In case you hadn’t noticed, Donald Trump’s is a no-fault presidency. No matter the problem, he is always the victim of not just circumstances but shadowy conspiracies designed to thwart his ambition and greatness. It’s the Democrats, or the media, or China, or the “deep state” who are behind his problems. This holds doubly true in the episode of the Trump soap opera dealing with the development and distribution of a (hopefully) forthcoming vaccine for the COVID-19 virus. In his telling, and that of his right-wing echo-chamber, the fault is not in the stars, nor in Trump, but in a cabal of naysaying researchers and physicians bent on denying him a second term.
Before dealing with the paranoid and inflammatory ramblings of the president and his team, we should briefly lay out what the real challenges are in creating a safe and effective COVID-19 vaccine. Under normal circumstances, the hurdles imposed by both the government and the pharmaceutical companies are more than adequate to ensure that only vaccines that have proven both effective and safe make it market.
On its own, the scientific challenge here is enormous. Universities, businesses, and governments around the world are plowing vast financial and human resources into understanding the foundational mechanics of the virus. (For a window into just how challenging this is, check out the This Week in Virology podcast.) We are already familiar with many of the questions scientists have been investigating and debating about the spread of the disease: Droplet or aerosol transmission? Masks or goggles or both for protection? The kinds of questions involved in preparing vaccines are less familiar: Given the virus’s structure and behavior in the human body, what is the best way to defeat it? What vaccine platform will be most effective—a whole virus, an live-attenuated virus, a protein subunit, DNA, or RNA? How long will protection last after vaccination? The kind of investigatory process needed to answer these questions requires uniting a massive, expensive, follow-all-leads ethos with grueling, unrelenting bench science and healthy doses of serendipitous discovery and skepticism. This complicated, messy process disciplines human insight and intuition and ensures that conclusions and recommendations are correct and well-founded.
Which is to say, the process necessary for developing a vaccine is very ill suited to the improvisational presidency of Donald Trump, who has only ever had one schedule: now. Trump is famously impatient with processes of all kinds. He’s always sought short-cuts and end-runs in his business and political life, preferring the quick, flashy win over the slow, stodgy, “three-yards and a cloud of dust” progress that characterizes most of ordinary life, including much of science. The risk under such a president is not whether the Food and Drug Administration’s investigatory and regulatory regimes are stringent enough but whether Donald Trump will allow those processes to function in a way that respects the slow and often unsatisfactory scientific processes that we hope will ultimately lead to workable solutions.
On this point, the available evidence is not encouraging. First, we have Bob Woodward’s recordings of the president acknowledging that, early in the crisis, he deliberately downplayed the threat to prevent a panic, although it seems clear that the panic he had in mind was in the stock market rather than the public. Then there has been his extraordinary reluctance to follow medical and scientific advice relating to masks and social distancing—a reluctance that has rippled out into a Republican governing class and public looking to him for leadership. He’s also gotten cross-wise with scientific recommendations relating to drugs and other therapies. The president talked up hydroxychloroquine and then convalescent plasma as huge breakthroughs, and successfully pushed the FDA to approve Emergency Use Authorizations (EUA) for both. The hydroxychloroquine EUA was later withdrawn. Blood plasma isn’t turning out to be a game-changer either. What they share in common is an overreliance on salesmanship, a rush for answers, and shaky scientific foundations.
Beyond these two rear-view-mirror examples, we are being inflicted with innumerable media cycles that demonstrate how President Trump’s impatience with sound science has led to meddling in the development of federal recommendations and regulatory processes. In July, news broke that the administration stripped the Center for Disease Control and Prevention (CDC) of control over coronavirus data, instead directing it to political appointees in the Office of the Secretary of Health and Human Services. Interference in the CDC’s operations didn’t end there: Presidential appointees with little or no scientific background have unilaterally amended CDC recommendations on COVID-19 testing. Just last week, following the sudden leave of absence of a troubled assistant secretary involved in the CDC testing recommendations, Alex Azar, the Secretary of Health and Human Services, announced that HHS was taking rule-making power away from the FDA. The department spokesperson downplayed this move, calling it mere “housekeeping,” but media reports suggest that this has been a fiercely contested issue between the FDA and HHS. The reasons for the new restriction, while unclear, appear of a piece with an effort to subordinate scientific to political considerations. At the very least, the decision is alarming coming from a president and administration that have not shown themselves overly concerned with the integrity of scientific investigation, advice-giving, or regulation.
Last but certainly not least, there is an undertone in the criticism of those raising the alarm about these tendencies, actions, and behaviors—a bizarro I’m-rubber-you’re-glue suggestion that the critics, are, in fact, the ones who are anti-science and quite possibly anti-vaccination. Bear in mind that Donald Trump (and members of his administration and his supporters in the Senate) have repeatedly expressed sympathy for actual anti-vaxxers who appear to make up a nontrivial portion of the GOP coalition. Rather than doing the responsible thing and giving the vaccines-cause-autism wingers the boot, Trump has treated them like he does the Proud Boys and QAnoners: He winks, nods, expresses sympathy, and mutters about “good people” all to show that he’s on their side—not because they are right but because they are on his side, right or wrong. In the end, this inverts the assertion that it is Trump’s opponents who will do and say anything to win. The truth, as with so many of Trump’s attacks on his political adversaries, is the opposite: He must win no matter the cost or suffering to others.
Trump’s real problem regarding the vaccine—as it is for so many other matters—is not a “deep state” of scientists who are committed to his defeat. It’s with the public, which, having watched his erratic management of the pandemic, registers massive doubt as to whether he can be trusted to act in their interest in the most important issue facing the country. Trump’s self-generated credibility gap on vaccines is just another in a series of too many promises made and too few kept. As always, he wants to make himself the victim but he isn’t. We are.