A pandemic plan was in place. Trump abandoned it — and science — in the face of Covid-19

President Obama was bothered. It was the summer of 2009 and he was in a meeting at the White House to talk about preparations for an expected autumn outbreak of swine flu. Elbows on the table, he thumbed through the pages of a report on preparations for it.

“So,” he asked no one in particular, “if you guys are so smart, how come you’re still making this in eggs?” he asked, referring to the nearly century-old process for making vaccines in chicken eggs.

Those around the table erupted into laughter. The president’s quip was a moment of levity at an otherwise serious meeting.

The “smart guys” the president was jesting with were the members of the President’s Council of Advisors on Science and Technology, or PCAST. Founded in 1990 by President George H. W. Bush, the council, administered by the White House Office of Science and Technology Policy (OSTP), is an advisory group of scientists and engineers appointed by the president to augment the science advice he receives from other White House advisors, departments, and agencies.

In June 2009, the recently inaugurated Obama had given his PCAST advisors their first assignment: What does the president need to do to prepare for an influenza pandemic? Five weeks later, on Aug. 7, they gave him their answers at a meeting in the White House’s State Dining Room.

The story of this meeting and the ensuing eight years of science-informed policy making, which I have drawn from interviews with members of PCAST and internet archives of documents, show a president comfortable with having back-and-forth discussions with an assembly of the some of the nation’s top scientific minds. The president was committed to integrating science into his day-to-day decisions. One of those decisions was how to plan for and respond to the outbreak of a pandemic illness.

Over the course of the Obama presidency, a pandemic infrastructure was put in place. It included recommendations for a top-level White House official devoted to planning and responding to emerging infectious threats and, to guide that person’s work, the “Playbook for early response to high-consequence emerging infectious disease threats and biological incidents.”

And then on Jan. 21, 2017, Donald Trump became president.

Beginning the morning after his inauguration, a spectacular science-related tragedy has unfolded. The Trump administration has systematically dismantled the executive branch’s science infrastructure and rejected the role of science to inform policy, essentially reversing both Republican and Democrat presidential administrations since World War II, when Vannevar Bush, an engineer, advised Presidents Franklin D. Roosevelt and Harry S. Truman.

President Trump’s pursuit of anti-science policy has been so effective that as the first cases of Covid-19 were breaking out in Wuhan, China, no meaningful science policy infrastructure was in place to advise him. As a consequence, America is suffering from a pandemic without a plan. Our responses are ineffectual and inconsistent. We are increasingly divided by misinformation and invidious messaging. And it’s not even over.

To understand how Trump walked America into this mess, and that his recent claim he “inherited practically nothing” in pandemic preparedness from the previous administration is plainly wrong, it helps to have a picture of the infrastructure he neglected and ignored.

Facts will drive scientific decisions, not the other way around

On April 27, 2009, on the eve of his 100th day in office, Obama made a five-block trip from the White House to 2101 Constitution Ave. There, in the Great Hall of the National Academy of Sciences, he spoke about his administration’s commitment to science.

“Science is more essential for our prosperity, our security, our health, our environment, and our quality of life than it has ever been before,” he announced. He introduced the members of PCAST and explained how his administration would engage the scientific community directly in the work of public policy.

“I want to be sure that facts are driving scientific decisions — and not the other way around,” the president said. The audience broke into laughter.

Obama explained that his science advisers were already briefing him daily on the emerging threat of swine flu, which some were projecting could kill thousands of Americans.

The day before this speech, which came just 12 days after the first case of swine flu had been reported in the U.S., Obama had declared a public health emergency. Three days after the speech he asked Congress for $1.5 billion to address this emergency.

In the weeks that followed, the White House science policy infrastructure he had introduced at the National Academy of Sciences set to work.

Memos and meetings with the president at any time

Although every president since Franklin Roosevelt has had some engagement with science policy making, the degree of the contact between the president and his science advisers has varied.

George H.W. Bush met frequently with his head of OSTP, Allan Bromley, a physicist and former Yale classmate of the president. George W. Bush, in contrast, met just seven times with the head of his Office of Science Technology and Policy, John H. Marburger III, and eliminated two associate directors from the office. Obama’s engagement with his science policy apparatus was singular. He met with his OSTP director, John Holdren, as often as seven times a week.

