The statements, and the subsequent clash with the president, were stark. In mid-September, Robert Redfield, M.D., the director of the Centers for Disease Control and Prevention (CDC), said clearly what most people in the public health world had known for some time: Contrary to what President Trump had been promising, a COVID-19 vaccine would not be widely available by the end of 2020—in fact, it likely would not be ready until the middle of next year.
Around the same time, Redfield—who had been installed as CDC head in 2018 after his short-lived predecessor, Brenda Fitzgerald, M.D., quit amid a conflict-of-interest scandal—also said that masks could very well be a more effective shield against COVID than a vaccine. This, too, is a belief widely held in the public health world, even if the efficacy of masks against COVID has constantly been undermined by the president himself, who has almost never worn one publicly.
Not surprisingly, Trump struck right back at his CDC director, saying that Redfield had “made a mistake” and been “confused” in his comments. Trump even went so far as to say that he’d called Redfield to tell him so.
It would’ve been nice if the clash had been only the latest instance of the head of the CDC once again countering the president’s wild and erroneous COVID claims with hard science. After all, the agency has long been considered among the world’s premiere resources for science and health guidelines untainted by politics.
But, in fact, it was perhaps the first time since COVID began that Redfield appeared explicitly to make a scientific statement in opposition to the wishes of the president. And, in interviews with TheBodyPro, several public health advocates and experts—many from the world of HIV—said that Redfield’s decision to publicly stand up for science came too little, too late.
In fact, Redfield—seemingly cowed by Trump—walked back his assertions shortly thereafter.
Insufficient COVID-19 Response Under Redfield’s CDC
In the world of public health, it is widely held that Redfield’s CDC suffered an epic failure on COVID. The missteps were evident in spring, when it bungled a testing rollout that lost the nation precious time. And they were evident in recent weeks, when it sent out mixed messaging—and in some cases, had its own website guidelines overwritten by outside political appointees—on everything from rules for churches and schools, to the dangers of airborne COVID, to who should be tested for COVID and when.
Even language in its own once-revered journal, Morbidity and Mortality Weekly Report (MMWR), which reported the first AIDS cases in 1981, has been meddled with by Trump appointees.
“The changing of positions of scientific matters such as the aerosol [airborne] transmission of [COVID-19], whether done in error or for some other reason, serves to undermine public confidence in [the CDC],” says David Holtgrave, Ph.D., who leads the school of public health at the University of Albany and who once led an HIV division at the CDC. “This is most unfortunate because it impedes the COVID-19 response, and because it undermines the outstanding reputation earned and built up by the CDC over decades.”
That reputation may have taken its hardest hit in communities of color, particularly Black communities, which have been disproportionately hurt by the pandemic. “It’s sad how the CDC has dealt with COVID,” says Rob Newells, director of national programs at the Black AIDS Institute. “I think over the last 30 years, particularly because of the HIV epidemic, people have had a lot of faith in the CDC”—despite, he says, persistent rumors in the Atlanta Black community that the CDC played a role in the cover-up of the true culprits of the infamous Atlanta murders of Black children in the late ’70s and early ’80s.
“But now,” says Newells, “when you see politics entering into the science, it’s hard to trust the leadership.”
The blame for the downgrade, experts tell TheBodyPro, lies squarely with Redfield. Because he wanted the job so badly, they say, and also perhaps because of his own longtime conservative, evangelical religious leanings that have caused controversy in his longtime field of HIV, he has been willing to yield to Trump, throwing the CDC’s longtime corps of top-rated scientists under the bus and tarnishing the agency’s storied reputation in a matter of mere months.
“There are some very good people at the CDC who could’ve guided us through this moment, such as Nancy Messonnier, [M.D.]” says longtime HIV activist Gregg Gonsalves, Ph.D., now a professor at Yale Law School and Yale School of Public Health. In his reference to Messonnier, Gonsalves is referring to the CDC doctor whom Trump threatened to fire after she warned the public of the COVID risk in February. “But Redfield decided to place his chips on fealty to the White House rather than supporting his staff. Which is why, a few weeks into COVID, we saw the CDC, the world’s premiere public health agency, go dark and become irrelevant.”
