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day0one · 4 years

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In next phase of pandemic, Trump appears poised to let others take the lead

President Trump has proclaimed the latest phase of pandemic response the “transition to greatness.” But Trump appears poised to preside over the eventual transition more as a salesman and marketer than a decider.

Many consequential actions are being done by others. The nation’s governors are overseeing their states’ plans to reopen their economies. Business leaders are making their own choices about how their employees can safely and responsibly return to work. Treasury officials are negotiating with Congress the details of financial stimulus packages. And scientists and public health officials are leading the race for a vaccine.

The United States under Trump has also retreated from its historic position of global leadership, declining, for instance, to participate in a coronavirus summit with other nations earlier this month.

Amid a once-in-a-century deadly pandemic, Trump has inserted his ego squarely into the U.S. response while simultaneously minimizing his own role — deferring critical decisions to others, undermining his credibility with confusion and misinformation, and shirking responsibility in what some see as a shrinking of the American presidency.

Historian Doris Kearns Goodwin, who studies presidential leadership, said Trump has diminished the influence of his office relative to the outsize responsibilities past presidents have taken on during crises, most notably Franklin D. Roosevelt amid the Great Depression and World War II.

“You just yearn for that kind of leadership coming from the presidency,” Goodwin said. “Right now, we’re looking to the leaders in the states for carrying the major burden of how to deal with both the science and the economics. We’re looking to private industries about how to reopen.”

White House spokesman Judd Deere said “the media refuses to acknowledge or report accurately the incredible work of this president to protect and support the American people throughout this pandemic,” including a newly announced initiative aimed at developing and distributing a vaccine by the end of the year, ahead of most predictions.

“The president has been leading every step of the way, and his actions, not only to protect public health but also the economy and workforce, will ensure we emerge stronger than ever before,” Deere said.

Many Democrats disagree. “It seems that the most important decision the president makes every day is whether he does a press conference and, if so, what time,” said Sen. Chris Murphy (D-Conn.).

But with the U.S. death toll at more than 88,000 and rising, Murphy said he prefers a leadership vacuum in the West Wing to what he views as Trump’s unhelpful meddling.

“At this point, I think the president has proved to be so incompetent that most of us in Connecticut don’t want him or the people that work for him micromanaging our response,” Murphy said.

Though Trump has repeatedly attacked Gretchen Whitmer (D), the Michigan governor said she has forged solid relationships with others in the administration, including Vice President Pence, whom she described as “accessible and cordial.”

“It doesn’t mean every single thing we need comes on time and perfectly and when we need it, but they’re good to work with and they’re doing their best,” she said.

Asked what she would like from the president, Whitmer said: “I would love to see a consistent, science-based message, and imploring people to keep their guard up and keep doing the right thing.” And, she added with a small laugh, “I would like swabs!”

Unlike former president Barack Obama — who made a point of getting photographed receiving an H1N1 vaccine to encourage the public to do similarly — Trump has largely modeled poor public health behavior. He refuses to a wear a mask, despite his own administration’s recommendation to do so, and until recently, he did not practice social distancing.

Some of Trump’s other decisions, meanwhile, have seemed rooted in part in public relations calculations. In an unprecedented move, the president suggested that his name be printed on all Internal Revenue Service stimulus checks, a proposal that threatened to slow their delivery by several days.

And before daily coronavirus press briefings were curtailed, Trump co-opted them as freewheeling, virtual campaign rallies. The ensuing dynamic transformed the coronavirus task force meetings in the Situation Room largely into planning sessions for what the president and other officials would present to the media that evening, aides said.

In pushing the nation to reopen, Trump is running anew up against his own limitations. A recent CNN poll found that while Trump’s approval rating remains largely unchanged at 45 percent, a smaller 36 percent of the public considers the president a trusted source of information about the coronavirus outbreak.

This trust deficit, said Richard Curtin, director of surveys of consumers at the University of Michigan’s Survey Research Center, makes it even harder for Trump to accomplish a task that would be daunting for any leader.