Holdren, a plasma physicist whose scientific career included 23 years co-directing the Energy and Resources Group at the University of California, Berkeley, had this regular and close contact with Obama because, in addition to leading the OSTP and acting as co-director of the President’s Council of Advisors on Science and Technology, he was the assistant to the president for science and technology.

The title of assistant to the president grants its holder great privilege and power. Assistants to the president have direct access to the president. An assistant can schedule a meeting with the president or send a memo directly to the president. Even cabinet secretaries aren’t afforded such direct and easy access. To send a memo or meet with the president, they must work through the assistant to the president for cabinet affairs.

There are, of course, many federal agencies and departments engaged in science policy, such as the Centers for Disease Control and Prevention, the Food and Drug Administration, the National Aeronautics and Space Administration, the departments of agriculture and energy, and more. Each has its own mission and focus. The PCAST provides the president with immediate daily access to science information and advice that are independent of the agendas of these various agencies and departments.

Easy and continuous access to science was of notable value to the administration’s early, rapid, and sustained efforts to plan for a viral pandemic.

Preparing for a pandemic, a priority from day 1

PCAST’s “Preparations for 2009-H1N1 Influenza” identified multiple ongoing efforts across the government to plan for a viral pandemic. It also made recommendations. One stands out.

During a pandemic, important decisions must be made rapidly and based on limited data. PCAST recommended designating one individual, preferably the homeland security adviser, to coordinate all policy development and report directly to the president.

Obama took that advice and asked John Brennan, a career CIA employee and assistant to the president for homeland security, to take on the task. Like Holdren, Brennan reported directly to the president. The two assistants worked closely together.

The initial flare of swine flu tapered off in the summer of 2009, but came back again in the fall as expected. The resurgence was managed well. Surveillance was in place, a vaccine was developed, and messaging had been implemented to quell unfounded fears of its risks.

What was clear, however, was that the next viral infection might not be so easily managed. Vaccines were not readily available for viruses such as Ebola and coronaviruses. The question wasn’t whether a pandemic would occur, but when.

More work and reports followed.

A 2010 PCAST report answered the president’s egg question. It recommended reengineering the influenza vaccine production enterprise. Recombinant DNA technology and other methods are now used to make vaccines in addition to the egg-based method.

By 2016, the final year of the Obama administration, much had been learned from swine flu about managing a pandemic, and more knowledge had been added from the responses to the 2014 Ebola outbreak in West Africa. From October 2014 through February 2015, Ron Klain, a former chief of staff to Vice President Joe Biden, was the White House Ebola response coordinator.

From this experience, Klain concluded that a director with singular focus was needed for a pandemic. “The next president should put a coordinating unit together before an outbreak begins,” he argued in his essay “Confronting the Pandemic Threat” in the spring 2016 Democracy Journal.

Klain called for a pandemic prevention directorate to make sure preparation and response are a priority from day one in a new administration and to oversee the government’s response to a pandemic.

PCAST endorsed Klain’s recommendation. In a November 2016 report, the council recommended that an assistant to the president for pandemic prevention and response should be part of the National Security Council staff. The council gave the incoming Trump administration what it called an important overarching observation: “There is significant overlap between some of the steps needed to protect the Nation from intentional biological attack and those needed to protect against natural outbreaks of new and emerging infectious diseases.”

Another important event in 2016 was a federal effort that engaged the work of PCAST, OSTP, and other agencies and departments to create the “Playbook for early response to high-consequence emerging infectious disease threats and biological incidents.” This 69-page document was written to coordinate a response to an emerging disease threat anywhere in the world. It detailed decision-making rubrics with key decisions and questions such as these: “Determine whether to implement screening and monitoring measures, or other travel measures within the U.S. or press for measures globally” and “What are the key services and critical infrastructure that need to come back on line for society to return to normal?”

Together, the November 2016 PCAST report and the playbook were messages to the incoming president to pick up where the Obama administration had left off, since more work was needed to prepare for and respond to a future pandemic.

None of that happened.

An anti-science administration

On the morning of Jan. 22, 2017, the day after Trump’s inauguration, the PCAST website was taken down and all of its reports vanished from the White House website (though they can be found in the Obama White House archives).

