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In 2005, President George W. Bush unveiled an ambitious $7.1 billion plan to get America ready for a possible pandemic.
"A pandemic is a lot like a forest fire," Bush said. "If caught early, it might be extinguished with limited damage; if allowed to smolder undetected, it can grow to an inferno that spreads quickly beyond our ability to control it."
Bush's plan called for early detection, international cooperation, stockpiling of vaccines and medical equipment, and public education about pandemic prevention.
President Donald Trump has ignored or contradicted almost all of Bush's suggestions, resulting in a delayed and chaotic response to the coronavirus crisis.
In 2005, while on vacation at his ranch outside Crawford, Texas, President George W. Bush read John M. Barry's "The Great Influenza." The book examines how the US was impacted by the 1918 flu pandemic, the deadliest viral outbreak since the Black Death.
At the time, the country was focused on other crises — notably the war in Iraq and global terrorism — but Bush was adamant about preparing for a massive national health crisis.
"He said to me, 'It may not happen on our watch, but the nation needs the plan,'" former homeland security advisor Fran Townsend told ABC News.
JIM WATSON/AFP via Getty Images
In a November 2005 address at the National Institutes of Health, Bush unveiled an ambitious $7.1 billion strategy to get America ready for a possible avian flu pandemic.
In granular detail, Bush called for increased epidemiological research, improved vaccine technology, detailed quarantine plans, and more stockpiling of everything from vaccines to personal protective gear.
His advice seems prescient now, but much of the plan has been ignored or contradicted by the Trump administration. The result has been a delayed and chaotic response to the pandemic.
1. Detect outbreaks early
US Navy/Mass Comm Specialist 2nd Class Erwin Jacob Miciano
US Navy/Mass Comm Specialist 2nd Class Erwin Jacob Miciano
"A pandemic is a lot like a forest fire," Bush said in 2005. "If caught early, it might be extinguished with limited damage; if allowed to smolder undetected, it can grow to an inferno that spreads quickly beyond our ability to control it."
US intelligence started reporting about a dangerous virus in China in November, and first warned President Trump about the threat on January 3.
Later that month, Trump trade adviser Peter Navarro sent the president a memo indicating the coronavirus could kill as many as 500,000 Americans.
But on January 30, Trump called the virus "a very little problem." As late as February 28, he told reporters it was "going to disappear. One day, it's like a miracle, it will disappear."
The president didn't acknowledge the severity of the outbreak until mid-March after it was declared a pandemic.
Rick Bright, the highest-ranking scientist on the government's coronavirus response team, told "60 Minutes" that when he spoke with Health and Human Services Secretary Alex Azar about the coronavirus on January 23, Azar downplayed the threat.
According to a federal whistleblower complaint, Bright was demoted in April after opposing the use of hydroxychloroquine to treat COVID-19.
2. Establish a global response
"To respond to a pandemic, members of the international community will continue to work together," Bush said. "An influenza pandemic would be an event with global consequences, and therefore we're continuing to meet to develop a global response."
Bush requested $251 million from Congress to help foreign nations train local medical personnel, expand their surveillance and testing capabilities, and detect and contain outbreaks.
In September 2019, the Trump administration stopped funding PREDICT, an initiative under the US Agency for International Development (USAID) that worked with dozens of foreign laboratories — including the one in Wuhan, China, that identified the novel coronavirus.
The program also trained thousands of people in Asia, Africa, and the Middle East to detect new viruses, according to the Los Angeles Times.
PREDICT was resurrected in April with $2.26 million in emergency USAID funding. But that same month, Trump ordered the US to stop funding the World Health Organization, claiming the organization allowed China to conceal the extent of the contagion.
The US has also pulled back from collaborating on international efforts to combat the pandemic: It didn't send a representative to the Coronavirus Global Response, a virtual summit that raised more than $8 billion for a vaccine, The Guardian reported.
And it has not said if it will attend the Global Vaccine Summit in London on June 4.
"What the United States has chosen in these recent meetings – not to attend, and not to participate – it has chosen instead to begin talking about a sort of go-it-alone approach," Stephen Morrison, director of the Center on Global Health Policy, told the Guardian.
That approach, he added, "fractures the international efforts and creates tensions and uncertainties and insecurities."
3. Strengthen domestic surveillance
"By creating systems that provide continuous situational awareness, we're more likely to be able to stop, slow, or limit the spread of the pandemic and save American lives," Bush said in his pandemic address.
His administration launched the National Bio-surveillance Initiative in 2005, which increased the government's ability to rapidly detect, quantify, and respond to outbreaks in both humans and animals.
It also set up systems to quickly share data between local, state, national, and international public health officials.
In 2018, Trump's National Security Adviser, John Bolton, disbanded the National Security Council's Global Health Security and Biodefense unit, set up by the Obama administration to handle pandemic preparedness.
Bolton tweeted that it was a "streamlining" of NSC structures.
Rear Adm. Timothy Ziemer, the top official responsible for overseeing our pandemic response, left the administration shortly thereafter.