“To convince consumers to go out and purchase — or to just go out — is a significant challenge, because it involves their most closely held emotions about life,” Curtin said. “Consumers started staying at home long before they were forced to by government regulations, because they knew that was the right thing to do, and I think the president has limited ability to change that.”

Peter Wehner, who served in the past three Republican administrations and is an outspoken Trump critic, was more blunt, arguing Trump’s “extreme narcissism” has impeded his administration’s pandemic response.

“There’s no question that he has miniaturized the office,” Wehner said. “He’s shrunken it, he’s degraded it, and he’s defaced it. It’s a kind of civic vandalism he’s inflicted on the office.”

For Trump, sometimes the message seems more important than the policy. During a Rose Garden news conference last week, Trump announced his administration was sending $11 billion to states and territories to help them with testing. But when a reporter asked him why every American who wants a test still can’t get a test, two months after Trump first promised they could, the president was exasperated.

“That’s the problem with a question like that,” Trump said. “We go through a whole announcement saying, ‘We’re number one in the world by far,’ by a factor of two, and even three and four depending on where you’re looking, and I get a question, ‘When will everybody be able to get tested?’ ”

The focus, he implied, should be on his ceremonial announcement, not the continued lack of what experts say is sufficient mass testing.

Meanwhile, Trump played a supporting role, at best, in negotiations to produce the four bipartisan bills enacted so far to address the pandemic. Treasury Secretary Steven Mnuchin was a constant presence on Capitol Hill, running point for the administration on relief measures, while the president’s suggestions — such as a payroll tax cut — were shrugged off and gained little traction, even among Republican allies.

At one point in mid-March, as a particularly hard-fought negotiation reached resolution, House Speaker Nancy Pelosi (D-Calif.) was asked if she had spoken with Trump. “There was no need for that,” she replied.

Trump and his allies stress that he deserves credit for some of the decisions he did make. Trump announced some restrictions on travel from China in late January — which he cites in claiming he took the virus seriously early on, despite having spent all of February dismissing its threat and ignoring calls to prepare for the worst.

Trump, habitually loath to share the spotlight, helped elevate public health officials to near celebrity status, including physicians Deborah Birx and Anthony S. Fauci. Despite some tensions and frustrations, Birx and Fauci insist Trump listens to their advice, even if he doesn’t always heed it.

While critics see Trump’s hyper-focus on public relations as a detriment, Jason Miller, a former Trump campaign adviser, said it is evidence of savvy leadership.

“Every president who has faced a global crisis — whether it be a kinetic war or a viral war or even an economic war — has become the face of that crisis, whether they like it or not, and I think it’s smart for President Trump to realize that his presidency will ultimately be defined by the successful recovery from coronavirus,” Miller said.

Other personalities, from doctors to governors, have emerged as influential. For example, the daily news conferences of New York Gov. Andrew M. Cuomo (D) became must-watch viewing for many Americans.

“The governors with the highest approval ratings are those who acted most quickly and seemed to listen most closely to the advice of the health-care experts,” said Whit Ayres, a Republican pollster.

Also drawing attention is Obama, who on Saturday joined a star-studded group — including basketball player LeBron James and education activist Malala Yousafzai — to deliver two televised commencement addresses for graduates across the United States.

Obama took sharp aim at the Trump administration’s handling of the pandemic, saying the crisis has “finally torn back the curtain on the idea that so many of the folks in charge know what they’re doing. A lot of them aren’t even pretending to be in charge.”

Ben Rhodes, a deputy national security adviser to Obama, said that were Trump to think more creatively, the president could easily craft a weekly schedule that helps both steady the nation and underscore his policy goals. For instance, Rhodes sketched out a Monday briefing alongside Fauci with “just the facts you need to know about fighting the disease”; a Tuesday video call on Zoom with small businesses to discuss guidelines for safely reopening; and a Wednesday photo opportunity at a local D.C. restaurant to help with curbside pickup.

