Donald Trump tried and failed on Wednesday to coerce two of the government's top medical experts to endorse his claim that a second wave of Covid-19 infections in the fall is unlikely, hours after a federal whistleblower said he was fired by the administration for limiting the use of an unproven drug treatment touted by the president.
During a televised briefing on the Covid-19 pandemic, the president publicly displayed the political pressure he puts on government scientists by badgering Dr. Deborah Birx, the White House coronavirus response coordinator, to agree with his rosy projection that the virus "might not come back at all."
"Doctor, wouldn't you say there's a good chance that Covid will not come back?" Trump asked Birx. As she began to respond, saying, "We don't know-" Trump cut her off to add, "and if it comes back, it's in a very small, confined area that we put out."
"The great thing is, we'll be able to find it earlier," Birx said, diplomatically declining to endorse Trump's unscientific theory. The best-case scenario, she added, is that widespread surveillance of new infections could enable the country "to stay in containment" mode later in the year, rather than being forced back into lockdowns to check the spread of infection.
Trump's failed effort to put words in the doctor's mouth came minutes after he had pressed Dr. Robert Redfield, the director of the Centers for Disease Control, to recant comments he made on Tuesday to The Washington Post, when he warned of the "possibility that the assault of the virus on our nation next winter will actually be even more difficult than the one we just went through." The reason for that, the newspaper quoted Redfield as saying, is that, "We're going to have the flu epidemic and the coronavirus epidemic at the same time."
After the president claimed that Redfield had been misquoted, he called the doctor to the podium to make a statement. Choosing his words carefully, Redfield said: "I didn't say that this was going to be worse; I said it was going be more ... difficult and potentially complicated, because we'll have flu and coronavirus circulating at the same time."
Moments later, however, when Jonathan Karl of ABC News read the full quote from the newspaper to Redfield, the CDC director acknowledged that he had been "accurately quoted in The Washington Post."
Trump tries to say that coronavirus could just disappear, but CDC Director Redfield warned in WaPo a second wave of COVID-19 in the winter could be worsened because it's also flu season. Redfield confirms: "I'm accurately quoted in The Washington Post." pic.twitter.com/JLz3WccgoE
- Amee Vanderpool (@girlsreallyrule) April 22, 2020
"We will have coronavirus in the fall, I am convinced of that," Dr. Anthony Fauci said shortly after Redfield's Galileo moment. "What happens with that will depend on how we're able to contain it when it occurs. What we're saying is that in the fall, we will be much, much better prepared to do the kind of containment compared to what happened to us this winter."
This live display of political pressure from the president on government scientists came just after one of the nation's leading vaccine development experts, Dr. Rick Bright, accused the Trump administration of firing him because he refused to approve the widespread use of the drug hydroxychloroquine, which was heavily promoted until recently by Trump as a potential "game-changer" for Covid-19 patients.
In a statement released by his lawyers, Bright said that he was removed this week as the director of the Department of Health and Human Services' Biomedical Advanced Research and Development Authority, or BARDA, and as the deputy assistant secretary for preparedness and response, in retaliation for his insistence on limiting the use of hydroxychloroquine.
Bright was transferred to a lesser role at the National Institutes of Health. "I believe this transfer was in response to my insistence that the government invest the billions of dollars allocated by Congress to address the COVID-19 pandemic into safe and scientifically vetted solutions, and not in drugs, vaccines and other technologies that lack scientific merit," Bright said. "I am speaking out because to combat this deadly virus, science - not politics or cronyism - has to lead the way."
"I also resisted efforts to fund potentially dangerous drugs promoted by those with political connections," Bright added. "Specifically, and contrary to misguided directives, I limited the broad use of chloroquine and hydroxychloroquine, promoted by the Administration as a panacea, but which clearly lack scientific merit."
The doctor also said that he had "resisted efforts to provide an unproven drug on demand to the American public," and "insisted that these drugs be provided only to hospitalized patients with confirmed COVID-19 while under the supervision of a physician."
"These drugs," Bright noted, "have potentially serious risks associated with them, including increased mortality observed in some recent studies in patients with COVID-19."
As The Intercept reported earlier this month, the American College of Cardiology released guidance warning that the combination of hydroxychloroquine, a drug normally used to treat malaria and lupus, along with the antibiotic azithromycin raises the risk for some patients of dangerous irregular heartbeats that could be fatal.
"I will request that the Inspector General of the Department of Health and Human Services investigate the manner in which this Administration has politicized the work of BARDA and has pressured me and other conscientious scientists to fund companies with political connections as well as efforts that lack scientific merit," Bright said. "Rushing blindly towards unproven drugs can be disastrous and result in countless more deaths. Science, in service to the health and safety of the American people, must always trump politics."
"Rushing blindly towards unproven drugs can be disastrous and result in countless more deaths," Bright said.
Bright's lawyers, Debra Katz and Lisa Banks, who previously represented Christine Blasey Ford when she accused then-Supreme Court nominee Brett Kavanaugh of sexual assault, said that they would ask for the doctor's "unlawful forced transfer" to be put on hold pending an investigation by the Health and Human Services inspector general.
