The Trump administration, state officials and even individual hospital workers are now racing against each other to get the necessary masks, gloves and other safety equipment to fight coronavirus — a scramble that hospitals and doctors say has come too late and left them at risk. But according to a previously unrevealed White House playbook, the government should’ve begun a federal-wide effort to procure that personal protective equipment at least two months ago.
“Is there sufficient personal protective equipment for healthcare workers who are providing medical care?” the playbook instructs its readers, as one early decision that officials should address when facing a potential pandemic. “If YES: What are the triggers to signal exhaustion of supplies? Are additional supplies available? If NO: Should the Strategic National Stockpile release PPE to states?”
The strategies are among hundreds of tactics and key policy decisions laid out in a 69-page National Security Council playbook on fighting pandemics, which POLITICO is detailing for the first time. Other recommendations include that the government move swiftly to fully detect potential outbreaks, secure supplemental funding and consider invoking the Defense Production Act — all steps in which the Trump administration lagged behind the timeline laid out in the playbook.
“Each section of this playbook includes specific questions that should be asked and decisions that should be made at multiple levels” within the national security apparatus, the playbook urges, repeatedly advising officials to question the numbers on viral spread, ensure appropriate diagnostic capacity and check on the U.S. stockpile of emergency resources.
The playbook also stresses the significant responsibility facing the White House to contain risks of potential pandemics, a stark contrast with the Trump administration’s delays in deploying an all-of-government response and President Donald Trump’s recent signals that he might roll back public health recommendations.
he U.S. government will use all powers at its disposal to prevent, slow or mitigate the spread of an emerging infectious disease threat,” according to the playbook’s built-in “assumptions” about fighting future threats. “The American public will look to the U.S. government for action when multi-state or other significant events occur.”
The guide further calls for a “unified message” on the federal response, in order to best manage the American public’s questions and concerns. “Early coordination of risk communications through a single federal spokesperson is critical,” the playbook urges. However, the U.S. response to coronavirus has featured a rotating cast of spokespeople and conflicting messages; Trump already is discussing loosening government recommendations on coronavirus in order to “open” the economy by Easter, despite the objections of public health advisers.
The NSC devised the guide — officially called the Playbook for Early Response to High-Consequence Emerging Infectious Disease Threats and Biological Incidents, but known colloquially as “the pandemic playbook” — across 2016. The project was driven by career civil servants as well as political appointees, aware that global leaders had initially fumbled their response to the 2014-2015 spread of Ebola and wanting to be sure that the next response to an epidemic was better handled.
The Trump administration was briefed on the playbook’s existence in 2017, said four former officials, but two cautioned that it never went through a full, National Security Council-led interagency process to be approved as Trump administration strategy. Tom Bossert, who was then Trump’s homeland security adviser, expressed enthusiasm about its potential as part of the administration’s broader strategy to fight pandemics, two former officials said.
Bossert declined to comment on any particular document, but told POLITICO that “I engaged actively with my outgoing counterpart and took seriously their transition materials and recommendations on pandemic preparedness.”
The playbook was designed “so there wasn’t piecemeal thinking when trying to fight the next public health battle,” said one former official who contributed to the playbook, warning that “the fog of war” can lead to gaps in strategies.
“These are recommended discussions to be having on all levels, to ensure that there’s a structure to make decisions in real-time,” said a second former official.
An NSC official confirmed the existence of the playbook but dismissed its value. “We are aware of the document, although it’s quite dated and has been superseded by strategic and operational biodefense policies published since,” the official said. “The plan we are executing now is a better fit, more detailed, and applies the relevant lessons learned from the playbook and the most recent Ebola epidemic in the [Democratic Republic of the Congo] to COVID-19.”