- The Washington Times - Monday, April 20, 2020

U.S. medical professionals embedded abroad could be ideally positioned to gather and disseminate crucial information in real time about a deadly new health challenge, but their ability to operate can be constrained easily by host governments bent on concealing the facts to protect their own reputations and willing to resort to extreme measures to preserve their versions of the truth.

As much of the U.S. clears the peak virulence of the COVID-19 curve, attention surely will turn to what the Trump administration could have done differently to prepare the country and the world for the crisis.

Critics, including President Trump’s likely Democratic rival, former Vice President Joseph R. Biden, already have zeroed in on a move in July to remove a Centers for Disease Control and Prevention field epidemiologist stationed in China. They say the public health researcher could have delivered critical details about the coronavirus to Washington long before the outbreak made global headlines. The position was part of the CDC’s field epidemiology training program. The researcher worked closely with Chinese professionals and would have had a great deal of knowledge about health conditions on the ground.

But numerous health professionals who spent years working overseas in similar programs told The Washington Times that it’s far from certain whether the CDC position, had it been left in place, would have made any difference at all. They point to Beijing’s determined early effort to hide the true nature of the outbreak. China just last week revised upward the death toll in the COVID-19 epicenter of Wuhan after widespread skepticism about the original count — even from trusted foreign colleagues.

U.S. health experts in China in theory could learn key details and funnel them to Washington or to the World Health Organization, but the specific circumstances surrounding the COVID-19 outbreak make such an outcome unlikely, specialists say.

“They’ll keep you away, and they will not share the information with you. Any country that is wanting to deliberately hide information, they will hide it,” said Dr. Chima Ohuabunwo, a medical epidemiologist and professor at Morehouse School of Medicine. Dr. Ohuabunwo once served as executive director of the African Field Epidemiology Network and is a graduate of the CDC’s epidemic intelligence service program.

“Once there is an outbreak, you will be part of a team that goes first to respond, so you will know …,” he said, “unless there is a very deliberate plan by a government to keep it away from you.”

There is universal agreement that the communist government in China implemented such a plan in the case of COVID-19. Foreign health professionals who tried to counter that narrative, whether they were part of the CDC’s field program, USAID’s Predict initiative or any other effort to detect pandemics, would be silenced and shut out.

“If you say anything else, that’s you. You’re on your own,” he said. “They can do that. They can threaten the person. It becomes a choice.”

U.S. role

The ill-fated CDC position was first thrust into the spotlight late last month when Reuters identified Dr. Linda Quick, the American medical professional who had been working in China as a field epidemiologist trainer until the post ended in July 2019. Several officials, including Bao-Ping Zhu, who served in the same role from 2007 to 2011, told the news service U.S. publlic health officials could have gotten a far earlier head’s-up on the threat if the position had been left in place.

Dr. Zhu, now director of performance management and scientific research at the National Association of Chronic Disease Directors, declined to be interviewed by The Times.

For its part, the CDC has vehemently denied any adverse effects from the decision to end the appointment. In fact, CDC officials told The Times that the Trump administration actually had extended the program two years past its original 2017 termination date.

“It was decided to extend the position for two years in order for adequate transition to Chinese officials. That transition was made complete last summer and the position was not filled,” the CDC said in a written statement. “This specific change did not make any difference in CDC getting early information about COVID-19; this was due to the government of China’s restrictions on sharing information externally during the early phases of the outbreak” in December and January.

While there were staffing changes in China throughout 2019, the CDC said that the agency’s China office consisted of three U.S. officials — a country director, an influenza director and an information technology officer — and 11 locally employed staff when the field epidemiology position was ended last July.

The CDC, along with other health officials, told The Times such programs are primarily designed to train foreign health workers, not necessarily to act as detectives on the ground tasked with passing information back to their home country — though it seems clear that by the very nature of the work, American personnel would have at least some knowledge of local health conditions, if that information wasn’t actively suppressed by government officials.

The CDC said it made the decision to drop that particular field epidemiology training program because,”China has changed over the past three decades both economically and in public health capacity, reducing the need for CDC’s financial and technical support.”