Bright's complaint came after a panel of experts convened by the the National Institute of Allergy and Infectious Diseases advised against treating Covid-19 patients with a combination of hydroxychloroquine, a commonly used antimalaria drug, and the antibiotic azithromycin - an unproven treatment Trump recommended repeatedly until last week.
While the results of randomized clinical trials of the drug treatment are still not in, a study of the records of 368 Veterans Affairs patients, released on Tuesday, found "no evidence" that hydroxychloroquine, with or without azithromycin, kept those infected with Covid-19 from needing ventilators. The study also found that 27.8 percent of those who were treated with hydroxychloroquine alone died, compared to 11.4 percent who received standard treatment without the drug.
Just a few weeks ago, hydroxychloroquine was Trump's darling drug. The president was enamored with the medicine that has been used for malaria, which he called "one of the biggest game changers in the history of medicine" in a tweet that was retweeted more than 100,000 times. When asked at an April 5 press conference about throwing his support behind an unproven treatment, he told reporters that the drug "doesn't kill people," going on to ask what he posed as a rhetorical question: " What do you have to lose? "
Less than three weeks later, after hospitals have given hydroxychloroquine to untold thousands of coronavirus patients, we have an answer to that question in the form of the study showing that veterans who were treated with the drug were significantly more likely to die than those who didn't get it. So, despite what Trump has described as his " natural ability " to understand medical science, it turns out the drug actually might kill severely ill Covid-19 patients - or at least dramatically increase their chances of dying.
The short and disappointing story of this one possible coronavirus treatment heightens the many dangers of having a president who is not a doctor but sometimes plays one on TV and, more broadly, of letting hype and politics rather than science drive medical decisions. Among the questions we need to be asking amid the desperation to combat the new coronavirus is not just what patients might have to lose from getting drugs based on the enthusiasm rather than science, but what others might have to gain.
BARDA, the division of the Department of Health and Human Services Bright led until this week, is at the heart of the government response to the pandemic. Charged with developing treatment and prevention options against a wide range of specified threats, it has already issued at least 25 contracts worth almost $1.5 billion for products related to the coronavirus. Since 2019, when BARDA's budget was $561 million, its spending has roughly tripled.
The biggest grants - worth more than $939 million - have gone to Janssen and Moderna Therapeutics for their work on potential coronavirus vaccines. While there are more than 70 candidates for a coronavirus vaccine, the criteria for selecting these companies for funding and the terms of their agreements are unclear. The BARDA contracts aren't open to bidding, as many other government contracts are, and may not include the usual oversight and accountability protections for taxpayers under the Bayh-Dole Act. And BARDA has not made them public. A FOIA request for the contracts from The Intercept is pending.
While there are more than 70 candidates for a coronavirus vaccine, the criteria for selecting these companies for funding and the terms of their agreements are unclear.
James Love, director of Knowledge Ecology International, a watchdog on pharmaceutical patent abuse, said he was concerned about a lack of transparency at BARDA. "They've been unwilling to share basic information to make the agency and its contractors more accountable," said Love.
"There's been a lot of deference to the institutions that work on these biomedical issues with the assumption that they're above reproach. But with something like this, where the president thinks the entire election hinges on this disease, it's more political than ever."
While the science behind BARDA's decisions remains obscure, it's clear that several of the companies that have recently received contracts have the personal support of the president. Executives from Moderna Therapeutics, Regeneron, and Johnson & Johnson, the parent company of Janssen, all of which recently received funding for coronavirus-related products through BARDA, were among a handful of pharmaceutical executives who met with Trump at the White House in early March. The president described the companies as "the biggest in the world, most prestigious, the ones that get down to the bottom line very quickly."
Trump, who already had a relationship with Johnson & Johnson CEO Alex Gorsky, singled out that company as "among the greatest in the world." Later that month, the administration announced it was giving the company a $456 million contract to work on "a new vaccine asset" for the virus.
According to a March 29 news release from the HHS office Bright helped run, Sandoz, a drug manufacturer, donated 30 million doses of hydroxychloroquine to the Strategic National Stockpile, a collection of lifesaving supplies for public health emergencies, which is overseen by BARDA, and Bayer donated 1 million doses of the drug. Earlier in March, Bayer also donated 3 million tablets of its drug Resochin, a chloroquine phosphate treatment developed in 1934 which has recently been available only in Pakistan. The FDA, reportedly under pressure from Trump, issued an emergency use authorization for the donated hydroxychloroquine and chloroquine to be used in the United States.
Tax law allows for deductions for charitable contributions to government "if the contribution or gift is made for exclusively public purposes." According to the law, the deduction is generally capped at 10 percent of a corporation's income.
Last week, Trump met for 40 minutes with people who had recovered from Covid-19 after taking hydroxychloroquine and pressed them to credit him for touting the drug.
"So you took the hydroxy?" he asked one of the survivors. "Why did you take the hydroxy? Why did you do that? You saw it on television?"
"So you might have said," Trump pressed the husband of one African-American patient who picked up her prescription for hydroxychloroquine late at night, "When you started that walk or run, 'What the hell do I have to lose?' Right?"
"You know my expression, 'What do I have to lose?'" Trump asked, referring to a phrase he first used to urge black voters to support him in 2016, and recently repurposed to promote the experimental hydroxychloroquine treatment.
"I thought about that - what you said," the man said. "Yeah."
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