The existential campaign issue no one is discussing

Donald Trump undermined public health measures during the Covid-19 pandemic. What would he do in a future health emergency? | Win McNamee/Getty Images

The 2024 presidential campaign has passed with the candidates barely being pressed about one of their core responsibilities: What would they do in the event of another pandemic?

That’s not usually a top question for voters. But it should be. During Donald Trump’s first term, we saw the damaging consequences of a leader who is disinterested in science and unwilling to tell uncomfortable truths to his political base. The Covid-19 pandemic would have challenged any president, but evidence suggests that Trump’s leadership contributed to unnecessary deaths: as many as 40 percent of American lives lost in the first year of the pandemic, according to one estimate. 

Now we are staring down the threat of H5N1, or bird flu, which continues to spread through America’s dairy herds and infect an increasing number of humans. If bird flu were to spiral into a pandemic, we would look back at this as a critical time to prepare. But while the Biden-Harris administration’s response has certainly been lax in some respects, Trump is on the campaign trail threatening to defund schools that require their students to be vaccinated and pledging to install anti-public health establishment crusaders into senior roles in his White House. 

Trump could ascend to the presidency again even as another pandemic threat is lurking. If the worst came to pass, would the sequel be any better? 

Probably not, experts told me. I started reporting this story with a smidge of optimism: While Trump had clearly been a problematic communicator during Covid-19, his administration was responsible for Operation Warp Speed, which delivered effective vaccines in record-setting time and likely saved hundreds of thousands of lives. That was a major, unexpected accomplishment for which the Trump administration deserves credit.

But rather than lay claim to such a big, beautiful success, Trump has mostly shunned it. Instead, he has embraced America’s most notorious vaccine skeptic, Robert F Kennedy Jr., and promised him a prominent place in the White House. That is probably a better signal of what would happen in Trump’s next term. 

In a future emergency, Trump “would make a political calculation, and not one based on what needed to be done,” Amesh Adalja, an infectious disease scholar at the Johns Hopkins Center for Health Security, told me. “Infectious disease in general has been completely subsumed by a tribal lens, and the tribe that is supportive of him is antagonistic to a proactive approach to public health.”

What an H5N1 response might look like under Donald Trump

Let’s establish a couple of things. First, while there has been sustained concern among infectious disease experts this year about H5N1 due to a steady drip of human infections, the virus has not yet ignited a pandemic. Maybe it never will. H5N1 has been infecting humans off and on for more than 20 years. 

Whether it’s bird flu or something else, new diseases have been emerging more often in the 20th and 21st centuries, and many scientists expect the frequency of pandemics to only increase as climate change and globalization create more opportunities for diseases to cross over in humans and spread among them.  

It’s inevitable that we’ll face another pandemic. The question is only what will cause the next one, and when. For now, H5N1 is the suspect drawing the most attention. 

Second, the Biden administration’s response to H5N1 has been very flawed. Vanity Fair recently investigated the inaction of the US Department of Agriculture (USDA), which has taken primary responsibility for the H5N1 response so far because most of the cases have been in livestock animals: chickens, turkeys, and now dairy cows. 

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Experts say the federal agency has been overly accommodating of agricultural industry interests, which has allowed the virus to continue escaping containment and tear through dairy farms across the country. The USDA has largely deferred to states to take the lead on H5N1, and state agricultural officials, especially in big farm states, are typically even more deferential to agribusiness than the federal government. 

In Missouri, state officials have been slow to act after the discovery of a human case with no obvious connection to farm animals. “They are overtly evading the fact that dairy cattle in Missouri are infected. They don’t want to find them,” Adalja told me.

Adalja said he saw little reason to expect a Kamala Harris administration to take a substantially different approach; her public health record is essentially her record as Biden’s vice president. But Trump, if he were to take over, would actively weaken the federal government’s ability to respond to a pandemic threat. 

He has said he would “probably” shutter the White House pandemic office, tasked with coordinating a response across the government in a future crisis. He has threatened to cut off federal funding for schools that institute vaccine or mask mandates. He has also pledged to slash the government budget and singled out the CDC as a candidate for cuts.

And while the bird flu response under Biden has been dysfunctional, there has at least been some attempt to centralize a response. The current administration has offered nearly $100 million for dairy farms to take preventive measures and has also signed a deal with Moderna to develop a new H5N1 vaccine, while adding to the stockpiles of existing flu vaccine prototypes. 

But in another Trump presidency, the states would probably be empowered to take an even more relaxed approach to public health, and leaders in Republican-controlled states would be motivated by the same public health skepticism as their conservative voters. The political environment would be ripe for a free-for-all in state-level responses, amplifying the divergences we saw during Covid-19, when some states allowed businesses and schools to reopen months before others did and even banned cities from setting mask or vaccine requirements.

A second Trump administration would likely also be staffed by people who are even more skeptical of public health interventions than we saw in his first term. In 2020, Trump still had credible infectious disease experts on his team, like Anthony Fauci, former director of the National Institute of Allergy and Infectious Diseases, and Deborah Birx, who served as the White House Covid response coordinator, even if he frequently undermined them.

Next time, it’s unlikely there would be any such voices in the room. The internal deliberations would instead be dominated by the likes of RFK Jr. or Florida Surgeon General Joseph Lapado, another vaccine skeptic who has been floated as a possible Trump appointee. To lead the USDA, Trump is reportedly eyeing Texas agriculture commissioner Sid Miller, who told Vanity Fair that bird flu is “not a big deal. It’s not even a little deal.” He has refused to cooperate with the CDC on testing farm workers in his state.

“Those types of people are all that’s left” to serve in a Trump administration, Adalja said. “People with expertise are not going to want to be part of it or be selected.”

It’s a frightening scenario to contemplate, and it illustrates our collective difficulty planning for unlikely but potentially catastrophic events. We all just lived through an experiment in what happens when the government struggles to respond to a health crisis. Yet even at the beginning of Covid, I heard from public health experts who worried we would not internalize the pandemic’s lessons, that public health would be shunted to the side after the urgency had passed.

They’ve mostly been proven right.

To be clear, the failure to learn from the example of Covid and prepare now for future pandemics with smart policies — many of which you can read about in Future Perfect’s Pandemic-Proof package — is bipartisan. There has been a stark absence of public health plans from the 2024 campaign, even having endured a pandemic so recently and staring down the possibility of another one so soon. We may end up worse off as a result.