Indeed, other health experts say it’s entirely reasonable to wind down such programs in a advanced developed country like China.

“They had the training,” said Dr. Scott McNabb, a research professor at Emory University’s Rollins School of Public Health and a former CDC epidemiologist.”Our epidemiologists helped them develop these training programs. We’ve been working there for 20 years. They already know how to do all of that.”

The U.S. can support programs in other countries, but “we should not be into neo-colonialism,” said Dr. McNabb. “Each individual country has responsibility and autonomy.”

But other specialists disagree. They argue that U.S. personnel on the ground in China would have been a major asset during the early days of the outbreak, especially since Beijing was actively expelling American journalists as part of its attempt to cover up what was happening in Wuhan.

“When you have that type of robust system and complete capture of the world in understanding what infectious microorganisms are causing infectious disease in various parts of the world, you are on better footing,” said Dr. Amesh Adalja, a senior scholar at the Johns Hopkins University Center for Health Security and an expert in emerging infectious disease. “Many people, including myself, are disappointed when these types of programs fall by the wayside and don’t have input to the highest levels of government. … We know that China expelled some Western journalists during this time, so it makes it better to have someone who can give you on-the-ground information. I do think it would be an asset in any type of outbreak.”

Several other former government health officials with knowledge of the field training program in China, such as former CDC Director Dr. Tom Frieden, also declined to be interviewed by The Times.

Politics of a pandemic

While the debate simmers, it’s already clear that the issue will have deep political repercussions. Prominent Democrats already have taken aim at the CDC’s move to end its field epidemiologist position and have singled out other programs — such as USAID’s PREDICT initiative, which was launched in 2005 and designed to uncover health flare-ups before they developed into all-out pandemics — that critics say were underfunded and underutilized in the crucial months leading up to the coronavirus outbreak in China.

While the PREDICT program reportedly had begun to wind down in 2019, a USAID spokesperson told the Los Angeles Times earlier this month that the initiative was “just one component of USAID’s global health security efforts and accounted for less than 20% of our global health security funding.”

The Trump and Biden campaigns in the coming months are likely to spar over whether the administration’s actions over the past three years paved the way for a global crisis. Top Democrats in recent weeks have questioned whether the White House was aggressive enough in getting U.S. personnel on the ground in China, and whether the Trump administration underfunded key global health programs.

Mr. Biden recently rolled out a new campaign ad highlighting February comments in which he said American experts in China were key to controlling the outbreak.

“We are going to need to be in your country,” the former vice president says in the commercial, which also features a narrator saying that “Biden told Trump he should insist on having American health experts on the ground in China.”

Both the Trump campaign and the White House are pushing back hard.

At a March 23 coronavirus briefing, CDC Director Dr. Robert Redfield said his agency has had a valuable, decades-long partnership with China — a partnership that was ramped up to an even greater degree when the severity of the pandemic became clear.

“The China office is actually being augmented, as we speak — and we’ve been embedded there for over 30 years,” he said. “There was a reason they call it the ‘Chinese CDC,’ because we’ve had that productive partnership.”

At the same briefing, the president brushed aside the issue as an attempt by the news media to discredit his administration’s handling of the crisis, though he did not directly address the specific CDC position in question.

“Every one of those things that were said was 100% wrong, and this sounds like another one of them,” Mr. Trump said.

In the end, specialists stress that China’s deliberate shielding of the truth is the true driver of the crisis, not the absence of U.S. personnel. They argue that Beijing made a calculated decision that in order to maintain its own reputation as a powerhouse in the global health sector, it wanted to do everything in its power to gain control of the outbreak without appearing as if it needed international help.

In such a scenario, it’s fair to question whether a handful of American medical professionals on the ground would have made any impact.

“Because it was an autocratic government, they had their power, and they didn’t want anybody to intervene or tell them what to do,” said Dr. Ohuabunwo. “They wanted to try their own systems, assert themselves, use their own capacity and do what they want to do to tell the rest of the world … that they have come of age and they can handle things by themselves, make their own rules.”

• Ben Wolfgang can be reached at bwolfgang@washingtontimes.com.

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