Inside America’s 2-Decade Failure to Prepare for Coronavirus

The nation’s health secretary was warned about a possible pandemic — and, he admits now, he didn’t take that first warning seriously enough. But he studied with experts at the Centers of Disease Control. He read papers on virology. He took his concerns to the president. And months later, the administration unveiled a plan to tackle the virus emerging out of Asia, investing in therapies and warning Americans to stock up on canned goods.

It’s a moment that feels ripped from the headlines about the current coronavirus crisis. But the year was 2005, not 2020.

And for his troubles, that health secretary — Bush appointee Mike Leavitt — was mocked as an alarmist by political rivals and late-night comics, even as that year’s threat of avian flu petered out around the globe.

“Secretary of Health and Human Services Michael Leavitt recommended that Americans store canned tuna and powdered milk under their beds for when bird flu hits,” host Jay Leno said on the Tonight Show in 2006, a recurring bit where he ridiculed Leavitt’s warnings. “What? … Powdered milk and tuna? How many would rather have the bird flu?”

Speaking to POLITICO this month, Leavitt described a trap that health and national security officials know too well: Prepare too early and you’re called Chicken Little. Act too late — and millions may die.

“In advance of a pandemic, anything you say sounds alarmist,” Leavitt explained. “After a pandemic starts, everything you’ve done is inadequate.”

The Trump administration has taken the brunt of the blame for America’s lack of preparedness for the Covid-19 pandemic, which has caught the world’s wealthiest nation embarrassingly off-guard and plunged it into an economic and health catastrophe. But the cycle of inattention has roots far deeper than that, according to interviews with top policymakers from three administrations covering 20 years.

After each major health crisis of the last two decades, American health and political leaders have launched preparedness programs and issued blunt warnings to their successors — only to watch as those programs were defunded, staff was allowed to depart and Washington forgot the stark lessons it had just learned.

That cycle then accelerated during the tumultuous Trump administration, said the health officials interviewed for this story, nearly all of whom cited Trump’s willingness to disregard evidence and stick with his gut as the coronavirus threat menaced the nation.

In interviews and reviews of years of remarks, Leavitt and more than a dozen other current and former officials who led or shaped preparedness efforts across the Bush, Obama and Trump administrations described a two-decade evolution in how government leaders learned to fight killer viruses — and how America forgot those hard-won lessons as the Covid-19 outbreak loomed.

Government agencies slowly abandoned their pandemic-planning efforts, with the Homeland Security department in 2017 shelving its decade-plus efforts to devise models of how outbreaks affect the economy. Rather than train government staff to respond to a pandemic, as some high-level officials urged, FEMA in 2018 instead coordinated a massive mock exercise across nearly 100 federal departments focused on a hypothetical Washington, D.C., hurricane — even though federal officials had responded to three real-life hurricanes the year before and called the simulation unnecessary.

“We felt we were not prepared for a pandemic and needed to build muscle memory in the way that only a national exercise could do,” said Katrina Mulligan, who was the Justice Department’s top preparedness official at the time, reflecting the kind of would-have, could-have thinking among many ex-policymakers interviewed for this story. A former FEMA official told POLITICO that it was too late in the planning process to shift to a pandemic exercise.

Meanwhile, White House budget officials repeatedly rebuffed requests to fund the nation’s emergency stockpile, turning down the health department’s $1.5 billion-plus proposal in early 2019 and asking Congress for $705 million instead.

And even as the coronavirus threat arrived this January, the National Security Council set aside a step-by-step playbook carefully crafted by the Obama administration and career officials – based on their own sometimes rocky experiences dealing with H1N1 and Ebola -- for an ad hoc process that’s left the White House running consistently days or weeks behind on its response.

New reports are emerging near-daily about officials whose warnings fell on deaf ears.

Now, the Trump administration is facing the biggest public health threat in a century — relying on some of the same career officials and experts who advised Bush and Obama on pandemics to shape their coronavirus strategy today. Top infectious-disease scientist Anthony Fauci has been an Oval Office staple since the Reagan administration, although his delicate clashes with Trump over drugs and policy have tested the 79-year-old’s political survival. Meanwhile, Trump’s health secretary Alex Azar and top health preparedness official, Robert Kadlec, have gone from understudies during Bush-era health crises to main characters in this response.

