Deborah Birx: US COVID-19 data was 'worse than what I found overseas'

As the United States global AIDS coordinator, Dr. Deborah Birx was known for her relentless pursuit of granular data about the HIV epidemic and for demanding that the U.S. government’s global health programs reflected what that data told her about what worked and what did not.

But that eye for detail was severely challenged when in 2020 she was asked by then-Vice President Mike Pence to serve as the White House coronavirus response coordinator, suddenly making her a household name in the U.S. as she led the domestic response to a chaotic crisis. It wasn't what she expected, and since leaving the White House when President Joe Biden took office, Birx has been much more forthcoming with her criticism of former U.S. President Donald Trump's management of the pandemic.

Birx said she was shocked to learn that the intricate data she relied on to fight pandemics in other countries was nowhere to be found when it came to COVID-19 in the United States.

“I was actually really disappointed in myself because I had spent more than 20 years building infrastructure in resource-limited settings, and I found settings in the United States worse than what I found overseas,” she said in an interview at Devex World on Tuesday.

In her recently published book — “Silent Invasion: The Untold Story of the Trump Administration, Covid-19, and Preventing the Next Pandemic Before It's Too Late” — Birx provides an inside account of how she worked to build a functional data system that could be used to change policies and messaging, and how it all ultimately fell apart.

Birx’s story of her time on the task force has reignited a debate about where to draw the line between working to fix a broken system from the inside and legitimizing the broken system — which is costing lives — by participating in it, and standing by as a president spread falsehoods and repeatedly questioned science and his own health experts.

“I just thought it would be no different than what advocates do every day. They stay and fight in their countries when it’s really hard, and they stay and work with governments that are really dangerous,” said Birx about whether she miscalculated how much her global health experience prepared her for the chaotic environment of Trump’s White House.

Many critics have questioned why Birx was unable to shift the United States’ response in a more data-driven direction.

An October 2020 investigative piece in Science magazine detailed allegations that Birx undermined the Centers for Disease Control and Prevention and that “Birx's actions, abetted by a chaotic White House command structure and weak leadership from CDC Director Robert Redfield, have contributed to what amounts to an existential crisis for the agency.”

Similarly, in a March 2021 tweet, Democratic Rep. Ted Lieu of California blasted both Trump and Birx's handling of the pandemic. “The malicious incompetence that resulted in hundreds of thousands of unnecessary deaths starts at the top, with the former President and his enablers. And who was one of his enablers? Dr. Birx, who was afraid to challenge his unscientific rhetoric and wrongfully praised him,” Lieu wrote.

At Devex World, Birx pointed to the Jan. 6 committee hearings on Capitol Hill to explain the challenges she faced in performing her duties during that period. “Exactly what is being described is exactly how the White House functioned. There were all these people always coming in from the outside, walking into the Oval Office and spouting what the president wanted to hear,” she said.

But Birx credited Pence for being open to her advice on what worked in the U.S. President's Emergency Plan for AIDS Relief, or PEPFAR, and how going into the community level had been effective in tackling malaria, tuberculosis and HIV. She asked to go out to communities to talk with state governors and city mayors about the pandemic because at that point “I wasn't going to change the president's rhetoric, but I could change how we programmed on the ground.”

“You have to develop relationships with the community and ensure that they understand the data and the science so that they're empowered to actually advocate and get what they need for their own health,” she added. Birx led PEPFAR from 2014 to early 2020.

"So many people told us and PEPFAR that we would never be able to control the [HIV/AIDS] pandemic. And then you look at rates of new infections that are the lowest they've been since 1990," she said. “So I think the vision in the United States is we should be responding to our current pandemics in an effective way and hold our institutions accountable.”

Instead, the U.S. was flooded with misinformation, “fake news,” and fear of a novel virus that would ultimately kill hundreds of thousands.

“It was a pandemic driven by assumptions and perceptions, rather than data and science,” she said.

Birx said she still has faith in the power of data to change minds and behaviors after witnessing African heads of states and health leaders shift policies even on highly political or contentious issues.

“Let’s face it, there were a lot of African presidents that didn’t want to talk about LGBT issues, that didn’t want to talk about what was needed on the ground. But in the end, they adjusted their policies,” she said.

She said the same thing happened in the U.S. when Republican governors in the South saw the data showing masks and social distancing reduced the spread of COVID-19. “So data does change people’s minds in a way that’s transformational.”

The problem she sees is that U.S. public health institutions appear not to have learned the lessons that their global health counterparts consider the bedrock of successful disease prevention, response, and treatment.

It is vital to understand what is actually happening in communities, what is preventing people from seeking or receiving necessary care, and then funding those gaps in a meaningful way, Birx said.

“Learn from the advocates. Learn how to work on the ground in a grassroots way. Fund local community outreach organizations that know how to rebuild trust,” she said.

“There’s no trust because there’s been zero federal support.”

“I was horrified that the United States had not expanded testing when every other country had,” she added. “We were only going to test through our public health laboratories. You probably don't even know where your public health laboratory is.”

Some parts of the U.S. don’t even have a doctor’s office, let alone a health laboratory, she said. Birx pointed out that half of America’s tribal nations have fewer health facilities than Malawi.

“The South has dollar stores, but they don't have primary care anymore. They're an hour and a half from the closest hospital,” she told Devex, becoming animated. “I could hear people in Washington say, ‘Just go to your local doctor and talk to them about your vaccine status,’ and I was like, ‘there's nobody there for them to talk to’.”

“I’m committed to working on rural health and tribal nation health. I think we have the lessons of what works, and it’s not expensive. It just needs to have the will to do it.”