It’s true that Pence faced an HIV outbreak while he was the governor, and that he eventually allowed a needle exchange. But his revisionist history misrepresents his role in what transpired in the small town of Austin, Indiana five years ago, where over 200 people were infected with HIV. What happened is that Pence failed to act in response to increasingly urgent signs of a significant HIV outbreak, and he delayed implementation of vital public health measures. Among public health experts, the Indiana outbreak is considered a failure of state response, and an example of how poor political leadership can actually make a crisis worse.

How do we know? We closely studied the dynamics of the Scott County HIV outbreak from 2011 to 2015, as well as the policy responses of the state’s leaders. Our full account was published in a 2018 article in the scientific journal The Lancet HIV. Here’s what happened.

By 2013, when Pence became Governor, HIV infection rates among people who use drugs had been declining year after year across the US. However, there was ample warning that southern Indiana might be susceptible to an outbreak of HIV among people who injected drugs. Already, in southern Indiana, there was evidence of prescription drug abuse, overdoses, and an outbreak of Hepatitis C virus among injection drug users.

Experts proposed needle-exchange programs to prevent further outbreaks—providing clean needles to people who use drugs who otherwise might share and spread the disease—but state law prohibited needle exchange. It was hard, if not impossible, for people even to learn they were infected, because the only HIV testing provider in the area had been a Planned Parenthood clinic that closed because of state cuts supported by Pence.

In November 2014, the first HIV infection in Scott County attributed to this outbreak was diagnosed. By January 2015, 17 new HIV infections had been recorded, and the Indiana State Department of Health began an investigation, but it wasn’t until late February 2015 that Indiana state officials even notified local authorities in Scott County about the crisis in their midst.

As late as early March 2015, Pence still resisted calls to establish needle exchange programs even though state legislators from Pence’s own party were now advocating for them. Pence supported the federal ban on needle exchange and also his state’s prohibition; a Republican state legislator, Ed Clere, told a reporter that Pence’s staff members “made it clear that he was categorically opposed to syringe exchange, period.”

However, after meeting with officials from the Indiana State Department of Health and the CDC, and an evening telephone conversation with Scott County Sheriff Daniel McClain on March 23rd, Pence said he would “go home and pray on it.”

On March 25, 2015, Pence finally declared a public health emergency, which permitted needle exchange in the town. Several days later, an HIV testing clinic opened. In early April, after consultations with Indiana State Department of Health, CDC and local law enforcement, Pence established a temporary syringe-exchange program for 30 days. Finally, in May 2015, Pence signed a bill that allowed counties in Indiana to apply for permission to establish syringe-exchange programs. These exchange programs were temporary and did not receive state money.

On the same day, however, Pence also undermined the effects of the new law, signing another bill that toughened the punishment for people found carrying needles. It upgraded possession of a syringe with intent to commit an offense with a controlled substance from a misdemeanor to a felony charge, subject to imprisonment for up to 2.5 years. Criminalizing possession of syringes, even clean ones, without a prescription undermines efforts to slow transmission of HIV among injection drug users, and may actually encourage needle sharing.

The damage was done: by 2017, a total of 215 cases of HIV infection had been attributed to the outbreak. When we performed our analysis of the the Indiana outbreak, we found that undiagnosed HIV infections peaked about 2 months before Pence declared a public health emergency—after the rise of HIV had been detected, but before the governor chose to act. Using a mathematical model of epidemic dynamics, we estimated that up to 127 HIV infections could have been averted if Pence had implemented public health measures like HIV testing and needle exchange proactively in 2013, when he had been urged to do so by experts in his state.

Was the outbreak avoidable? Public-health experts largely think it was. In the aftermath of the outbreak, researchers at the CDC and the National Institute on Drug Abuse asserted that public health measures to the Scott County outbreak were not implemented early enough to avert a severe epidemic, and most seriously, that the outbreak over which Pence presided was avoidable and preventable.

Pence’s handling of the Indiana HIV outbreak is a case study in mismanagement of a public health crisis. His inaction as governor gave Austin, Indiana with a population of around 4,200, a higher HIV incidence than “any country in sub-Saharan Africa,” said Dr. Tom Frieden, former director of the CDC.

In the President’s Saturday news conference, Pence did not directly address the criticism of his role in the 2015 HIV outbreak in Indiana, and the president made clear that he is confident in his vice president’s abilities. In an earlier interview with Rush Limbaugh, Pence suggested his actions as governor of Indiana were evidence of his qualifications to lead the novel coronavirus response: “I think it might be the main reason why President Trump asked me to do this.”

Pence may look back with pride on his role in the events in Austin, Indiana, but in reality, his delay in approving needle exchange programs facilitated a public health crisis. If Pence could not handle a preventable outbreak of HIV in his home state, he may not be prepared to address the far larger and more complex challenge presented by the novel coronavirus SARS-CoV-2 as it spreads across the United States. Americans facing coronavirus should hope that the lesson their vice-president learned wasn’t that he knew how to handle an epidemic, but the danger of letting his own politics get in the way of the right response.