Even some officials’ behaviors feel like a rerun. The Trump White House has rolled out social distancing strategies that mirror plans devised by the Bush White House’s national security team. At least several Trump appointees are reading “The Great Influenza,” John Barry’s book on the 1918 global flu pandemic, much like their predecessors in the Bush administration, who were assigned the book as required reading 15 years ago.

But current and former officials say there are tactics and tool kits, lost in the bureaucracy, that could better help with the current coronavirus fight. Several individuals pointed to one disease-surveillance tool, developed by the health department for the 2009 H1N1 flu pandemic, that could be used to answer the ethnic and racial questions about coronavirus that have boggled state officials — but is instead sitting quietly inside the Medicare agency rather than be shared publicly, overlooked by current leaders.

The officials also described the complexity of trying to stave off future threats and tamp down existing ones, such as the Obama-era effort to set up a long-term, global health security strategy with foreign partners in 2014 while simultaneously fighting the spreading Ebola outbreak ravaging West Africa.

“There was a trade-off every day,” said Beth Cameron, a former career official who led the National Security Council’s pandemic preparedness office during the end of the Obama administration and the beginning of the Trump administration. “How much time was I going to spend focused on the potential of pandemic versus talking to CDC about the actual one?”

2001: How 9/11 Changed the Game

Modern preparedness efforts were birthed under the Bush administration, which inherited some pandemic planning from the Clinton administration but had done relatively little on the issue during its first eight months in office — even abolishing the White House office on global health and security.

“Until 9/11, it was very hard to get anyone interested” in public-health preparedness, said one former official who worked on those early efforts.

Then the world changed. The terror attacks on Sept. 11, 2001, forced Bush’s deputies to grapple with questions they’d previously overlooked: Could terrorists cripple the country through a bio-attack? What would those hazards look like? And who was even in charge of responding? In fact, then-HHS Secretary Tommy Thompson was scheduled to receive one of his first pandemic preparedness briefings on the morning of Sept. 11, before the terror attacks scrambled his schedule and delayed the briefing for months, according to two of Thompson’s former top deputies.

By Sept. 12, top HHS officials had traveled to a still-smoldering New York City, trying to understand how to contain the next threat. By that weekend, they were recruiting a new brain trust to combat the biohazards they worried were looming.

“On Sunday afternoon, September 16, I received a call from Secretary Thompson’s office asking me to attend a 7:00 p.m. meeting that night,” D.A. Henderson, a Johns Hopkins scientist known for his efforts to eradicate smallpox, wrote in his 2009 memoir. “Officials feared there might be a second terrorist attack, and some considered smallpox virus or anthrax to be the most likely weapons.”

Henderson, who passed away in 2016, wrote that he had never met Thompson before that evening. Their first meeting lasted until nearly midnight. By October, Henderson would join the health department to lead its new office of public health and emergency preparedness, helping staff it up and develop the first national biosecurity plans. Henderson’s team included future pivotal figures in U.S. preparedness efforts, like physician Luciana Borio, who went on to lead the National Security Council’s pandemic-preparedness efforts 15 years later.

The efforts at the health department were reflections of larger-scale moves by the White House, which swiftly created roles like a presidential homeland security adviser and carved out the new Homeland Security department — and even brought back officials like Ken Bernard, who had been President Bill Clinton’s special assistant for security and health, to fill the same role for Bush.

Those moves were championed by Vice President Dick Cheney, who also fixated on a separate plan: nationally vaccinating Americans against smallpox, a deadly virus that Cheney feared terrorists would use to strike at the United States.

That goal pitted the vice president against career scientists like Fauci and Henderson, who worried that the complications from a national mandatory vaccine would lead to significant deaths and sickness, particularly among children.

Henderson in his memoir described making a plea to Bush aboard Air Force One during a trip to Pittsburgh in 2002, where he spent an hour urging the president not to embark on a nationwide smallpox vaccination campaign.