For a long time, Gonsalves says, the U.S. government’s failure on COVID looked like it was driven by “incompetence and bumbling idiots. But we know now from Trump’s recent interviews with Bob Woodward that they all knew it was a problem. They acted with malign intent, and Redfield, who as a civil servant is supposed to protect this country, is 100% complicit. He’s betrayed his post.”
Redfield’s Controversial Record on HIV
HIV advocates and experts go back a long way with Redfield. He first caused controversy in the 1980s and 1990s when, as an Army doctor based at Walter Reed Medical Center, he supported quarantining HIV-positive soldiers, telling their entire chain of command of their diagnosis with minimal concern for their privacy, and investigating their sexual histories. He also helped create the policy barring people with HIV from joining the military, which still exists today.
An evangelical Christian, Redfield also aligned himself with a Christian HIV group, Americans for a Sound AIDS/HIV Policy (ASAP), that supported mandatory HIV testing of the general public and quarantining of those who tested positive. As reported in March by Mother Jones, Redfield wrote the intro to a book by ASAP founder Shepherd Smith. Redfield, bucking public health consensus, wrote: ”It is time to reject the temptation of denial of the AIDS/HIV crisis; to reject false prophets who preach the quick-fix strategies of condoms and free needles; to reject those who preach prejudice; and to reject those who try to replace God as judge. The time has come for the Christian community—members and leaders alike—to confront the epidemic.”
In the early 1990s, as reported by Kaiser Health News in 2018 upon Redfield’s installation as CDC head, Redfield notoriously promoted a bunk HIV vaccine—even after he admitted that it was flawed. KHN quoted former Air Force Lt. Col. Craig Hendrix, a doctor who is now director of the division of clinical pharmacology at Johns Hopkins University School of Medicine: “Either [Redfield] was egregiously sloppy with data or it was fabricated. … It was somewhere on that spectrum, both of which were serious and raised questions about his trustworthiness.”
In the eyes of the HIV community, some of that trustworthiness was restored during Redfield’s many years as an HIV researcher and clinician at the University of Maryland, where he developed a reputation as being kind and compassionate toward the urban, marginalized communities he served—including gay men, Black people, and drug users—despite his conservative evangelism.
“I’ve known him and worked with him a long time,” says Paul Kawata, the longtime head of NMAC (formerly known as the National Minority AIDS Council). Kawata says that, when he learned that Redfield would likely head the CDC, he told Redfield he was concerned that he wouldn’t be able to function effectively under Trump.
“He talked to me at length about his experience taking care of people living with HIV in Baltimore and how that experience had completely changed his life, and that he saw the world through a very different light from when he first started this work [in HIV],” says Kawata. “And that rang true to me,” he says, because the same thing had happened with C. Everett Koop, M.D., an evangelical who was the surgeon general under Ronald Reagan and who turned out to be surprisingly frank with the American public about the science behind HIV prevention—specifically, the efficacy of condoms.
Plus, Kawata contends, it was basically Redfield’s close ties to Trump political appointees that gave Redfield the clout to get the administration to greenlight the federal Ending the HIV Epidemic in America plan—which was supposed to go into full effect next year, but now has been heavily sidelined by COVID, as have many other health priorities.
Lynda Dee, the longtime head of AIDS Action Baltimore and national HIV treatment and research advocate, also has positive memories of Redfield’s time at the University of Maryland.
When Redfield came to Baltimore, she recalls, “he reached out to me. And not only was he kind, but he showed up for events and really went out of his way to prove that he thought that community engagement was important. One of my best friends is a doctor who said that, [in his tenure in Baltimore], Redfield was always on the right side of the issues.”
But both Kawata and Dee say they are dismayed by Redfield’s helming of the CDC under Trump in the COVID era. Kawata puts it diplomatically: “He doesn’t have the skill set to manage this particular moment in history. Every master’s program in public health in America teaches the scenario of how to respond when there’s a new virus and no treatment, no vaccine. Thousands of plans have been written. This is the CDC’s raison d’être. Yet Redfield couldn’t meet the challenge.”
Yes, allows Kawata, Trump has made it hard for all government health officials to do their job under COVID, including National Institute of Allergy and Infectious Diseases chief Anthony Fauci, M.D., who somehow has managed to maintain public credibility while only sometimes bumping up against Trump.
