Donald Trump has appointed his vice president, Mike Pence, to oversee the US government’s response to the rapidly spreading coronavirus outbreak – despite his long record of statements that go against science, and his history overseeing a disastrous HIV epidemic in his home state.
Mr Pence’s appointment has also been met with derision given Mr Trump himself expressed disdain in 2014 when Barack Obama appointed “an Ebola Czar with zero experience in the medical area and zero experience in infectious disease control”.
But while Mr Pence doesn’t have a background in medicine, he does have plenty of opinions about science, many of which owe little to the field and instead derive from his own social conservatism. And as governor, he has previously put those views into practice.
As democratic representative Alexandria Ocasio-Cortez put it: “Mike Pence literally does not believe in science. It is utterly irresponsible to put him in charge of US coronavirus response as the world sits on the cusp of a pandemic.
“This decision could cost people their lives. Pence’s past decisions already have.”
In 2000, Mr Pence wrote an op-ed in which he denied the risks of smoking. "Time for a quick reality check", he wrote. “Despite the hysteria from the political class and the media, smoking doesn't kill."
And he has also advocated directing federal funds away from “organisations that celebrate and encourage the types of behaviours that facilitate the spreading of the HIV virus” in favour of “those institutions which provide assistance to those seeking to change their sexual behaviour.”
In fact, Mr Pence’s history on HIV is a theme that runs particularly strongly through his record – and is the single thing that’s causing the most outrage at his appointment.
While serving as governor of Indiana, Mr Pence faced an outbreak of HIV in the south of the state, mainly among intravenous drug users. Many had become addicted to opioid painkillers and ended up sharing needles with other HIV-positive addicts.
The outbreak soon started to overwhelm public health agencies in the area. Scott County, home to 24,000 people, saw more than 200 cases; HIV had previously been all but unknown there.
And because many people in the area were misinformed about the virus or afraid to report their symptoms to health authorities, both prevention and treatment programmes proved very difficult.
Mr Pence was soon under pressure to authorise a response including the setup of needle exchanges – of which the governor, a hardline social conservative, was a longtime opponent.
He believed that needle exchanges encouraged intravenous drug use, despite abundant public health research indicating the opposite. And his initial response to the pressure was not to start opening more exchanges, but to pray.
He first declared the outbreak a public health emergency in March 2015, saying the number of cases had “reached epidemic proportions” and that the time had come to act: “I’m prepared to make an exception to my long-standing opposition to needle-exchange programs. This is a public health emergency driven by intravenous drug use.”
The emergency order called for a temporary needle exchange programme to be set up – but only in Scott County. Mr Pence later signed a law making it easier for other counties to start needle exchange programmes; however, to get authorisation to do so, they had to prove that they were suffering HIV or hepatitis C outbreaks of their own.
Mr Pence expressed gratitude to the legislators who put the bill together: "This measure will save lives and give public health officials the broadest range of options to confront this and other public health emergencies in the future."
Today, some affected areas of the state are recovering, and Scott County has addiction centres and needle exchanges in place. But Mr Pence, who cut funding for crucial health agencies and then dragged his feet on the response, is still blamed by many for what happened.
Meanwhile, many counties in rural America are deemed at risk of HIV outbreaks among intravenous drug users – including several in Mr Pence’s home state.
And so the former governor will now oversee the government response to an outbreak that Dr Nancy Messonnier, director of the National Centre for Immunisation and Respiratory Diseases, recently declared essentially inevitable.
"It's not so much a question of if this will happen anymore, but rather more a question of exactly when this will happen and how many people in this country will have severe illness," she said.
As the US’s public health systems brace for the coming epidemic, Mr Pence’s record in Indiana doesn’t seem to be inspiring much hope.