Deirdre Shesgreen | USA TODAY

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WASHINGTON—In May 2018, President Donald Trump’s biodefense preparedness adviser warned that a flu pandemic was the country’s No. 1 health security threat, and the U.S. was not prepared.

“We know that it cannot be stopped at the border,” Luciana Borio, director of medical and biodefense preparedness at the National Security Council, said at a symposium that day.

Borio left the Trump administration in 2019. Other high-level global health experts headed for the exits even earlier, after the White House dismantled the National Security Council’s global health security office.

The demise of that elite team is now under scrutiny as the Trump administration struggles to respond to the coronavirus pandemic.

Trump bristled when asked about his decision to disband the office at a news conference in the Rose Garden on Friday.

“I just think it's a nasty question,” the president responded. “And when you say ‘me,' I didn't do it. ... I don't know anything about it.”

John Bolton, Trump’s former national security adviser, has defended the decision in recent days.

Trump chose Bolton to lead the National Security Council in April 2018. A month later, Bolton nixed the pandemic preparedness office as part of an effort to streamline the agency.

“Claims that streamlining NSC structures impaired our nation's bio defense are false,” Bolton tweeted Saturday. “Global health remained a top NSC priority, and its expert team was critical to effectively handling the 2018-19 Africa Ebola crisis. The angry Left just can't stop attacking, even in a crisis.”

But global health experts say Bolton's decision left the Trump administration flat-footed in confronting the virus that has caused nearly 6,400 cases of COVID-19 and killed 108 in the U.S. as of Tuesday evening.

"Bolton’s chosen approach to NSC 'streamlining' involved decapitating and diluting the White House’s focus on pandemic threats," Jeremy Konyndyk, a senior policy fellow at the Center for Global Development, wrote in a rebuttal. "He eliminated the senior director position entirely, closed the biodefense directorate, and spread the remaining staff across other parts of the NSC."

Closing the pandemic office "clearly reflected the White House’s misplaced priorities and has proven to be a gross misjudgment," Konyndyk wrote.

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Pandemic office created after Ebola epidemic

Whether the office was disbanded or streamlined, there's no question a number of top-notch global health experts left the administration in the wake of Bolton's decision. At the top of that list: Rear Adm. Timothy Ziemer, who had been Trump's senior director for global health security and biodefense at the National Security Council. Before that, Ziemer led a global anti-malaria initiative in the George W. Bush administration.

President Barack Obama created the pandemic preparedness office at the National Security Council in 2016, after his administration was criticized for its initial response to the Ebola epidemic in 2014 and 2015.

Republican lawmakers blasted Obama for refusing to impose travel bans and quarantines. When two American nurses contracted Ebola in 2014 while caring for an infected patient, some GOP lawmakers called on Obama to designate a czar or oversee the response.

“I’d like to know who’s in charge,” Sen. John McCain, R-Ariz., said at the time. Obama eventually tapped Ron Klain, who had served as chief of staff to two Democratic vice presidents, to lead the Ebola response.

As the outbreak in West Africa subsided in 2015 and he prepared to leave, Klain pressed Obama to set up a permanent directorate within the National Security Council to coordinate pandemic preparedness and response across the federal government.

Obama took Klain's advice and created the unit to prepare for future disease outbreaks and prevent them from mushrooming into pandemics.

"That was a very essential step," said J. Stephen Morrison, director of the Global Health Policy Center at the Center for Strategic and International Affairs, a Washington think tank. After Ebola, Obama and his advisers realized "this was just dangerous and chaotic and let’s not do that again."

"We live in an era of recurrent crises of this kind that come with greater velocity, greater impact and costs," Morrison said. The White House, he said, needs a point person who can coordinate multiple agencies and "see things early, act very quickly and bring about accountability and coordination of the U.S. response."

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'Sluggishness and confusion' in Trump's response to coronavirus

That foresight and coordination has been missing in the Trump administration's response, Morrison said. "You can attribute some of the sluggishness and confusion that we have seen bedevil this effort since the very beginning ... to the absence of effective structures within the White House."

Beth Cameron, who led the office under Obama, said the Trump administration's decision to nix the directorate cost the United States "valuable time" in responding to COVID-19, although the full impact is still unclear.

In a Washington Post op-ed, Cameron wrote that the office was created out of a "recognition that epidemics know no borders and that a serious, fast response is crucial. Our job was to be the smoke alarm — keeping watch to get ahead of emergencies, sounding a warning at the earliest sign of fire — all with the goal of avoiding a six-alarm blaze."

She said her team constantly monitored myriad global health threats, from the H7N9 influenza in China to an outbreak of yellow fever in Angola.

Bolton and his allies shot back after Cameron's op-ed was published, saying she and other critics were misleading the public by saying the office had been disbanded. Tim Morrison, one of Bolton's deputies at the National Security Council, said it was bloated and the decision to consolidate the global health unit with two others eliminated "overlap" within the National Security Council.

"If anything, the combined directorate was stronger because related expertise could be commingled," Tim Morrison wrote in his own Washington Post op-ed Monday.

He said the current staff "is fully up to the job" of responding to COVID-19, and he trumpeted Trump's work on biodefense and vaccines.

In an interview, Morrison said Bolton would regularly send him early-morning emails about possible emerging health concerns.

He said the problem with the COVID-19 outbreak has nothing to do with the structure of the National Security Council and everything to do with China’s attempts to hide the outbreak at first.

“The fault lies with China sitting on this thing for five weeks,” Morrison said. “We could have nipped this thing in the bud if the Chinese had come clean earlier.”

Trump has acknowledged that he cut global health experts from his staff and tried to slash funding for the World Health Organization, the Centers for Disease Control and Prevention, and other agencies charged with spotting and responding to such epidemics.

"Some of the people we cut, they haven’t been used for many, many years," Trump said during a Feb. 26 briefing on the coronavirus response.

"I’m a business person — I don’t like having thousands of people around when you don’t need them," he said. "When we need them, we can get them back very quickly."

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