A planned national vaccination announcement was later called off, Henderson wrote, with one individual crediting Henderson’s frank talk with Bush.

“Did [Bush] overrule the vice president?” Henderson mused years later in his memoir. “It is all but certain he did.”

Henderson's warnings to Bush were corroborated by two officials who worked closely with Henderson. Bush and Cheney did not respond to requests for comment.

Bush eventually settled on a compromise to vaccinate some first responders and soldiers against smallpox — a plan that would end up petering out over time. In retrospect, health officials say that Bush made the right choice to avoid a national campaign, despite myriad incentives to go further as advisers encouraged him to avert the next 9/11.

“Where we ended up was the right decision,” said one former senior official who spent months on the project. “There was more political pressure than scientific pressure to do the vaccinations.”

But in the moment, some of Bush’s critics weren’t so forgiving, an episode that encapsulates the difficulties facing presidents on preparedness.

“Smallpox is Bush’s worst failure,” policy analyst Jonathan Rauch wrote in The Atlantic in 2003, exhorting the president to ramp up vaccination efforts.

“Imagine, President Bush, how you would look to history if, a year after you left office, America were devastated by a smallpox attack—one for which you left the country underprepared, despite ample knowledge of the nation's vulnerability. Does that get your attention?” Rauch wrote.

2005: A Pandemic Flu Plan – With a Big Omission

The vaccination plan also tested a young Republican legal star, Alex Azar, who was HHS general counsel at the time and charged with helping carry out the president’s plan. At one point in 2003, the plan stalled after unions demanded vaccine-injury compensation; the future HHS secretary had about 24 hours to write what became a vaccine-injury compensation program, which enabled vaccinations for first responders to continue, said two people familiar with the episode.

Staff who worked closely with Azar said that the experience taught the future HHS secretary that preparedness required a mix of long-term planning and short-term urgency — a lesson he seemed to absorb. Azar touted a binder that he called a “‘book of many tabs’ — all the things we’d need to do in case of any emergency,” said one former senior HHS official who worked with him.

By 2005, Azar was tapped as the top deputy to Leavitt, who was settling in as Bush’s second health secretary — and initially didn’t share his team’s urgency on pandemics.

Leavitt said that his mind was changed when aide Stewart Simonson, the nation’s recently installed health preparedness chief, threw two books on his desk. One was a copy of Barry’s “The Great Influenza,” the story of the 1918 flu outbreak that killed 50 million people around the globe. The second: A copy of Congress’ 9/11 commission report, revealing the government’s many failures to prepare for the 2001 terror attacks.

“And Stew said to me. . . if you don't read the first book and get the next flu right, there’s going to be another one of those second books — and it's going to be about you,” Leavitt said, recounting the story last week. “So that got my interest. Self-preservation.”

Azar also prevailed on Leavitt and other HHS leaders, one Bush-era official said, issuing a dire warning that the world would look poorly on the same country that spent years to develop the atomic bomb — but failed to spend time on developing a response to pandemic influenza. Azar worked closely with the health secretary on the subsequent pandemic flu plan and became one of its top champions, as the two men organized regional events and traveled to every state and territory to drum up support.

“Alex was my partner in all of this,” Leavitt said.

The final 381-page pandemic flu plan that Leavitt, Azar and other health officials announced in November 2005 includes tactics, models and other details that eerily resemble today’s coronavirus crisis. One scenario, cut from the final report, even described how a respiratory disease would swiftly move from sickening dozens in an Asian village to killing as many as 1.9 million Americans — a “grimly compelling” vision, the New York Times reported at the time, and a framework that would have foreshadowed future discussions about the Covid-19 outbreak. Staff who worked on the plan say they can’t remember why the Asian flu scenario was removed from the final plan.

Asked about Azar’s years of work on preparedness efforts, an HHS spokesperson declined to comment on behalf of Azar.

Robert Kadlec, meanwhile, was a former Air Force physician and Bush White House aide who had moved on to Capitol Hill, where he served as the director of the Senate’s bioterrorism and public health subcommittee. In that role, he ended up shaping the 2006 Pandemic and All Hazards Preparedness Act — a package that gained importance after the Bush administration’s botched response to Hurricane Katrina in 2005.

