The White House/Flickr

Out of all the responsibilities President Donald Trump has shirked during the COVID-19 pandemic, from not pressing China for information on the virus in its early weeks to not building up a testing regime in the United States, none has been more derelict than his administration’s failure to provide front-line healthcare workers with the medical and protective equipment they need.

What’s most exasperating is that there was a system in place to provide that equipment: the U.S. Strategic National Stockpile, an integrated collection of secret, federally-controlled warehouses with billions of dollars worth of precisely the kind of critical supplies that were needed in this crisis, such as masks and ventilators.

Once the CIA warned Trump of a coming pandemic in January, his administration should have immediately ordered more such equipment to meet the coming surge. That he didn’t left American hospitals overwhelmed. It left states having to claw to obtain the materials they need to save lives. Of course, it didn’t help that Trump did nothing to replenish or update the stockpile in his first three years in office; by mid-April, it had already distributed 90 percent of its supplies.

The president and his administration then compounded these grievous errors with lies and misinformation. The president’s son-in-law Jared Kushner has said the stockpile was for the federal government, not the states. In fact, it was built precisely for states and localities to use in the case of an emergency. Trump, meanwhile, has repeatedly blamed his predecessor for leaving him with a depleted stockpile. “Our cupboards were bare,” he told reporters last weekend. Yet the Obama administration, having used the stockpile to deal with the swine flu and the Ebola crises, tried to increase funding for it, but was blocked by Tea Party Republicans and sequestration.

Trump’s mismanagement of the reserve is more than just another case of the administration’s tendency to shift blame and spew lies. It gets at the heart of one of the key roles of any president—to prepare for threats that have not yet happened.

One president who exemplified this foresight was Bill Clinton, who created the Strategic National Stockpile in his second term. For more insight into this, I spoke with Richard Clarke, Clinton’s chief counterterrorism adviser on the National Security Council and the man the president tasked with building the stockpile.

The following Q&A has been edited and condensed for clarity.

What led to the creation of the national stockpile? It’s been reported that President Clinton came up with the idea after reading a bioterrorism thriller. Is that true?

There were a lot of novels out. Richard Preston wrote one. The president was a great reader of everything. He stayed up late every night reading. He went through several books a week. I recall getting a couple bounced over to me, with questions like, “Could this really happen?”

But it wasn’t just that he had read novels. There were two events in the mid-1990s that, together, jarred the president: the Oklahoma City bombing, which was done by two Americans with an 18-wheel tractor trailer filled with explosives, and separately, in Tokyo, a fringe group called the Aum Shinrikyo developed their own biological and chemical weapons and tried them out on the Tokyo subway.

This caused the president, among others, to think: What if those two things came together? What if, suddenly, we had large attacks using chemical or biological weapons on our subways? President Clinton asked me to see if we were at all prepared to handle that. We came back to him and said we weren’t. There were no detection capabilities for most of these kinds of attacks. There were no response capabilities in most cities. Nobody was trained, nobody was equipped.

Not only would we not be able to deal with the consequences, we wouldn’t even have detected the attack. There was no detection equipment deployed anywhere. The Army had some for battlefield use, but there was nothing in any cities. There was nothing in the White House. We wouldn’t have known if the White House had been sprayed with a biological weapon.

So we started a program. It was originally designed to deal with bioterrorism. But we also realized that you could use it for a pandemic.

How did you realize that?

Well, in investigating all that, we found a lot of interest from the Public Health Service and the Centers for Disease Control and Prevention. They told us a very similar thing could happen naturally—an emerging infectious disease, like the 1918 flu. We weren’t prepared for that either. What we figured out was, we could set up a nationwide detection system and an international system that would work for both biological attacks from terrorists and emerging infectious diseases.

The president secured money from Congress to put into the Public Health Service and the CDC to create a stockpile. A lot of it was grant money that went down to the state and county level, so they could have labs that would be able to detect and test. They set up a system so that when people came to emergency rooms and reported illnesses, that information would go into a national monitoring system. We realized that if a big event happened in any city, the city would be overwhelmed. So we set up a national stockpile of emergency medical gear that included medicines, hospital beds, ventilators, and put it in warehouses around the country.

We had a plan that when the equipment reached near its expiration date, it would be rotated, either through the Defense Department or Veterans medical systems, so that the equipment would be used before their expiration dates.

How was the stockpile set up so that the government could use it if a real crisis happened?

We created a program in 157 metropolitan areas to train and equip first responders so they could detect when they had an incident and they would be able get into protective gear. The stockpile was combined with the training of medical personnel. You can’t just put things in warehouses. You have to train people how to use them. You have to have exercises periodically. You have to regularly review what’s in the stockpile, to change the mix depending on new information. It wasn’t meant to just be a stash. It wasn’t meant to be a living, growing, adapting stockpile.