“But Fauci has worked in the federal government since the 1980s,” says Kawata, “which has given him the experience and understanding of how Washington works when it has to deal with something it doesn’t want to deal with. He doesn’t have anything to prove, and he knows that COVID is part of his legacy and he has to be right on it. He has the capacity to see the bigger picture.” Not so with Redfield, says Kawata.
Dee describes Redfield’s CDC incarnation in harsher terms. “He’s the biggest brown-noser I’ve ever seen, kowtowing to Trump,” she says. “How can anybody allow those who work for him to be put through this kind of stuff, let MMWR be used like this, have your guidances on who should be tested go back and forth like a tennis ball? I was proud that he started the Ending the [HIV] Epidemic initiative. But if you look at his whole record, the bad outweighs the good.”
Gonsalves scoffs at any suggestion that Redfield lacks the skill set to succeed in the current political climate. “It’s not his first time at the rodeo,” he said. “He’s been through more than 30 years of the AIDS epidemic. He’s watched [the Obama administration address the virus] H1N1 from the sidelines. He has absolute context. His personality is craven and authoritarian-submissive. It’s pretty clear that his goal was not to protect the public, but the president’s political fortunes. He should’ve said, ‘They’ve known about this for months, and I can no longer agree to serve [under this administration].’ But it’s too late for that now.”
“I don’t think he got corrupted” by Trump during the COVID-19 pandemic, says Thomas Coates, Ph.D., a longtime HIV researcher who heads the University of California Global Health Institute. “I think he went in willing to do whatever he needed to do.”
What Lies Ahead for Redfield and the CDC?
Most experts spoken to for this story believed that the integrity and trustworthiness of the CDC would only degrade further in the event of another Trump term. The hope, they say, is that Joe Biden will win the election, in which case the new administration will have its work cut out for itself ridding the CDC—and countless other federal agencies—of Trump appointees and trying to get back to a pre-Trump baseline of scientific independence.
“There are still many good people at CDC, even though we don’t know how many have taken early retirement due to Trump,” says Gonsalves. “Maybe the political rot on the top can get scraped off quickly and the agency can get itself back into shape. But there is already so much damage done, embedded in regulations and appropriations bills. A lot of bullshit has to be unraveled. How deep has the rot gone? Hopefully we can have a quick reset and move into 2021 with a better sense of purpose on how to deal with this pandemic.”
Right off the bat, says Newells, “We’ll need to have a CDC director who is going to engender trust again. I don’t know if people now believe anything that comes out of CDC. I’m worried that they won’t believe CDC when it tells them [this season] to get their flu shots. And that’s partly because of using language like ‘Operation Warp Speed’ [on the COVID vaccine initiative]. The name alone sets up red flags and the impression that Trump is going to have control over how the science is released.”
Gonsalves also thinks that, if Biden runs the next administration, there should be a kind of Truth and Reconciliation Commission, of the sort that was set up in South Africa after apartheid, to do a full investigation into who knew and did what—or didn’t do what—during the Trump era regarding COVID-19.
“There has to be absolute transparency of how [the Trump response to COVID] transpired, all the emails from the White House to [Health and Human Services head Alex] Azar to Redfield. Let’s hear how this all played out.” (In fact, the nonprofit American Oversight has been filing countless Freedom of Information Act requests with the government to get at precisely those questions at the CDC.)
Gonsalves is echoed by Jeremiah Johnson, the HIV project director at the nonprofit Treatment Action Group. “There is going to have to be some very transparent and stringent accountability for everyone involved in these terrible decisions, to show that there are consequences when you allow politics to dictate public-health messaging,” he says. “And there’ll have to be a concerted, multi-year campaign to bring in [public health] leadership from the communities most impacted by COVID to show that the government is really advancing the principle of ‘Nothing for us without us.’”
As for Redfield’s career should the Trump administration end in January, few think that most secular universities would take him after the fiasco of COVID. “He and [FDA commissioner Stephen] Hahn aren’t going to be able to get a job in the disgraced dogcatcher department after this is over,” predicts Dee.
But, again, many feel that Redfield should have already stepped down by now. “I’m sure Redfield and [Trump coronavirus task force principal Deborah] Birx feel it’s better to be inside [the power circle] than outside, but they’ve all been sidelined,” says Gonsalves.