One outside expert who advised on the package: Nicole Lurie, a Clinton administration veteran and physician who called for more funding on disease surveillance and staffing. “I believe that a significant investment in leadership development is essential,” she urged the Senate in 2006.

In a twist of fate, the legislative package would create a new job — the dedicated HHS assistant secretary for emergency preparedness — that Lurie would hold three years later under Obama and Kadlec would hold more than a decade later under Trump.

The job was modeled on the need to have a single decision-maker in a health crisis, Kadlec said in a 2018 interview, years after he helped write the position into law. “It just was a coincidence that [a dozen] years later, I was asked to become the ASPR,” he added.

2009: Swine Flu Challenges a New President

By Bush’s second term, partly because of his administration’s efforts, there was growing consensus that pandemics had emerged as arguably the biggest threat to global security. One champion of the idea: a young senator from Illinois, just five months into his new job, but already convinced that a worldwide virus posed substantial risk.

“We must face the reality that these exotic killer diseases are not isolated health problems half a world away, but direct and immediate threats to security and prosperity here at home,” then-Sen. Barack Obama wrote in the New York Times in June 2005, alongside Republican colleague Dick Lugar.

But as president four years later, Obama promptly ignored a lesson from the past: He initially abolished the White House’s dedicated office on global health security, the same move that Bush did before him and Trump would do years later, and a decision that preparedness experts like Bernard have called a mistake.

Obama would soon face the reality of pandemics, as a devastating swine flu — H1N1 — swept across the globe. More than 12,000 Americans died from the virus between 2009 and 2010. The episode has gotten considerable attention during the current coronavirus outbreak, with Trump and other Republicans seeking to cast Obama’s handling of H1N1 as a failure by comparison. For instance, Obama took months to declare a national emergency, and flu vaccination rates lagged even as the death count grew in 2009.

“Their response to H1N1 Swine Flu was a full scale disaster, with thousands dying, and nothing meaningful done to fix the testing problem, until now,” Trump tweeted last month, arguing that his own administration had addressed problems that haunted Obama’s response a decade ago.

But Trump’s claims have been generally panned by fact-checkers; for instance, Obama did declare a public health emergency before a single American had died. At the time, experts even concurred that H1N1 was generally well-handled. An HHS retrospective in 2012 portrayed the response as “successful,” albeit one marked by delays that would foreshadow the current difficulties in procuring testing and treatment for the coronavirus outbreak today.

Meanwhile, an Obama-era improvement plan crafted post-H1N1 offered suggestions that were batted back by the Republican-led Congress — for instance, investing in the nation’s hospital preparedness program, which has undergone years of winnowing by congressional appropriators, and ensuring a sufficient supply of ventilators and masks in the stockpile, another problem that’s haunted the response to Covid-19.

"HHS aggressively contracted for the development of a next-generation, low-cost ventilator as well as the high-speed production of masks,” said Lurie, who ran the health department’s emergency preparedness efforts at the time, before handing the projects off to the Trump administration. While Obama officials’ vision has yet to be fully realized, some of their projects are still underway, current and former officials say.

But even the H1N1 crisis didn’t prevent the Obama administration from backing away from the no-holds-barred approach to national security that had characterized the Bush administration, paring back funding for preparedness amid the Great Recession. The health department and Homeland Security department cut preparedness funding by nearly $900 million between fiscal years 2010 and 2011.

“The preparedness budget cuts may make it particularly difficult for the nation – and the country’s public health agencies and workforce, in particular – to achieve the goals" set by the White House and CDC for national health security, Columbia University’s National Center for Disaster Preparedness experts warned in 2011. “The New York metropolitan area, in particular, is at greater risk for large-scale catastrophic events, and cannot afford to be less than maximally prepared.”

2014: Ebola, A Warning and a Political Football

The H1N1 crisis was bookended by the 2014-2015 Ebola outbreak, which hung over the 2014 midterm elections and shaped how Obama approached his waning years in office. Officials working in the Obama administration described being surprised as the outbreak unpredictably surged in West Africa, sickening thousands of people and killing about 40 percent of those who were infected. Historically, the deadly virus had burned itself out before jumping borders and becoming an epidemic.

