pandemic, some experts warn that the country risks missing some important public health-crisis lessons if fingers are pointed only at him. (Sarah Silbiger/Getty Images)
While much criticism has been heaped on President Donald Trump and his administration’s handling of the coronavirus pandemic, some experts warn that the country risks missing some important public health-crisis lessons if fingers are pointed only at him. (Sarah Silbiger/Getty Images)
Posted April 7, 2020 at 6:30am

Much blame has fallen on President Donald Trump for his handling of the coronavirus pandemic. Critics point to his administration’s early defenestration of a White House pandemic preparedness task force established by the Obama administration and his whipsawing, frequently off-the-cuff approach to the widening public health emergency.

But a variety of longtime experts in disaster response who spoke to CQ Roll Call warn that the country risks missing some of the lessons from what is the largest public health crisis in a century if opprobrium is heaped solely at Trump’s feet. Rather, they say, there is blame to be shared, going back decades through multiple presidencies and on both sides of the political aisle.

Blind spots in the U.S. national security culture led to the earliest signs of the crisis being downplayed, exactly when an inter-agency process centered in the White House should have been shifting into high gear. To avoid such a bureaucratic failure again will mean permanently elevating disaster preparedness and response to a footing similar to that given to more traditional bastions of U.S. security such as diplomacy, intelligence collection and the military, experts say.

“People don’t seem to understand that public health is a critical element of national security,” said Randall Larsen, a retired Air Force colonel and the national security adviser of the Center for Health Security at Johns Hopkins University. “That’s the most important thing. If they understood that, it would take care of so much of these other details."

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For years while he was a professor and department chair at the National War College, Larsen argued for expanding the curriculum beyond the core subjects that make up the "DIME" construct (diplomacy, intelligence/information, military and economy) as it has been taught to U.S. military officers, State Department officials and other government security professionals since the 1970s. But getting the point across — that public health and disaster response were as important to national security as tanks and bullets — was not easy, according to Larsen.

Trump’s former national security adviser John Bolton has come under considerable criticism for his 2018 decision to disband the pandemic preparedness directorate at the National Security Council, which was formed by the Obama White House following the 2014 West Africa Ebola epidemic. But less well known is that both the Obama and George W. Bush administrations disbanded early in their presidencies similar NSC task forces established by their respective predecessors only to rush to reestablish them when confronted with a serious biological threat.

“This is not one or two biased people,” said retired Rear Adm. Kenneth Bernard, who served as a special assistant to the president for security and health during the Clinton and George W. Bush administrations. He likes to point out that smallpox killed more people in the 20th century than all of the wars of that century combined. “This is an entire system that would prefer to see national security not include public health.”

Bernard, who serves on the Defense Department’s Threat Reduction Advisory Committee, is caustic in his description of the biases that he says shape the thinking of national security bureaucracies in favor of focusing on possible wars with Russia, China, Iran and North Korea. More probable threats, such as a major disease outbreak that costs thousands of American lives, are frequently excluded.

“The security sector is not enthusiastic about being told that issues such as pandemics — about which they had minimal training at the Kennedy School, Georgetown School of Foreign Service, University of Chicago Law School, the military war colleges, or the FBI academy — should be considered ‘front burner’ security problems,” Bernard wrote in a 2013 essay for the journal “Biosecurity and Bioterrorism.”

“The United States spends close to $1 trillion every year on national defense,” wrote Connecticut Sen. Christopher S. Murphy — who sits on the Foreign Relations and Health, Education, Labor and Pensions committees — in a Foreign Policy op-ed this week. “What’s the point of this largesse if a single virus can spread from a provincial city in China to the United States in a matter of weeks, taking down the entire economy in the process? Why did the coronavirus so quickly pierce our national defenses? How did we fail, and how do we do better next time?”

