Pence’s handling of 2015 HIV outbreak gets new scrutiny
INDIANAPOLIS
(AP) — President Donald Trump’s choice of Vice President Mike Pence to
oversee the nation’s response to the new coronavirus threat is bringing
renewed scrutiny to the former governor’s handling of an HIV outbreak in
southern Indiana when he was governor.
Pence reluctantly agreed to authorize a needle exchange program in Scott County
in March 2015 after the epidemic centered there saw the number of
people infected with HIV skyrocket, with nearly 200 people eventually
testing positive for the virus that year.
Despite his own
misgivings — Pence worried about how the exchanges would affect
“anti-drug policy” and had misgivings about providing clean needles to
addicts — he initially issued an executive order allowing one in Scott
County before later signing a law allowing the state government to
approve them for counties on a case-by-case basis.
Greg Millett,
director of public policy at amfAR, the Foundation for AIDS Research,
said Indiana’s HIV outbreak would have been “entirely preventable” if
Pence had acted earlier in response to data that was available to
Indiana public health officials and clearly showed an outbreak was
imminent.
The outbreak primarily infected intravenous users of the
painkiller Opana in an impoverished, rural area with few health
resources. The needle exchange Pence finally approved for Scott County
successfully curbed the epidemic’s spread by providing clean needles to
IV drug users to reduce needle-sharing that spreads HIV, hepatitis C and
other diseases.
Pence took credit for the needle exchange during
an interview Wednesday with Fox News Channel’s Sean Hannity. “We worked
the problem early in the year from a law enforcement standpoint, from a
health standpoint,” he said. “I don’t believe in needle exchanges as a
way to combat drug abuse, but in this case we came to the conclusion
that we had a public health emergency, and so I took executive action to
make a limited needle exchange available.”
Millett said Scott
County had averaged five new HIV cases annually between 2004 and 2013,
but between November 2014 and Jan. 11, 2015, it suddenly saw 13 new
cases in just over two months.
Quick implementation of a needle
exchange program could have stopped that escalation, but new cases
continued to surge without one, he said.
“This would have been
entirely preventable if Indiana had acted fast with a syringe exchange,”
he said. “To have some 200 people become infected over such a short
time period was unprecedented.”
Millett, who worked as an
epidemiologist with the Centers for Disease Control and Prevention
between 1999 and 2013, doing HIV research, said the CDC later determined
that Indiana’s outbreak resulted in infections that will amount to $100
million in health care costs — expenses he said could have been reduced
or avoided by a quicker response.
Despite his reservations about
Pence, Millett said he’s encouraged by the vice president’s announcement
Thursday that Debbie Birx, the administration’s global AIDS
coordinator, will serve under the vice president as the White House
coronavirus response coordinator. Millett called Birx an effective and
respected public health leader.
“She’ll bring in people who are experts in infectious diseases who can mount an effective response,” he said.
But
Steven Thrasher, a Northwestern University journalism professor who has
studied Indiana’s outbreak as part of his research into HIV and LGBTQ
health issues, said Pence’s response as Indiana governor raises real
questions about whether he’s the best person to helm the response to the
virus.
Thrasher said that while HIV cases were mounting in Scott
County — which lies about 30 miles (48 kilometers) north of Louisville,
Kentucky — Pence told local officials wondering whether he would approve
a needle exchange “that he was going to pray on it.”
“His
background shows that he brings religion, a lack of science and a
budgetary mindset to public health matters. In a time of emergency,
those are not the safest ways to be approaching what could become an
epidemic,” Thrasher said.
Pence’s state health commissioner at the time of the HIV outbreak, Jerome Adams, is now U.S. surgeon general
and is widely credited with helping persuade Pence to accept the needle
exchange program that now operates in nine of Indiana’s 92 counties.
Pence’s
office, when asked for comment by The Associated Press, referred a
reporter to Adams. He defended Pence’s actions Thursday, saying the
then-governor worked closely with him in responding to the outbreak,
including implementing the syringe exchange program “that helped change
the scope of the unprecedented crisis.”
“As a result, our efforts
became a model for how other states and localities respond to similar
crises,” Adams said in a statement.
Joey Fox, who was legislative
director for the Indiana State Department of Health during the HIV
outbreak, said Thursday that the criticism of Pence is unfair because
Indiana’s response to the HIV outbreak went far beyond just authorizing a
needle exchange program.
Fox said the state’s response included
bringing HIV testing to the small city of Austin — the community at the
heart of the outbreak — at a “one-stop-shop” office where the county’s
needle exchange was initially based. At that office, people could get
tested, enroll in Medicaid to begin HIV medical treatment, get state
identification cards and birth certificates and receive other services.
“It’s
unfair to criticize the governor,” Fox said. “He was personally engaged
with the public health and the public safety of Scott County, and the
Indiana government was engaged from day one on the HIV outbreak.
“Before Mike Pence syringe exchanges were illegal in Indiana. When he left office there were programs around the state.”
Democratic
Sen. Patty Murray of Washington urged Trump on Thursday to reconsider
the choice of Pence, citing his “lack of public health experience and
record of putting ideology over science” and his “leadership failure
during the Indiana HIV outbreak.”
House Speaker Nancy Pelosi told
reporters she spoke to Pence on Thursday morning and “expressed to him
the concern that I had of his being in this position.” Pelosi said that
while she wants to work with the White House, she told Pence she was
wary of his leadership after his track record in Indiana.
Indiana’s
needle exchange debate in 2015 was complicated by opposition from law
enforcement groups who worried that such programs would enable drug
abuse.
Scott County’s current health administrator said the
county’s exchange — through which participants swap used needles for
clean ones to stem the spread of diseases through needle-sharing — had a
dramatic impact on the outbreak.
Since the county’s needle
exchange began in early 2015, the number of new HIV cases tied to the
outbreak has declined each year, said Michelle Matern, administrator for
Scott County’s health department.
“I think the data speaks for itself, that it’s decreasing the transmission of infectious diseases,” she said.
In
2015, there were 187 new HIV cases linked to the same HIV strain
involved in the outbreak. Cases plunged to 27 in 2016, 12 in 2017 and 10
in 2018, with a preliminary count of seven new cases last year, Matern
said.
Health advocates have long criticized Indiana’s Republican-dominated government for paying scant attention to public health, with the state ranking 47th in public health funding, according to a 2019 study by the United Health Foundation.
Associated Press Writer Lisa Mascaro in Washington contributed to this report.