Trump’s ‘Hail Mary’ drug push rattles his health team

Top health officials are increasingly unsettled by President Donald Trump’s continued championing of an unproven drug in the fight against the coronavirus pandemic, even as some of the president’s political and policy advisers and outside allies cheer him on.

A growing number of senior Trump appointees have moved toward viewing hydroxychloroquine, a pill typically used to treat malaria and lupus, as a potential salve for the Covid-19 outbreak — adding it to the national stockpile, urging manufacturers to ramp up its production and sending huge shipments of the drug to hospitals and pharmacies in hot zones like New York City where doctors are free to prescribe it to patients.

Trump has become an avid promoter of the drug from the White House podium. “What really do we have to lose?” he told reporters over the weekend. “It is a very strong, powerful medicine. It does not kill people. We have some very good results and some very good tests,” he added, glossing over concerns from some of his own officials, who fear that the evidence of the drug’s efficacy is anecdotal at best.

The nation’s top infectious-disease expert, Anthony Fauci, has repeatedly warned in public and private that no definitive evidence exists about the drug. Behind the scenes, career health officials have raised even stronger warnings about the risk to some Americans’ heart health and other complications, but been warned not to publicly speak out and potentially contradict Trump, said two officials.

The divide highlights widening tensions in the Trump administration between protecting the American public against the spread of the coronavirus and reopening the economy as soon as possible. The president and many of his economic, policy and political advisers within the White House are trying to overrule scientific experts who increasingly worry that touting the drugs could harm Americans and cost valuable time to research other treatments. Interviews with more than a dozen officials for this story highlighted tensions within the administration that are occupying increasing amounts of time among health officials and drawing attention away from other critical issues.

Many health experts have worried about creating shortages for proven uses of the drug for patients with other conditions. And some have issued explicit warnings against widespread use of the drug. “I would not prescribe it,” Patrice Harris, president of the American Medical Association, told CNN on Sunday. “You could lose your life. It’s unproven.”

Trump’s focus on the drugs — driven by his faith in scant evidence that they work to speed recovery from Covid-19 — has increasingly warped his administration’s response. Health officials have been told to prioritize the anti-malaria drugs over other projects that scientists believe have more potential to fight the outbreak.

The rush to focus on unproven drugs also comes after months of lost opportunities to contain the spread of the outbreak. “There’d be less focus on [hydroxychloroquine] now if we had planned better then,” said one official, who added that the drug is seen by some career scientists as a “Hail Mary” effort to find a Covid-19 cure.

Trump is as enthusiastic about the drug in private as he is in public, said one senior administration official. He talks about the drug so often, another official added, because he views it as a potential therapy for the coronavirus when people have no other options.

“He thinks that it’s the drug that’s going to get everyone back to work. Do you have a supply?” joked one Republican close to the White House.

At one point, Trump heard there was some promise in its performance and he seized on it, said another White House official.

That approach has been amplified by officials such as trade adviser Peter Navarro, one of the economic aides Trump trusts. “You’ve got Dr. Navarro and he’s pretty much facing off against the medical expertise of the administration ... who say let’s take our time, let’s be cautious and let’s do more trials and let’s do more tests,” said a person familiar with the deliberations of the coronavirus task force. “He’s not a lonely voice in the wilderness but he's the loudest voice in the wilderness.”

The administration is already taking major steps to make the drug more available, said one senior administration official — signaling the debate is more settled internally than outsiders may realize.

The Trump administration has worked with pharmaceutical companies to locate tens of millions of doses of hydroxychloroquine and chloroquine, issuing emergency-use authorizations last week that would allow Americans to use the drugs and beginning to now deploy the treatment to retail pharmacies.

On Saturday, the coronavirus task force voted to send a surge of hydroxychloroquine to hospitals and pharmacies in the hot zones of the virus in the coming weeks — with the caveat that it can be prescribed only by physicians for their patients.

Trump discussed other potential treatments in a similarly hopeful manner during Monday night’s briefing at the White House, when he acknowledged that a vaccine was still a ways off but that U.S. pharmaceutical companies were working hard on therapeutics. The president held a call earlier Monday with top executives from Amgen, Genentech, Gilead and Regeneron.

“The vaccines are going to be always a little bit later because of the testing period,” Trump said Monday. “But therapeutics, getting the kind of things that I heard about today, talking to these brilliant companies and brilliant people on the phone, it was fantastic. It was such an incredible conversation.”

Officials generally describe three camps inside the administration on the hydroxychloroquine debate: One group of Trump devotees, like Navarro and other policy advisers and outside allies, who fully support the president’s belief that the drugs represent a viable path to rapidly controlling the outbreak.

“In peacetime, the traditional model of ‘wait until all of the clinical trials are done and there is full FDA approval’ may well be the appropriate position, but when you are in the fog of war and you are facing mass casualties, you need to think about leaning more forward and assuming additional risk,” said Navarro, assistant to the president for trade and manufacturing and the Defense Production Act policy coordinator.

“The reality is, this is a drug that has been around for a long time, and there is one point of view — and it appears to have considerable support within the medical and scientific community — that hydroxychloroquine may have both therapeutic and prophylactic efficacy,” he said.

Meanwhile, officials in a second group, such as Surgeon General Jerome Adams and Food and Drug Administration Commissioner Stephen Hahn, are willing to entertain the possibility that the drugs work — given the lack of other existing treatments — but stress that the decision should be made between a doctor and a patient.

“There are some accounts, some stories out there regarding hydroxychloroquine helping,” Adams told “Fox News Sunday,” adding that the drug has already been on the market. “So we feel a little bit better regarding its safety than we do about a completely novel drug, even though this is being used at much higher dosages.”

Finally, a third group of officials — like Fauci — have repeatedly taken a tougher line against widespread use of the drugs, urging the president to wait on what clinical trials will reveal. Officials also have grown concerned about the president’s advocacy of combining hydroxychloroquine and zithromax, a treatment that some front-line providers have attempted but could significantly raise the risk of cardiac problems.

White House spokesman Hogan Gidley downplayed the differences between Trump and Fauci. “There is no daylight between them on this issue as both men have been clear about the need to consult your doctor before taking hydroxychloroquine or any other drug,” he said in a statement.

Two officials said Fauci and another top health adviser, White House coronavirus coordinator Deborah Birx, have been boxed in as they work to keep the president’s ear on public health measures like social distancing.

They also have lacked robust allies: Centers for Disease Control and Prevention Director Robert Redfield, who’s been minimized in recent weeks, and other career scientists, have also struggled to effectively warn the president away from his focus on hydroxychloroquine, the officials said. White House officials, in particular, hold Redfield and the CDC responsible for the country’s lag in producing an adequate number of tests for the coronavirus.

Just as Trump’s top political advisers have tried to cast him as a wartime president during the coronavirus outbreak, they and some of his top policy aides are now trying to characterize the debate over hydroxychloroquine in the same vein.

“In this fog of war and broader strategic chess game, President Trump is doing exactly what he should be doing — and history is likely to be strongly on his side when all is said and done,” Navarro said about the push to use the drug.

But the debate alone has caused significant frustration in the medical field, with doctors saying that Trump is amplifying shoddy science while ignoring the risks. “Public figures should refrain from promoting unproven therapies to the public,” physicians in the Annals of Internal Medicine argue. “The hasty and inappropriate interpretation of the literature by public leaders has potential to do serious harm.”

Daniel Lippman contributed to this report.