How Trump’s Failed 2020 COVID Policy Birthed His 2024 Public Health Nominees

It’s not enough to say that Donald Trump is installing a gaggle of opportunists, gadflies and, in some cases, quacks to run public health.

Rather, it’s that over time, many of those who Trump has appointed have bent their perspectives in various ways towards ideas that he has favored. On cures, treatments, and public health strategies that Trump has promoted like ivermectin, hydroxychloroquine, and herd immunity, these appointees have aligned themselves with, or held back criticism of, the Trump-endorsed path forward.

It’s a long-term byproduct of a signature issue with the Trump administration’s response to COVID, which emerged in the pandemic’s earliest days in 2020: it caught experts off-guard by politicizing elements of the response, seemingly at random. Whether it was invoking the Defense Production Act, giving guidance on mask-wearing, describing the virus’s origin, or promoting various proposed treatments, Trump turned facets of the pandemic into sites of furious partisan contestation.

And for many of his new administration’s nominees’ commentary, public health considerations appeared to fall by the wayside as they sought either to keep Trump happy or offer ways forward that broke with the same expert community who explicitly or implicitly criticized the former President for his disastrous handling of the pandemic.

Two of the issues on which that pattern can be seen most starkly are a proposed treatments for COVID, hydroxychloroquine, and with a proposal to use “herd immunity” as a means to quickly escape the pandemic.

Hydroxychoroquine

Early in the pandemic, doctors were racing to find anything that might help patients suffering from COVID. There was, at the time, no known treatment, and a lot of desperation as the virus spread rapidly. Out of that fog came one now-infamous proposal: hydroxychloroquine. The FDA initially authorized hydroxychloroquine in March 2020 on an emergency basis, as the first wave of the pandemic broke over the United States. But after more research showed that it was ineffective and potentially harmful in some cases, FDA officials rescinded authorization in June 2020.

In that time, however, it had become politicized.

Trump said on Fox News in May that he had taken the treatment. His supporters started to flock to the drug, and it became a totem of loyalty.

Several of Trump’s picks for public health-related agencies were involved in the debate around hydroxychloroquine in real time.

Dr. Mehmet Oz, the TV doctor and Trump’s nominee to run Centers for Medicaid and Medicare Services in the new administration, pushed officials in March 2020 to back a study he wanted funded on the drug, emails released by the House Coronavirus Committee in 2022 showed.

Initially, Oz’s entreaties were met with receptiveness. In one message to Jared Kushner, Oz said that it was a “national priority” to complete his study on the drug.

But by the end of March 2020, he started to encounter more skepticism. Dr. Deborah Birx, then a key player in the White House’s COVID response, replied only that “we should talk” after Oz cited data from a French doctor who was claiming a near-100 percent success rate for the treatment.

Other future nominees also became involved.

After Trump said in May that he had been taking hydroxychloroquine on a daily basis, Dr. Janette Nesheiwat — the current surgeon general nominee — appeared on Fox News.

Nesheiwat tried to walk a tight line. She said that it was “very smart” for Trump to take the drug as a “preventative measure,” and later added an admission that the efficacy of the drug was somewhat unclear. She had prescribed the drug for COVID patients, she said, and “some of them benefitted from it, some of them did not.”

Nesheiwat, later in the pandemic, gently pushed back against another cure that had become popular in conservative circles as an alternative to vaccination: ivermectin, a drug with a variant used for horse deworming. After podcast host and ex-fear factorer Joe Rogan complained that CNN had accused him of taking horse dewormer over his use of the drug, Nesheiwat tried to clarify, affirming that it was used as a horse dewormer and also for humans, without addressing whether it’s useful for COVID or as a vaccine substitute. “Misinformation is harmful,” she wrote.

Herd immunity

Another future Trump appointee, FDA nominee Dr. Marty Makary, was willing to reject hydroxychloroquine in a December 2020 appearance on Fox News before ingratiating himself with the MAGA right by opposing vaccine mandates and advocating for herd immunity in an op-ed for the Wall Street Journal.

Makary was referencing a concept that had been proposed in an October 2020 public letter fancifully known as the “Great Barrington Declaration.” Dr. Jay Bhattacharya, who Trump nominated to run the National Institutes of Health this week, was one of three doctors who drafted the letter.

Bhattacharya would later entertain ivermectin and hydroxychloroquine, the MAGA COVID fad cures. In 2022, he attributed the rejection of the two medications to a conspiracy: drug companies have no interest in funding trials for off-patent drugs, whose production would be far less profitable.

“If you have a drug that is offpatent, there is nobody interested in testing it,” he said.

It was a clever tack, as unmoored from reality as it was, casting as villain widely reviled pharmaceutical manufacturers.

But in the Great Barrington declaration, Bhattacharya called for the U.S. to enact a policy of “focused protection.” Residents of long-term care facilities, home to the most vulnerable, would be kept isolated, while the government would stop implementing and advocating non-pharmaceutical interventions like masking and social distancing. The result would be to let the virus sweep through the population, in theory creating herd immunity while taking the most vulnerable out of the way.

The theory was immediately met with a chorus of criticism, largely pointing out that the long-term effects of COVID on healthy people were unknown, and that the United States had a massive population of unhealthy people who were vulnerable to the virus for reasons like obesity, and who were not residing in long-term care facilities.

But it was a great solution if you wanted to avoid the arduous tradeoffs that COVID necessitated: in theory, you could run the economy at full tilt with a herd immunity strategy. Trump administration officials met with Bhattacharya and others in the days after the declaration was released.

Dr. Birx put the issue succinctly in an email later released in a congressional investigation.

More than 80 million Americans not in long-term care were vulnerable, she wrote.

“Without masks and social distancing we end up with twice as many deaths –– we will never look as good as even Sweden due to our co-morbidities,” she wrote, calling Bhattacharya, among others, a “fringe group without grounding in epidemics, public health or on the ground common sense experience.”

Pushing herd immunity, as the White House was considering, would trigger an “unacceptable death toll.”