“This would be politically hugely popular, to make people feel like they’re getting usable information from the government and like they’re being shown by the president about how they might go about resuming their lives,” Rhodes said. “This is one of those moments where doing the job well would have political benefit.”

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healthandfitnessrecipes-blog · 6 years

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Trump’s Pick for CDC Director Is Experienced But Controversial

https://healthandfitnessrecipes.com/?p=1003

In the first year of his administration, Donald Trump has repeatedly filled important scientific positions with candidates who seem to be either unqualified for the roles or diametrically opposed to the very purpose of those roles. Scott Pruitt was chosen to lead the Environmental Protection Agency after having repeatedly sued it. Rick Perry became Secretary of Energy, heading a department that he formerly wanted to eliminate and that he couldn’t remember the name of. Sam Clovis, a now-withdrawn nominee for chief scientist at the United States Department of Agriculture, had no scientific background. Brenda Fitzgerald seemed a reasonable choice to direct the Centers of Disease Control and Prevention (CDC) but was forced to resign after Politico reported that she had bought shares in a tobacco company shortly after taking up her post.

Given this parade of foxes in henhouses, it should have been a moment of joyous relief when Robert Redfield was confirmed as the new director of the Centers for Disease Control and Prevention on Wednesday. A leading virologist, Redfield has spent more than 30 years researching HIV and other infectious diseases. He served in the U.S. Army Medical Corps for 20 years and later cofounded the Institute of Human Virology at the University of Maryland School of Medicine, where he now acts as associate director. He has overseen a clinical program that treats more than 5,000 patients in the Baltimore-Washington area, and has experience treating people in sub-Saharan Africa. His supporters speak of him as a kind and compassionate doctor, who is devoted to his patients.

A scientist-physician with decades of experience in controlling and preventing diseases to lead the CDC? Check and check.

As part of his work treating HIV patients, Redfield has also dealt with many cases of heroin addiction—valuable experience, given the Trump administration’s focus on tackling the opioid crisis. His “scientific and clinical background is peerless,” said the Health and Human Services secretary, Alex Azar, in a press release announcing Redfield’s appointment. “Bob Redfield is a talented and committed physician/scientist who has steadfastly devoted the past three decades to the study and care of HIV-infected individuals,” adds Anthony Fauci, the director of the National Institute of Allergy and Infectious Diseases, and a leading HIV researcher himself. “He is highly regarded.”

But Redfield has not escaped the controversy that has dogged other Trump-era appointees. In the mid-1990s, Redfield oversaw a clinical trial of an experimental HIV vaccine at the Walter Reed Army Institute of Research. He was accused of manipulating data from the trial, “sloppy or, possibly, deceptive” data analysis, and overstating results in a number of talks and publications. After an investigation, the military cleared Redfield of misconduct charges, but as Jon Cohen reported for Science at the time, the Army never provided an explanation of how it reached its conclusions.

Despite clearing him, military investigators chastised Redfield for having a “close relationship” to a nonprofit called Americans for Sound AIDS/HIV Policy (ASAP) “to a degree that is inappropriate.” ASAP, now known as the Children’s AIDS Fund, was founded by evangelical Christians; it has championed abstinence-only education as a method of combating HIV and other approaches grounded more in religious belief than scientific evidence.

Redfield also has a history of supporting other contentious HIV-related policies. In 1985, he supported an unprecedentedly large program of mandatory HIV screening for the military—against the recommendations of the CDC and other health professionals. After testing positive, many recruits were barred from service, while several active soldiers were segregated, in breach of any patient confidentiality. “The reason we have done what we have done is that we think it’s good medicine,” Redfield told Laurie Garrett, the journalist who broke the news about the segregation, at the time.