“Our handling of Ebola wasn’t perfect initially,” said Jeremy Konyndyk, who led USAID's Office of US Foreign Disaster Assistance during Obama’s second term, allowing that the unprecedented spread of the virus in early 2014 caught U.S. officials by surprise. “But once we understood its risks, when the evidence of the risk profile changed and cases started spreading again in West Africa in June and then began exploding in July… within weeks of that happening, we were deploying.”

The virus also arrived in Dallas, Texas, in September 2014 — as one man died and two of his nurses contracted the disease — prompting Obama to tap administration veteran Ron Klain to coordinate the nation’s Ebola efforts. The move was Obama’s tacit acknowledgment that U.S. hospitals and health workers had been caught unprepared by the spreading disease, and that a full-time coordinator was needed to handle emerging health crises and cut through bureaucratic logjams.

The Ebola outbreak has assumed more political significance in retrospect. Trump — then a private citizen — used the outbreak to launch dozens of attacks on the Obama administration, elevating his profile with public-health claims that he’d disregard as president several years later.

"The U.S. cannot allow EBOLA infected people back,” Trump tweeted on Aug. 1, 2014, as the Obama administration sent an air ambulance to rescue two Ebola-stricken missionaries from West Africa. “People that go to far away places to help out are great-but must suffer the consequences!”

A White House digital analysis later determined that Trump’s tweets represented a turning point in U.S. public perception of Ebola. “It was that tweet that created a level of anxiety in the country,” Amy Pope, a senior Obama administration official who worked on the outbreak, told author Reid Wilson. “That was a crystallizing moment.”

Meanwhile, Klain has gone on to become a top campaign adviser to Joe Biden, the presumptive Democratic nominee for president and Klain’s longtime mentor, and is expected to take a senior White House role if Biden wins.

Klain’s leadership during the Ebola crisis helped to galvanize the Obama administration, which set up a permanent pandemic preparedness team inside the National Security Council, crafted its pandemic playbook and took other steps intended to avert a disjointed response from happening again.

“I would get asked, what keeps you up at night?” said Lisa Monaco, who served as Obama’s homeland security adviser between 2013 and 2017. “An emerging infectious disease like a new strain of flu was the thing I worried most about.”

The outgoing team in 2017 also prepared a transition exercise on pandemics for the Trump administration’s incoming leaders, seeking to impart the lessons learned from Ebola and other crises. In the hypothetical scenario, the Trump team walked through a respiratory illness framed as the worst pandemic since the 1918 flu, and told how to prepare for challenges like ventilator shortages and insufficient personal protective equipment.

The Obama officials also warned their successors: Be ready to act fast. “In a pandemic scenario, days — and even hours — can matter,” the incoming Trump leaders were told, in a handout given to attendees.

2017: A New Team’s Mixed Record

But the Obama-era warnings were largely ignored, forgotten or abandoned. Two-thirds of the Trump appointees who attended the 2017 pandemic transition exercise would end up leaving the administration before the coronavirus outbreak arrived this year. The pandemic playbook — which specifically warned of the high lethality of a coronavirus — was set aside.

“The thing I wish people understood more,” Klain said, “we not only fought Ebola in 2014-2015, we built out an agenda and put resources into pandemic preparedness that have been allowed to ebb since then.”

Still, Trump’s pandemic preparedness efforts had begun with more promise, largely thanks to Bush veterans who picked up the threads from previous administrations.

In the White House, Tom Bossert, a Bush administration veteran, was tapped as Trump’s first homeland security adviser where he was enthusiastic about the pandemic playbook prepared by his predecessors, advocated for readiness and began devising what became the 2018 National Biodefense Strategy.

Installed as the health department’s preparedness chief in 2017, Kadlec set up a program to train national disaster medical responders on how to fight infectious disease and transport highly infectious patients. On the speaking circuit, he stumped for more money, repeatedly noting that the U.S. spends twice as much on a single aircraft carrier than the $7 billion that goes toward biodefense every year.