For two years, the directorship of OSTP was vacant, the longest in its history. The staff was reduced by two-thirds. The current director, Kelvin Droegemeier, a professor of meteorology at the University of Oklahoma whose appointment was confirmed by the Senate on Jan. 2, 2019, isn’t an assistant to the president and is unable to directly communicate with the president.

PCAST lay dormant until November 2019, when Trump appointed members to it. Unlike its predecessor, which included a diversity of scientists from academia and industry, the current version includes members drawn primarily from industry. Their charge has been narrowed. The council is to advise the president on “how does America win in the Industries of the Future and how do we prepare the workforce of the future to take advantage of this opportunity?” They’re not to produce any reports (the prior PCAST produced 39 reports).

The minutes of the council’s meeting on Feb. 3 and 4, 2020, include no discussion of the Covid-19 pandemic.

The sum of the work done by Trump’s Council of Advisors on Science and Technology? Zero.

The follow-up on the 2016 recommendation for an assistant to the president dedicated to pandemic prevention and response also fell on deaf ears.

As Ebola was once again breaking out in West Africa, Rear Admiral Timothy Ziemer, who had been charged with creating a national biodefense strategy, resigned from Trump’s National Security Council on May 11, 2018. At the time of his departure, that strategy hadn’t yet been created.

The remaining staff members were faced with managing a portfolio that bundled together epidemics, biological threats, and weapons of mass destruction. Dividing their time among many responsibilities whose day-to-day urgencies can seem to be greater than preparing for a future pandemic is precisely what Ron Klain and PCAST had warned about in 2016. The Pandemic Playbook was neglected, and its existence has even been denied.

By the end of December 2019, as the Covid-19 epidemic began breaking out in China, Trump was largely without any coherent scientific input into his policy making. Given that none of the president’s assistants, the people with direct access to him via memo or meeting, have any scientific expertise, his nonresponse, even complacency, in the face of the emerging epidemic in China is sadly understandable.

On March 10, after a meeting with U.S. senators about Covid-19, the president remarked to the press that America was prepared and doing a great job. “And it will go away. Just stay calm. It will go away,” he insisted.

The next day, the World Health Organization said that the global outbreak was a pandemic. And in the U.S. alone, as I write this nearly 1.5 million Americans have developed Covid-19 and nearly 90,000 have died from it.

Remarks such as “it will go away” cannot be excused as occasional gaffes or verbal missteps. They’re the words of someone who simply doesn’t understand science — and doesn’t want to.

The Covid-19 pandemic is a problem that must be understood and addressed using sciences such as virology, epidemiology, public health, and biomedicine. Yet in the face of a crisis that needs science, America is led by an administration that not only isn’t scientific but is actively anti-science.

Trump’s remarks, from long before he was elected president and throughout his presidency, on a variety of topics including vaccines and autism, climate change, and wind farms, show he rejects scientific conclusions and methods.

From the stage of the White House briefing room, Trump has likened the Covid-19 virus to a bacterium that is resistant to antibiotics, insisted that the virus could not cause a pandemic, that warm weather, as well as sunlight, will kill it, and has repeatedly touted untested pharmaceuticals such as hydroxychloroquine and noxious household detergents as interventions to either prevent or treat infection.

Too little and too late Trump let scientists such as Anthony Fauci and Deborah Birx share the stage. But even then he has undercut their messages and spread confusion.

Trump, for example, asserted that Fauci was “playing both sides” (sides he did not name) in decisions about whether and how to reopen schools. Fauci, in fact, had called for an approach to reopen schools that was informed by evidence to respect regional differences. “We have a very large country and the dynamics of the outbreak on different, in different regions of the country. So I would imagine that situations regarding school will be very different in one region versus another, so it’s not going to be universally, or homogeneous.”

I’m a scientist. I don’t believe in science — I reserve belief for religion. I trust in science to help me diagnose and treat my patients, to understand how Alzheimer’s disease robs them of their memories and ability to function, and to find new treatments for it and other diseases. And now, during this awful pandemic, I desperately want my president to trust it too. And yet he won’t even wear a mask.

Jason Karlawish is a physician, co-director of the Penn Memory Center, and author of the forthcoming book, “The Problem of Alzheimer’s: How science, culture and politics turned a rare disease into a crisis and what we can do about it” (Macmillan/St. Martin’s Press, November 2020).