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A dangerous health strategy that leaves the American public far from “safe” or “healthy.”

It should be difficult to render the most pandemic-prepared nation in the world vulnerable to a virus with mostly mild cases and low fatality.  However, three years into the Trump administration, a long list of shortsighted decisions left us exposed as we confirm close to 500 coronavirus cases and 22 deaths across 35 states, and counting, including a patient reporting symptoms in Puerto Rico. Confronting a potential pandemic efficiently requires empowered experts, resources, deft diplomacy, and a healthcare system that protects everyone. Instead, we have a White House that undermines scientists, cuts public health funding, strains global relationships, and is dismantling the Affordable Care Act (ACA). This is a dangerous (non)strategy and it leaves the American public far from “safe” or “healthy”—the two priorities cited by the president during his coronavirus press briefing last week. 

The COVID-19 viral disease has ticked off two out of the three criteria for a pandemic and the CDC has warned that Americans should prepare for “significant disruption” from “inevitable” community spread. President Trump, worried about a volatile stock market, countered that the virus was “very much under control” and transmission here “not inevitable.” It is certainly not the first time the president has disregarded science to offer his personal take on highly technical issues like hurricane forecasts or forest fire prevention. In some instances, it’s not just that experience is ignored but that an entire team of specialists is eliminated.  A pandemic response czar and a supporting global health security unit were fired in 2018 and not replaced until last week when the White House succumbed to public pressure.  Now we are in the hands of Vice President Pence. The same Pence who is credited for public health policies that enabled the worst HIV outbreak in Indiana’s history while he was governor. The same Pence who doubts climate change science.  Feel safe yet?

Pandemic-readiness requires preventive funding at home and abroad, but the Trump administration strategy has been the opposite of precautionary. In 2018 it slashed national health spending by $15 billion. Global health allocations were also reduced, so much that the CDC pulled out of 39 countries where we collaborated on monitoring, prevention and response activities. One of the countries we withdrew from is China. On the heels of a trade war, it is safe to assume that trust and information sharing with our Chinese counterparts are not at an all-time high. This has made it harder for us to prepare.  To make matters worse, a Complex Crises Fund at the State Department, created to provide diplomats with quick-response funding, was also scrapped.  Our diplomatic corps are not only experiencing constraining financial resource reductions but it also faces a thinning of the ranks. The forced and willing departure of senior officials has left a gap in institutional memory and little top cover for those left behind to deal with a global crisis like this one.

In theory, a well-resourced country like the United States should be healthy enough to weather this storm. Yet, the untenable situation of healthcare in our country, from lack of access to Trump’s efforts to sabotage the ACA, puts us at a disadvantage. Close to 27 million still have no coverage and costs are twice as expensive than in any other developed country. Polls show that health care is a top concern for people that are using up savings or taking on debt to pay for out-of-pocket expenses. Even more worrisome for a rapidly spreading disease, the sick are staying home and delaying treatment because of costs. If and when the virus starts keeping children from schools, and creating labor shortages, Americans will need to trust their leaders in Washington DC. This trust will depend on their ability to provide facts, play well with others, and ensure that the billions requested in emergency funds protect the most vulnerable. Our capable National Institutes of Health, CDC, and research groups across the country are on the case and it seems we have resolved our initial monitoring issues. Hopefully, it’s not too late. A majority of Americans already have confidence that scientists respond in the public interest, at least more than they trust politicians. For our sake, let’s hope the “not czar” and the rest of the foresight lacking White House can stay out of their way.