Lessons learned, again and again

In 1998, Bernard was assigned to work on international health security issues at the Clinton White House. He eventually led its new Health and Security office on the NSC only to see it shuttered later by the Bush administration. But after the 2001 anthrax attacks, Bernard, a medical doctor by training, was called back by NSC homeland security director Tom Ridge to reopen the office. It was closed for a second time by the incoming Obama administration, which dispersed its portfolio across three separate NSC directorates: preparedness/resilience, international development and nonproliferation. However, biodefense and health security were not the primary focus of any of those offices.

It wasn’t until after the experience of the Ebola epidemic that a health and security directorate was reestablished at the National Security Council to monitor emerging foreign disease outbreaks that could reach the United States and to quickly start an inter-agency response to them. However, the office was shuttered for a third time by Bolton, who fired its senior director and dispersed the remaining staff to other divisions in the NSC.

“I bet you Bolton didn’t even know about it,” Bernard said of Bolton, who in the face of the spreading COVID-19 crisis has defended his earlier decisions to reorganize the NSC. “He didn’t give a crap, he was dealing with North Korea and he didn’t care about whether the preparedness planning office was reorganized. And that’s because he is like the classic national security weenie [who believe that] real men do binational confrontational politics.”

“Instead of giving the issue a distinct institutional presence, expertise, and voice in the policy process, Bolton’s reorganization left it fragmented across other directorates that were focused on other higher priorities,” said Jeremy Konyndyk — who headed up the U.S. Agency for International Development’s humanitarian response to the Ebola epidemic — in a March op-ed for Just Security.

Bolton pushed the responsibility for coordinating biodefense efforts out of the White House and gave it to the Health and Human Services Department. The 2018 National Biodefense Strategy and an accompanying presidential memorandum charged HHS chief Alex Azar with leading a Cabinet-level biodefense steering committee.

But imagining that a “down table” department head like Azar — lower on the Cabinet pecking order —would be able to convene regular biodefense preparedness steering meetings with his “up table” counterparts at Defense, State and Treasury was unrealistic, according to Bernard.

“The secretary of Health and Human Services has no sway over the secretary of Defense,” Bernard said. “The secretary of Defense wouldn’t even probably return the HHS secretary’s phone call most of the time.”

Azar, a former pharmaceutical executive, delegated the day-to-day work of inter-agency coordination in support of the steering committee to Robert Kadlec, assistant secretary of HHS for preparedness and response.

Kadlec has a deep background in the biodefense community. A physician and retired Air Force colonel, Kadlec succeeded Bernard as special assistant to the president for biodefense issues in the Bush administration. But as an HHS assistant secretary, he has less bureaucratic influence than he did during his time at the Bush White House, according to Larsen.

In 2015, some 60 Senate-confirmed government positions had biodefense or outbreak preparedness in their official job duties. But it wasn’t the full-time job of any one official, according to Larsen, who did the bureaucratic analysis.

Larsen compared the situation of having dozens of officials with some biodefense and preparedness responsibilities but no one top official to having 25 assistant coaches on a football team but no head coach. “Can you imagine any of your teams getting to the Super Bowl if they don’t have a head coach? You’ve got to have a head coach to coordinate everything,” he said.

Missed opportunities

Unquestionably, longtime experienced professionals like Kadlec, National Institute of Allergy and Infectious Diseases Director Anthony Fauci, and U.S. Special Representative for Global Health Diplomacy Deborah Birx have been working for years on disease outbreak issues within the bowels of the Trump administration. However, during the earliest days of the coronavirus appearance in Hubei province in central China, the absence of a top-level individual focused exclusively on biodefense and reporting directly to the national security adviser and the president almost certainly had an impact on Trump’s initial dismissal of the seriousness of the health threat.

For example, a 2019 interagency pandemic response exercise, organized by HHS and overseen by Kadlec and involving a dozen states, accurately foresaw many of the problems the federal government and states are now grappling with. Those problems include fights between states over insufficient supplies of stockpiled medical equipment, disparate state responses on whether to require social distancing and federal agencies unclear on who was in charge.

