One of the most lethal leadership failures in modern times unfolded in South Africa in the early 2000s as AIDS spread there under President Thabo Mbeki.
Mbeki scorned science, embraced conspiracy theories, dithered as the disease spread and rejected lifesaving treatments. His denialism cost about 330,000 lives, a Harvard study found.
None of us who wrote scathingly about that debacle ever dreamed that something similar might unfold in the United States. But today, health experts regularly cite President Trump as an American Mbeki.
“We’re unfortunately in the same place,” said Anne Rimoin, an epidemiologist at U.C.L.A. “Mbeki surrounded himself with sycophants and cost his country hundreds of thousands of lives by ignoring science, and we’re suffering the same fate.”
Trump says he deserves an A-plus for his “phenomenal job” handling the coronavirus, but the judgment of history is likely to be far harsher.
“I see it as a colossal failure of leadership,” said Larry Brilliant, a veteran epidemiologist who helped eliminate smallpox in the 1970s. “Of the more than 200,000 people who have died as of today, I don’t think that 50,000 would have died if it hadn’t been for the incompetence.”
Trump in particular “recklessly squandered lives,” in the words of an unusual editorial this month in the New England Journal of Medicine. Death certificates may record the coronavirus as the cause of death, but in a larger sense vast numbers of Americans died because their government was incompetent.
As many Americans are dying every 10 days of Covid-19 as U.S. troops died during 19 years of war in Iraq and Afghanistan, and the economists David Cutler and Lawrence Summers estimate that the economic cost of the pandemic in the United States will be $16 trillion, or about $125,000 per American household — far more than the median family’s net worth. Then there’s an immeasurable cost in soft power as the United States is humbled before the world.
“It’s really sad to see the U.S. presidency fall from being the champion of global health to being the laughingstock of the world,” said Devi Sridhar, an American who is a professor of global health at the University of Edinburgh. “It was a tragedy of history that Donald Trump was president when this hit.”
The United States has made other terrible mistakes over the decades, including the Iraq War and the War on Drugs. But in terms of destruction of American lives, treasure and wellbeing, this pandemic may be the greatest failure of governance in the United States since the Vietnam War.
The paradox is that a year ago, the United States seemed particularly well positioned to handle this kind of crisis. A 324-page study by Johns Hopkins found last October that the United States was the country best prepared for a pandemic.
Credit for that goes to President George W. Bush, who in the summer of 2005 read an advance copy of “The Great Influenza,” a history of the 1918 flu pandemic. Shaken, Bush pushed aides to develop a strategy to prepare for another great contagion, and the result was an excellent 396-page playbook for managing such a health crisis.
The Obama administration updated this playbook and in the presidential transition in 2016, Obama aides cautioned the Trump administration that one of the big risks to national security was a contagion. Private experts repeated similar warnings. “Of all the things that could kill 10 million people or more, by far the most likely is an epidemic,” Bill Gates warned in 2015.
Trump argues that no one could have anticipated the pandemic, but it’s what Bush warned about, what Obama aides tried to tell their successors about, and what Joe Biden referred to in a blunt tweet in October 2019 lamenting Trump’s cuts to health security programs and adding: “We are not prepared for a pandemic.”
[I]n retrospect, Trump did almost everything wrong. He discouraged mask wearing. The administration never rolled out contact tracing, missed opportunities to isolate the infected and exposed, didn’t adequately protect nursing homes, issued advice that confused the issues more than clarified them, and handed responsibilities to states and localities that were unprepared to act. Trump did do a good job of accelerating a vaccine, but that won’t help significantly until next year.
Trump’s missteps arose in part because he channeled an anti-intellectual current that runs deep in the United States, as he sidelined scientific experts and responded to the virus with a sunny optimism apparently meant to bolster the financial markets. . . . . The false reassurances and dithering were deadly.
A basic principle of public health is the primacy of accurate communications based on the best science. Chancellor Angela Merkel of Germany, who holds a doctorate in physics, is the global champion of that approach. Trump was the opposite, sowing confusion and conspiracy theories; a Cornell study found that “the President of the United States was likely the largest driver of the Covid-19 misinformation.”
Instead of listening to top government scientists, Trump marginalized and derided them, while elevating charlatans: One senior health department official, Michael Caputo, who had no background in health, was ousted only after he denounced government scientists for “sedition” and advised Trump supporters, “If you carry guns, buy ammunition.”
Instead of leading a war against the virus, Trump organized a surrender. He even held a super-spreader event at the White House, for Judge Amy Coney Barrett, and that’s why the White House recently had more new cases of Covid-19 than New Zealand, Taiwan and Vietnam combined.
It didn’t have to be this way. If the U.S. had worked harder and held the per capita mortality rate down to the level of, say, Germany, we could have saved more than 170,000 lives. And if the U.S. had responded urgently and deftly enough to achieve Taiwan’s death rate, fewer than 100 Americans would have died from the virus.
“It is a slaughter,” Dr. William Foege, a legendary epidemiologist who once ran the C.D.C., wrote to Dr. Redfield. Dr. Foege predicted that public health textbooks would study America’s response to Covid-19 not as a model of A-plus work but as an example of what not to do.
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