People thought we were crazy for doing it because we were responding to something that hadn’t happened. But for once, the government got out ahead of something.

One thing the Trump administration has said is that the stockpile isn’t there for the states. Is that true?

No, it’s for whoever needs it. The states are the people who are going to need it. They are the owners and operators of the first responders. The federal government doesn’t even have first responders. The stockpile is there for community hospitals around the country.

The creation of this stockpile was all done near the end of Clinton’s tenure. It was obviously designed to help his successors if the country ever faced this kind of crisis. Was the Bush administration similarly responsive to other threats you warned them about?

Dick Cheney came in really concerned about bioterrorism. I think that came from his time as secretary of defense. We told him about the program, he looked at it and said, “Well, that’s great. I didn’t know you had any of this, but it’s way too small.” And so they greatly increased the funding for it.

“Most senior White House people either ignore warnings, or they do what political scientists call ‘satisficing.’ They give just enough attention to it so they can say that they did something, in case anything goes wrong.”

But obviously, Bush didn’t want to hear that there was a major al Qaeda attack coming to the U.S., even though he was told specifically that. Didn’t want to hear it. Rather than saying, “Tell me more, go find out about it, tell me what more we can do,” he reacted by saying, “Well, you’ve covered your ass now by telling me that.” That’s a very different kind of approach than Obama or Clinton, who were always looking for the thing that was going to bite them in the ass.

Did the Obama administration also show an interest in preparing for possible disasters?

Back in 2008, when Obama was coming into office, he wanted the entire national security cabinet to get together and play a war game. So I ran one for them on a nuclear bomb being smuggled into New York; it was a no-win scenario. It was designed to get them to understand how a terrorist crisis would play out. They all loved it. Years later, when the Trump people are coming in, the Obama people wanted to have that tabletop exercise again on crisis management. They did it for the Trump team a week before the inauguration. It was on a global pandemic that starts in China and comes to the United States and has high lethality and high contagion. That was kind of the way the outgoing Obama administration said to the incoming Trump administration: This is important. Get ready for it. It’s going to happen.

So it seems as though the Clinton and Obama administrations were always scanning the horizon for risks and were trying to prepare the government for something that might or might not happen on their watch, and the Trump administration simply wasn’t. Is that a fair assessment?

Well, you know, my book Warnings is all about how senior people handle warnings, and how often they ignore them. A lot of senior people reject them because they have their own agenda. They have their own programs. They came into their senior position with an idea of what they wanted to do. And now this expert comes in with his or her hair on fire and says the executive has to drop whatever their plans were. They have to spend a lot of time on that issue. And they have to spend a lot of money that they were going to spend on something else. And oh, by the way, the thing that the expert is saying is going to happen—it’s never happened before.

Under those circumstances, most senior people either ignore the warning, or they do what political scientists call “satisficing.” They give just enough attention to it so they can say that they did something, in case anything goes wrong. They give it a little money, a little attention. But they never do all the things that would be necessary to deal with the problem before it manifests. And then, after the problem manifests, it costs 1,000 times more money than it would have if you had addressed it before.

So, ideally, how should have the administration responded once they get these warnings from the CIA back in January?

What you should do when you get these warnings, at a minimum, is you should start investing in the long-lead-time items. If the crisis actually does happen, and you’re going to have to buy some things, you need to start buying those things right away. At least you could have shortened the time horizon. You could wait a little while to see what more intelligence comes in, but as the intelligence comes in and it confirms the initial warning, you need to spend more, do more, put more in place. I don’t think they did that.

In which case we would have had more ventilators and PPE if they started getting more of it back then. Are there any other policy actions or decisions that should have been made?

Assume you’re sitting in a National Security Council’s principals meeting in January. And the CIA reports that there’s a potential pandemic outbreak in China, of a flu that’s characterized by high degrees of contagion and high degrees of lethality, and for which there is no vaccination available. If someone said that at any table in the Situation Room when I was around, I would say, “Let’s get going. Let’s assume the worst-case scenario, and then work back from that.” Worst case scenario is it’s a pandemic and it comes here. Are we ready? No. Well, what’s in short supply? Let’s buy up those supplies. If we can’t buy up supplies, let’s kick in with the Defense Production Act to make private industry make the stuff we need.

What do you think we have learned from all this?

This all shows how much you need a president and a White House staff that is always looking for the next crisis, whether it’s a pandemic, or an asteroid headed toward Earth, or whatever. There’s no one whose job it is right now to go looking for the next disaster, and then ask if we are adequately prepared for it. We need to set up a warnings staff—a small number of people who scan the horizon for indications and warnings, and then bring in experts to supplement them. Otherwise, by the time the crisis hits, it will be too late.