How Presidents Handle Pandemics

Obama’s response to the Ebola outbreak will affect his legacy. But he’s far from the first president to deal with such a crisis.

10.16.14 9:45 AM ET

The government’s response to Ebola’s arrival in America has been rocky at best, with each new case raising legitimate questions about preparedness at the Centers for Disease Control and Prevention. In true Washington fashion, a reporter asked White House press secretary Josh Ernest during the Tuesday briefing if the president still had confidence in his CDC chief, Dr. Tom Frieden.

The answer was yes, but with the likelihood of more Ebola cases developing and the midterm elections less than three weeks away, President Obama’s handling of this public-health crisis could impact the midterms and become central to how he is looked at by historians. “One thing we can say presidents tend to be held responsible for responses to emergencies,” says Bill Galston, a senior fellow with the Brookings Institution.

And for a president who hasn’t always paid attention to the optics of his schedule, Obama moved quickly on Wednesday to cancel campaign events in New Jersey and Connecticut after word reached the White House that a second nurse had fallen ill with Ebola in Dallas. After hastily convening a meeting in the Cabinet Room with agency officials from across the government, Obama told reporters his administration will respond much more aggressively in the coming days, with the CDC dispatching a “SWAT team” within 24 hours to investigate each new case.

Presidents have not always been seen as so central to public-health issues. The Spanish flu killed hundreds of thousands of Americans and millions worldwide when Woodrow Wilson was in the White House, but he escaped blame. “It was not a time when the political elites assumed the president should do something about it,” says David Bennett, professor emeritus of history at Syracuse University. America was at war, and Wilson was asked to stop troop transfers to Europe to help contain the disease. Military commanders persuaded him the war took precedence.

“Americans thought then we were at the cutting edge figuring out typhus and yellow fever,” says Bennett. The Spanish flu was airborne and easily spread. State and local communities imposed quarantines, and Wilson himself contracted the virus at Versailles in 1919, when he was nearing the end of his second term. Still, there were no federal policies or presidential press conferences focused on the flu, and Wilson is still considered by many historians to be one of our better presidents.

“People didn’t expect the government could do much about the disease apart from quarantine,” says Jack Pitney, professor of government at Claremont-McKenna College. “People’s expectations about what government could do were limited.”

Polio peaked while President Eisenhower was in the White House, but the Salk vaccine changed everything when it was announced in 1954. Public swimming pools were re-opened and children once again could congregate without fear of getting paralytic poliomyelitis and ending up in an iron lung. Then Cutter Laboratories in Berkeley, California, made a bad batch of vaccine, and 40,000 children were sickened with polio. The surgeon general, Dr. Leonard Scheele, shut down the vaccination program and it took the personal intervention of the vaccine’s creator, Dr. Jonas Salk, before it was reopened three weeks later.

Oveta Culp Hobby, named by Eisenhower to head the newly created Department of Health, Education, and Welfare, the forerunner of today’s Department of Health and Human Services, made the decision to approve the Salk vaccine for widespread distribution. Her resignation in 1955 after serving less than two years in the post was attributed in part to her not putting stringent enough safety measures in place.

As for the president, he was not defined by or damaged by what today would be seen as a major scandal.  “We hired Eisenhower to run the Cold War, not administer shots,” says Pitney. Hobby’s reputation recovered as well, and Eisenhower even tried to get her to run for president in 1960.

Gerald Ford and the swine flu pandemic that never happened in 1976 is a cautionary tale that government action can backfire. Alarmed by an outbreak of severe flu among military recruits at Fort Dix, New Jersey, Ford mobilized a vaccine program to head off what he feared could be a repeat of the 1918 Spanish flu. Forty million Americans were inoculated, unnecessarily as it turned out. The strain of flu wasn’t that lethal, and the shot left some 500 people with Guillain-Barre syndrome, a paralyzing nerve disease. Thirty people died.

It was a debacle, and it didn’t help Ford in the 1976 election. But his pardon of Richard Nixon and his statement in a debate with Jimmy Carter about Poland not being under Soviet domination did a lot more damage than the swine flu.   

When Ronald Reagan was in the White House, expectations for presidential involvement in pandemics had greatly increased, and he was criticized for being late to the issue of recognizing HIV/AIDS. He was saved by Surgeon General C. Everett Koop, who spoke out forcefully about the virus and the need for sex education in schools to promote the use of condoms as a way to combat the spread of AIDS—positions that put him at odds with the conservative activists who had backed him.

Initially derided by liberals, Koop became a leading voice on public health during the Reagan administration and beyond, and remains the gold standard of what a surgeon general can be in times of crisis.

Remembering Koop brings us full circle to Obama and his surgeon general, a post that has gone unfilled for more than a year. Sen. Rand Paul, among others, is blocking confirmation of Dr. Vivek Murthy, a British-born American, because of his political views. He co-chaired Doctors for Obama, and once tweeted that guns are a health issue.

Asked whether the absence of a surgeon general has hurt the government’s response to Ebola, press secretary Josh Ernest said it would be a benefit if the administration had a “dedicated public-health professional who was involved in helping us communicate with hospitals and medical professionals all across the country to ensure that these protocols—the proper protocols—were in place and closely followed.”

For Obama, who took office saying in every crisis there is opportunity, Ebola has arrived when faith in government has collapsed. One way to restore that faith is to do something big, and to do it right. With or without a surgeon general, if Obama’s response to Ebola is ultimately successful, it could be a powerful way of showing government can work, even when all else fails.