The White House also eliminated the $30 million Complex Crises Fund, which the secretary of state can access to deploy disease experts.
Trump's budget proposals have consistently called for the Centers for Disease Control and Prevention's budget to be slashed by millions of dollars, though Congress has declined those provisions.
4. Stockpile vaccines, antiviral drugs, and medical supplies
Bush warned that, in a pandemic, "everything from syringes to hospital beds, respirators, masks, and protective equipment would be in short supply."
In 2003, the Bush administration placed the country's reserve of vaccines and antitoxins under the control of the Department of Health and Human Services and Homeland Security.
It also expanded the reserve to include medical equipment, like ventilators and personal protective equipment, and renamed it the Strategic National Stockpile.
In his address, Bush asked for $1.2 billion for enough avian flu vaccine to inoculate 20 million Americans and $1 billion to stockpile antivirals like Tamiflu.
The Obama administration utilized the stockpile during the 2009 H1N1 and 2016 Zika outbreaks but did not replenish it. The Trump administration also failed to replace those items despite warnings the stockpile was not prepared for a pandemic, according to NBC.
In February, HHS requested $2 billion to replenish the stockpile, but was rebuffed by the Office of Management and Budget, the Washington Post reported, resulting in a screaming match in the Situation Room between Azar and an OMB official.
The White House ultimately trimmed Azar's request down to $500 million when it was brought to Congress.
Once the virus came to the US, hospitals and state officials sounded the alarm about a lack of protective gear, but Trump called PPE shortages "fake news."
The White House has appeared territorial about the stockpile: at an April 3 White House press briefing, the president's son-in-law and senior adviser, Jared Kushner, said states should not expect support from the Strategic National Stockpile.
"It's supposed to be our stockpile," he said. "It's not supposed to be states' stockpiles that they then use."
5. Accelerate new vaccine technologies
University of Maryland School of Medicine/AP Photo
In the event of a pandemic, Bush said, the US "must have a surge capacity in place that will allow us to bring a new vaccine online quickly and manufacture enough to immunize every American."
He made new vaccine technology the cornerstone of his strategy, calling for $2.8 billion to speed the development of cell-culture vaccines, which are grown in mammal cells rather than chicken eggs, flu vaccines had been typically.
Bush's goal was to have enough vaccine for every American to be inoculated within six months of the start of a pandemic.
But a 2019 National Security Council study that called for the government to speed up the production and distribution methods for new vaccines went "unheeded" by the Trump administration, according to the New York Times.
It wasn't until the end of April that Trump announced "Operation Warp Speed," a consortium of scientists, government officials, and corporate leaders tasked with producing 100 million doses of a coronavirus vaccine by November, CNN reported, even though experts say a vaccine may be more than a year away.
Trump has also been hesitant to use the Defense Production Act, which enables the government to force businesses to work on vaccines and medical equipment.
"We're a country not based on nationalizing our business," he said in March, NPR reported.
6. Prepare the country for an outbreak
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"A pandemic is unlike other natural disasters," Bush said. "Outbreaks can happen simultaneously in hundreds, or even thousands, of locations at the same time. And unlike storms or floods, which strike in an instant and then recede, a pandemic can continue spreading destruction in repeated waves that can last for a year or more."
Bush asked for more than $500 million for pandemic preparedness, including $100 million to help states develop and test out pandemic exercises before a health crisis hit.
And he tasked HHS Secretary Mike Leavitt to work with state and local public health officials on coordinating their contingency plans.
In 2017, outgoing members of the Obama administration briefed Trump's team on dealing with a pandemic, according to Politico, though some staffers were dismissive of the simulated exercises.
7. Give Americans accurate information to protect themselves and others
"The American people need to have information to protect themselves and others," Bush said. "In a pandemic, an infection carried by one person can be transmitted to many other people, and so every American must take personal responsibility for stopping the spread of the virus."
Bush felt education was a vital part of any response, and launched pandemicflu.gov, offering tips to decrease the odds of infection or spreading disease.
That website now forwards to a general Centers for Disease Control and Prevention landing page for pandemic influenza, with a link off to the CDC's separate page for the current coronavirus pandemic.
Instead of tools to combat the pandemic, Trump has shared conjecture, misinformation, and unproven remedies in public statements and on social media.
"I think when we get into April, in the warmer weather, that has a very negative effect on that and that type of a virus," he said in February. "So let's see what happens, but I think it's going to work out fine."
He suggested disinfectant as a treatment for COVID-19 and touted the use of the antimalarial drug chloroquine to prevent infection."It may work, it may not work. I feel good about it," Trump said. "That's all it is. Just a feeling."
In May, the president announced he had been taking hydroxychloroquine for more than a week, despite no evidence it was safe or effective.
The CDC recommends all Americans wear face masks when they cannot social distance, but both President Trump and Vice President Mike Pence have been seen in public not wearing masks where protective covering is required.
This week, Trump shared one tweet mocking Democratic presidential candidate Joe Biden for wearing a mask at a Memorial Day ceremony and another claiming face masks represented "silence, slavery, and social death."
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