Trump administration might consolidate pandemic response at State Department

GabOrr and Nahal Toosi

Aides to President Donald Trump are considering a plan to shift the government’s global response to future infectious disease outbreaks to a new unit inside the State Department, according to documents obtained by POLITICO.

The proposal, discussed during a National Security Council deputies committee meeting on Thursday, already has set off a turf battle between the State Department and the U.S. Agency for International Development. USAID officials were surprised and perplexed by the idea, which could lead them to lose control of significant funds and authorities.

People familiar with the issue say Dr. Deborah Birx, a top official handling the administration’s response to the ongoing coronavirus pandemic, is likely to wind up in charge of the new unit if it becomes a reality. The proposal also could, to some degree, establish an alternative mechanism to some of the work done by the World Health Organization, whose U.S. funding Trump has threatened to permanently end.

The overall effort, first reported by the media platform Devex, is described as the President’s Response to Outbreaks, or PRO.

Under the proposed initiative, the State Department would appoint a coordinator to oversee nearly every aspect of pandemic preparedness and response — from the global distribution of vaccines and therapeutics to the development of modernized protocols to prevent the spread of an outbreak.

“Having a singular initiative to focus global attention and resources has been an effective model to turn the tide of diseases like HIV/AIDS and malaria,” reads an outline of the new model that U.S. officials planned to circulate on Capitol Hill. “Through PRO the U.S. will assert global leadership for mobilizing private and public partners, multilateral institutions and other bilateral donors to support a global pandemic response that will deliver results for the American people.”

The proposal comes as senior administration officials grapple with ongoing flaws in the federal government’s response to Covid-19, which has pitted top agencies against one another as they work to secure medical supplies for U.S. stockpiles and other nations and often resulted in conflicting guidance from the White House and public health officials.

The plan could decrease USAID’s role by consolidating pandemic preparedness under the State Department, which lacks the volume of supply chain experts, epidemiologists and public health experts on staff at USAID. There also are questions about whether the initiative will focus strictly on infectious disease outbreaks or be expanded to include other types of global health issues.

One USAID official familiar with the proposal described it as a “power-grab” by the State Department. Another called it a “turf fight.”

The State Department declined to comment on “purportedly leaked deliberative documents.” A spokesperson for USAID declined to comment.

Some at USAID questioned whether now is an appropriate time to overhaul the existing response model, given the ongoing coronavirus crisis. The number of pandemic-related deaths in the United States is nearing 100,000, and the Trump administration is shifting its focus to a swift reopening of the U.S. economy.

But, according to one USAID official, State Department leaders have been frustrated with USAID’s response to the novel coronavirus, feeling it’s been slow and not always aligned with Secretary of State Mike Pompeo’s priorities.

Members of the White House coronavirus task force, led by Vice President Mike Pence, also previously complained about USAID’s distribution of medical supplies to other countries at the height of the Covid-19 crisis, when U.S. hospitals and front-line workers faced shortages of personal protective equipment.

USAID is technically an independent agency, but it is supposed to take policy guidance from the secretary of State, whose department plays a role in USAID’s budget management.

“My read of it is they’re unhappy with USAID,” the USAID official said, speaking on condition of anonymity because of the sensitive nature of the topic. “USAID hasn’t been able to deliver on certain things.”

Documents circulated inside the administration were short on details about which programs at USAID could be relocated under the two components of PRO: America’s Response to Outbreaks, and the Preparedness Initiative for Pandemics and Emergency Response. It will differ from programs such as the President’s Emergency Plan for AIDS Relief and the President’s Malaria Initiative, but will incorporate lessons from them, according to an FAQ.

Aside from working on the coronavirus response, Birx — who could not immediately be reached for comment — holds titles including U.S. special representative for global health diplomacy. She’s been based at the State Department, and her duties include dealing with global HIV/AIDS programs, including PEPFAR.

“The goal at this stage is to develop a unified whole-of-government response and approach to pandemics that will allow us to bring together all of our government’s tools to meet the challenges we will face in this new era of pandemics,” one of the documents reads. “As the discussions progress towards implementation, we will clearly define specific roles and responsibilities across agencies, consistent with their mandates.”

According to the proposal, the ARO coordinator would work with government agencies and the private sector “to ensure the full power and expertise of the United States are leveraged to … prevent, detect, and respond to infectious diseases and mitigate and prepare for future disease outbreaks.”

Coordination with the National Institutes of Health and the Food and Drug Administration on vaccine development and distribution would also fall under the purview of this position. The new position would require congressional approval.

The second component of the new pandemic initiative, PIPER, would include a central fund “to focus bilateral, multilateral and private-sector funds to fight pandemics.” The fund would be led by a coalition of public and private donors, represented by the ARO coordinator, and would feature three centers focused on the prevention, detection and overall response to pandemics.

The initiative would also promote private-sector innovation in the pandemic-response sphere with a fund specifically reserved for the development and deployment of detection methods “and response solutions around the world.”

Officials involved with the effort claimed it would position the U.S. and other nations “to make the right choice in the face of the blatant efforts by China, Russia, and others to sow discord and champion authoritarian systems that have little regard for individual human suffering from this pandemic.”

Top U.S. officials, including the president, have repeatedly accused the Chinese government of spreading disinformation related to the Covid-19 pandemic as part of a broader effort to sow fear inside the U.S. and other nations and to undermine the Trump administration’s coronavirus response.

The Trump administration also has accused the World Health Organization of being too influenced and intimidated by the communist government in Beijing. Earlier this week, Trump said “substantive improvements” at WHO must be made within the next 30 days or his administration would permanently pull U.S. funding the organization, which has received $1.4 billion from the U.S. since Trump took office, according to a recent study by Forbes.

One of the documents circulated among administration officials said the federal government “must develop a more effective alternative” to WHO, and suggested the PIPER initiative would “enhance global preparedness in the face of future pandemics by establishing an international body to focus on infectious disease outbreaks.” The document put the cost of the entire effort at $2.5 billion, but noted that current Covid-19 resources would be used initially.

Critics say Trump is criticizing China and Beijing in a bid to deflect attention from his slow initial response to the pandemic as the virus spread inside the United States.