US preparedness to deal with the threat of coronavirus has been hampered by the personnel and budget cuts made by the Trump administration over the past three years, according to health experts.
There is no one in the White House tasked specifically to oversee a coordinated government-wide response in the event of a pandemic, since the post of senior director for global health security and biothreats on the national security council (NSC) was eliminated last May.
The office was established in 2016 after the outbreak of the Ebola virus in Africa demonstrated the US government was not set up to move with the speed and decisiveness necessary to react to a really lethal epidemic.
The White House global health “czar” was supposed to coordinate international, national, state and local organisations, public and private, to confront a global epidemic, backed by the direct authority of the president.
After he became national security adviser, John Bolton eliminated the office as part of an NSC reorganisation, as he did not see global health issues as a national security priority.
As the first person-to-person transmission of coronavirus in the US was reported, and as evidence emerges that it could be much more contagious than initially thought, health and disaster planning experts argued for contingency preparations for a global outbreak.
“You have to at least now be anticipating and responsibly planning against a sort of pandemic level scenario reaching the US,” Jeremy Konyndyk, who ran foreign disaster assistance in the Obama administration, said.
“The fact that they explicitly dismantled the office in the White House that was tasked with preparing for exactly this kind of a risk is hugely concerning,” said Konyndyk, now a senior policy fellow at the Center for Global Development. “Both the structure and all the institutional memory is gone now.”
Funding has also been cut drastically to the Centers for Disease Control and Prevention (CDC), forcing it to reduce or discontinue epidemic-prevention efforts in 39 out of the 49 countries it had been helping. Among the countries where CDC efforts were scaled back were Haiti, Rwanda and the Democratic Republic of Congo as well as China, where the agency provided technical assistance.
In its 2020 budget the Trump administration proposed a further 10% cut in CDC funding, equivalent to $750m. It zeroed out funding for epidemiology and laboratory capacity at state and local levels.
Funding will also dry up this year for a tiered epidemic response within the US. The system was set up in the aftermath of the Ebola scare, and involved identifying patients infected by “special pathogens” in frontline hospitals and their transfer up a chain of specially equipped regional hospitals where they could be safely treated.
After this year’s cuts, 10 advanced treatment facilities will still receive funding, but not the 60 other treatment centres one tier below.
“Those assessment and treatment hospitals are kind of wondering where they’re going to get funding to continue these very costly efforts,” said Saskia Popescu, an infection prevention epidemiologist, at George Mason University. “So not only are we creating more vulnerable hospitals, but we’re getting this message across that hospitals, if you want to prepare, you’re kind of on your own.”