According to a recent New York Times report on this “Crimson Contagion” exercise, which coincidentally imagined an influenza pandemic that originated in China, the lessons learned from that months-long exercise — particularly about the importance of making testing widely available and urging social distancing — appeared to not have reached or made an impression within the top echelons of the Trump administration.

It is not clear if having a dedicated biodefense directorate in the White House would have done a better job ensuring that the urgent lessons of the 2019 exercise were impressed upon the Trump Cabinet and so avoided some of the missteps the president and the White House have made in the handling of the coronavirus crisis.

But the 2014 Ebola epidemic impressed upon the Obama White House the need to reestablish an NSC biodefense office, one that would coordinate inter-agency response plans that could be quickly implemented. For example, if someone infected with a dangerous contagious disease was flagged upon arrival at a U.S. airport: Where would they be quarantined? Would a federal agency or a local health office be in charge of monitoring them? And where would they go for medical treatment if their symptoms required hospitalization?

“That structure was created to avoid losing time in a crisis. It wasn’t that the previous structure couldn’t produce great policy, it did,” said Beth Cameron, who toward the end of the Obama administration served as the senior director for global health security and biodefense in the reestablished NSC office. “When you are talking about adding a function for emerging outbreaks and deciding when the emerging outbreak is getting ready to or becoming a crisis, you don’t have the luxury of time or the extra steps it takes to send up a flare. You just send up a flare.”

“History will tell what the right structure is,” she added. “But I’m willing to bet whoever stays or comes into the White House next will have a dedicated pandemic preparedness and response team.”

Moving forward while looking back

Natasha Bajema, a senior fellow at The Council on Strategic Risks — a Washington think tank that looks at crosscutting national security risks — and a former Defense Department biodefense official, said it is confounding to her that the federal government’s response to the coronavirus crisis has been “so terrible.”

“If we had had enough tests in the first place to be able to understand the breadth of the outbreak and to be able to understand where it was going through testing and contact tracing, we might not have had to have had such extreme social isolation recommendations, Bajema said. “I think we might have been better positioned to have had an experience more like South Korea and Singapore.”

Some Republicans and former Trump administration officials have criticized Democrats for spending too much time and energy finding fault with the administration’s past public health and bio-preparedness decisions.

“When people play politics in the middle of a crisis, we are all less safe,” Tim Morrison — who briefly led the NSC directorate on countering weapons of mass destruction and biodefense after Bolton’s 2018 reorganization — wrote in a March Washington Post op-ed. “We are less safe because public servants are distracted when they are dragged into politics.”

Konyndyk strongly disagreed with that argument.

“A public health emergency is exactly the time when experts should praise and criticize where merited, and the government should be eager to hear both forms of analysis,” he wrote in his own response to Morrison’s op-ed. “What undermines public confidence is not the critics who point out government errors; rather it is the administration’s own failure to acknowledge those errors and rectify them.”

House Speaker Nancy Pelosi announced this week the coming formation of a special bipartisan oversight panel, the House Select Committee on the Coronavirus Crisis, which is to be led by Majority Whip James E. Clyburn. Even as some Republicans such as House Minority Leader Kevin McCarthy accused Pelosi of politicizing a major crisis, other senior GOP members allowed that there was an urgent need to understand what had gone so wrong.

Texas Sen. John Cornyn told reporters that after beating the coronavirus health crisis and stabilizing the economy, “the most important thing we need to do is learn the lessons from this pandemic because we kind of got sucker punched. And we need to figure out where the vulnerabilities are and what we need to do to fix them.”

Bernard warned that Congress will have to stay focused on the issue for a long time because of the national security community’s longstanding aversion to focusing on health security unless forced to do so.

“Everybody is slapped upside the head now and understands why we had a problem here,” he said. ”But I guarantee you that when this is over, the national security people are going to run the other direction.”