“We don’t have a sustained level of funding — a line item for pandemic influenza, for example — that would give us great confidence” in long-term planning, Kadlec warned at a Senate hearing in January 2018. “We’re operating with about half an aircraft carrier of resources to do this mission, this national security mission, to protect 320 million people.”

Azar, who took over as Trump’s second health secretary that month, repeatedly warned that pandemic flu was set to be a “global health disaster” and steered new investments into vaccine research.

“The thing that people often ask is: 'What keeps you most up at night in the biodefense world?'” Azar said at an April 2019 biodefense summit. “Pandemic flu, of course. Everyone in this room probably shares that concern.”

Some of the Trump team’s moves unnerved their predecessors and career officials, who noted that efforts and investments begun years ago ran aground under the new administration. For instance, an Obama-era plan to develop low-cost ventilators fizzled out in the United States, even as the company — drawing on HHS funding — ended up selling versions overseas.

Former officials also bristled that Trump appointees — perhaps emulating the president — rejected their predecessors’ advice and walled out career experts. Kadlec fought to move control of the nation’s emergency stockpile from under CDC’s control to HHS, a bureaucratic battle that he won at the end of 2018 but divided the department.

"This administration has constantly been at war with itself,” said one longtime health department official. “The fighting and feuds are just extraordinary, even for Washington.”

2020: A Playbook Discarded

When the pandemic finally came, the team that had prepared their careers for it were working for a president unwilling and unready to act.

Azar in January first briefed Trump on the virus’ concerning spread, but found that the president and his political aides didn’t share his urgency and even interpreted his views as alarmist, according to the secretary’s colleagues. Kadlec by February was privately raising concerns in an email thread, noting that there were flaws in the U.S. response, even as the administration publicly touted its success.

Bossert was already long gone. The pandemic-preparedness advocate had been dismissed in the spring of 2018 and the new national security adviser, John Bolton, dissolved the White House’s pandemic office and shifted the staffers into a broader National Security Council team. That meant Bossert was left trying to warn his former colleagues about coronavirus via Twitter and on TV, urging the administration to move faster to stop an outbreak that he predicted could kill hundreds of thousands of Americans.

Meanwhile, Trump was slow to act and even slower to understand the potential risk of a pandemic, let alone use the term in public. One of the first times was on February 27, at a White House meeting for African-American supporters.

“I know politics,” Trump told attendees. “But when it comes time to talk about pandemics or whatever you may want to call it, you got to get away from politics. And the Schumers -- Cryin' Chuck and all of these people… you can’t go out and just say ‘terrible, it’s terrible.’ We’re doing incredibly.”

“It's going to disappear,” Trump said of the coronavirus. “One day -- it's like a miracle -- it will disappear.”

Instead, the number of confirmed U.S. coronavirus cases has ballooned from several dozen that day to more than 470,000 today.

Weeks or even months to prepare were lost as Trump and some of his top aides dithered across January, February and even March of this year, hoping that the virus would miss the United States or even disappear as the weather warmed.

Had the Trump administration followed the Obama-era pandemic playbook, which some staff briefly consulted and then discarded, the White House would have begun procuring protective equipment for U.S. health workers nearly three months ago, rather than the frenzied bidding that began in recent weeks. Had the president listened to his top health advisers, the nation could have more rapidly instituted the social-distancing measures that have so far worked to slow the virus’ spread.

But “you have complacency when you have the same people -- and they warn about the same things and it never happens,” said a former senior Trump official, explaining why the president and his top advisers weren’t more attuned to the warnings of Kadlec, Azar and others.

About the only thing that current and former preparedness officials think Trump did well and swiftly on coronavirus: The president was right to limit travel from China at the end of January, as his administration tried to slow the emerging disease and grapple with its spread.

But even the fallout from that decision was mishandled, as the CDC’s lab tests faltered and the administration failed to urgently ramp up additional testing. That meant the virus silently spread throughout the United States in February, even as Trump insisted that Covid-19 cases would soon drop to zero and his aides mocked questions about whether the administration had successfully contained the outbreak.

Global health experts increasingly view the U.S. response as among the worst in the developed world.