For these reasons, Senator Patty Murray, the ranking member on the Senate Health, Education, Labor, and Pensions Committee, wrote a letter to the White House expressing concerns about Redfield’s appointment and that he has “taken no action to distance himself from those positions.” “What one wants in a director of the CDC is a scientist of impeccable scientific integrity,” added Peter Lurie from the Center for Science in the Public Interest, a consumer advocacy group. “What one would get in Robert Redfield is a sloppy scientist with a long history of scientific misconduct and an extreme religious agenda.”

But these controversies are now decades-old, and some critics are hopeful that Redfield’s positions have shifted. “I am cautiously optimistic, and I’m hoping that, in all these years, his views have become more mainstream on disease control and prevention,” says Gregg Gonsalves, a professor of epidemiology at Yale University and a longtime AIDS activist.

His main concern is that Redfield maintains ties to the Children’s AIDS Fund, and still sits on its board. “But in emails with Dr. Redfield yesterday he reassured me that he shares common goals with the rest of the AIDS community, scientists and researchers, patients and advocates,” says Gonsalves. “So, we all wait and see.”

These are tricky waters to navigate, and Redfield is hardly the first to run aground in them. After Julie Gerberding was named CDC director in 2002, she convened a meeting on HIV prevention which included the religious right. “It blew up, with gay leaders of AIDS groups being called degenerates by some in attendance,” says Gonsalves, who was there.

Similarly, the President’s Emergency Plan for AIDS Relief (PEPFAR) has been widely and deservedly lauded for delivering life-saving antiretroviral drugs to 11.5 million people with AIDS in sub-Saharan Africa, but also criticized for funding ineffective attempts to prevent HIV infections by teaching abstinence and faithfulness.

Redfield will begin his directorship at a pivotal time for the CDC. Infectious diseases are emerging at an ever faster pace, drug-resistant microbes are sweeping the world, and the United States is struggling to deal with its opioid epidemic. Meanwhile, Trump’s proposed budget for fiscal year 2019 threatens to slash the CDC’s budget by 8 percent, although Congress’s spending bill, announced this morning, gives the agency a $1.1 billion increase instead. The agency is also set to fall off a funding cliff that will force it to downsize its disease-fighting work in 39 countries, leaving the U.S. and the world more vulnerable to pandemic threats.

Given these challenges, others have concerns about Redfield’s experience. That may seem odd for someone with such deep medical credentials, but the CDC is a public-health agency, and improving the health of entire populations requires different skills and knowledge than caring for individual patients. CDC directors must be more than experienced physicians or scientists; they must run an agency of 15,000 employees with a budget of over 7 billion dollars, and ideally, they’d jump into the post already having strong relationships with public-health officials at the state and local level.

For that reason, most former directors have either run a city or state public-health department before, or have worked at the CDC itself. Julie Gerberding was acting deputy director at the National Center for Infectious Diseases before she became CDC director in 2002. Her successor Tom Frieden was commissioner of the New York City Department of Health and Mental Hygiene for seven years before he took the role. No director in the CDC’s history has come in with so little public-health experience as Redfield.

“He is passionate about HIV; how he administers a public-health agency will have to be determined,” adds May Chu from the Colorado School of Public Health, who has worked at the CDC before. “Personally speaking, I would have preferred a seasoned public-health administrator.”

One such candidate was already in post—Anne Schuchat. She joined the CDC in 1988 as one of its frontline disease detectives and has since held several leadership positions in the agency, culminating in two stints as acting director, before and after Fitzgerald’s appointment. A career civil servant and public-health specialist, Schuchat has dealt with anthrax outbreaks in the United States, Ebola in West Africa, and SARS in China. She is highly respected within the agency, and many hoped that she would be permanently appointed. “You’d have joyous celebration if they made her permanent director,” one analyst told Lena Sun at the Washington Post.

Redfield’s appointment does not require Senate confirmation. He did not respond to a request for comment.

https://cdn.theatlantic.com/assets/media/img/mt/2018/03/Dr._Robert_Redfield_/lead_960.png Credits: Original Content Source

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