Several officials characterized the situation as a perfect storm entering 2020: an administration that had defunded preparedness efforts; a leadership team that’s infamously tumultuous, like the FDA cycling through four different leaders between April and December 2019; a Congress that had failed to fully “advise and consent,” letting Trump persist with vacancies in key roles; and a president whose approach to governing includes claims that he knows better than his scientists.

“If a president chooses to ignore advice, it doesn’t really matter how you’re organized,” one longtime preparedness adviser said, echoing concerns that the coronavirus failure was worsened because of Trump’s broader approach to expertise.

Gregg Gonsalves, a Yale epidemiologist who’s tracked outbreaks for decades, argued that it’s wrong to single out just a few decisions that weakened the U.S. response to Covid-19, saying instead that years of failure to act on the lessons of the past by strengthening public health — combined with Trump’s uniquely disruptive approach — teed up this year’s fragmented response.

“It’s been a slow war of attrition on public health and social spending in the U.S.,” Gonsalves said. “We may talk about how they fired the global health person, or they didn’t do this [project] or have that report — but the groundwork was laid long ago.”

The Future: Where We Go Next

Even beyond the White House, officials have struggled to pass their preparedness tests. A prime example: The coronavirus outbreak that’s ravaged New York for the past month. More than 7,000 people in the state are already dead and serious supply shortages, hospital bed crunches and other health crises will persist for weeks. While Gov. Andrew Cuomo and New York City Mayor Bill de Blasio are now loudly warning on coronavirus’ risks, both officials also spent days in mid-March raising questions about whether measures like ordering residents to shelter-at-home were even necessary.

If New York had moved a week or two faster to lock down public events and encourage residents to “social distance” by staying at home, the state’s death toll could’ve been cut by up to 80 percent, said Tom Frieden, who led the CDC under President Barack Obama. But “if New York had acted two days later, the death toll would have been double what it is and will be,” Frieden added.

House Democrats have already announced plans to investigate the Trump administration’s response to coronavirus, but experts like Cameron, who led the White House’s pandemic preparedness team for Obama and briefly for Trump, say it’s essential to use this moment to look forward too.

“Thinking about the next thing gets that much harder right now,” she acknowledged, but said that the coronavirus outbreak has revealed the need for more work on developing global supply-chains to ensure access to medical equipment. Cameron also said she’s convinced that senior leaders need to undergo many more, regular exercises that “force them to debate the toughest decisions,” like ventilator availability, so they can be better prepared to solve those problems in the middle of a crisis.

“Those kinds of things should be done relatively quickly when things aren’t in the distant rearview mirror,” Cameron said. “You can have perfect vision but that vision does start to become rosy after a while.”

Leavitt, Bush’s former health secretary, said he’s also worried that short-term thinking is crowding out long-term planning right now. “The vast majority of people are still thinking about this, talking about it like it’s a three-six month period and then we’ll get on with it,” he said. “This pandemic, like all pandemics, will change the world in fundamental ways.”

But what about officials like Azar and Kadlec, who engaged in those exercises and wrote out plans? Why weren’t they able to overcome the decades-long cycle of lessons learned and lessons lost? Leavitt acknowledges the irony but suggested that the blame should be directed elsewhere.

“Alex has now experienced both the ‘alarmist’ part and the ‘inadequate’ part” of being health secretary, said Leavitt, who defended his protege. “It is vastly unfair to personify inadequacy in just one department and in any one person — no secretary of health is alone in these decisions.”

As for Leavitt, he found himself in the uncomfortable position of a former official who sensed the pandemic that he warned about in 2005 finally manifesting in 2020.

"It is a time to make sure your family is prepared,” Leavitt wrote to his family and friends on Feb. 2, almost a month before the first U.S. death from Covid-19 would be announced.

In a sober, three-page memo that echoed his one-time briefings to the president, the former health secretary explained to the people closest to him how pandemics worked, warned that any vaccine was months away and urged others to brace for societal disruption — and stock up on necessities like food and medicine too — as the virus swept around the world.

“The consequences of being unprepared are too profound to ignore,” he wrote.