We will look back on this time and the hundreds of thousands of deaths we could have avoided with sorrow, anger, and disbelief

Analogies are never perfect. However, over the past eight months of the covid-19 pandemic, I have looked for touchstones to explain what is happening in the United States, which is witnessing an unprecedented abdication of federal government responsibility to contain or mitigate the outbreak.

Over the past few weeks, I have watched as our world-renowned public health agencies, including the Centers for Disease Control and Prevention and Food and Drug Administration, capitulated to the whims of the White House on convalescent plasma and on the rejection of the need to test asymptomatic individuals for SARS-CoV-2. Scientists like Anthony Fauci, the head of our main infectious disease research institute and Deborah Birx, who once ran the US global AIDS programme, have been cast out of the inner circle of the US taskforce on the pandemic and replaced with those holding fringe-worthy views on herd immunity. Last week, according to a new book, Donald Trump, president of the United States, admitted that he had initially played down the threat of covid-19 as he did not want to cause “panic.” And then it dawned on me, I had been here before.

In the early 2000s, I worked, and for part of that time lived, in South Africa. Those were the years of AIDS denialism, when the President of the Republic, Thabo Mbeki, rejected mainstream views about HIV/AIDS, denying that the human immunodeficiency virus caused the disease and that antiretroviral therapy, saving lives around the rest of the world, was akin to poison. The entire state apparatus was overhauled to ensure that the President’s views became national policy, with his health minister Manto Tshabalala-Msimang, following Mbeki’s lead on HIV and suggesting that beetroot, garlic, lemons, and African potatoes were better than AIDS drugs for the disease, while quack cures like Virodene got championed by President Mbeki and his Deputy President Nkosazana Dlamini-Zuma. Most of the provincial leaders followed suit, except in the Western Cape where activists from the Treatment Action Campaign, doctors and nurses from Médecins Sans Frontières, and the provincial health department started a programme to get antiretroviral drugs to the people who needed them.

After Thabo Mbeki resigned in 2008 after almost ten years in office, a Harvard University study estimated that over 350,000 deaths were attributable to the refusal of his government to provide AIDS treatment to his citizens. South Africa rebooted its AIDS response quickly after his departure and now has the largest AIDS treatment programme in the world.

If Thabo Mbeki had his Manto Tshabalala-Msimang, Donald Trump has found something of an equivalent in the shape of Scott Atlas, from Stanford’s Hoover Institution. Atlas was the subject of a scathing piece in the Washington Post in late August, which reported that he has championed the idea of sequestering the elderly and letting the coronavirus rip through the rest of the nation, akin to the Swedish “herd immunity” model which was tried unsuccessfully earlier this year, and in which deaths mounted and the economy suffered, even though this laissez-faire approach was supposed to ameliorate both. After the Washington Post story, Atlas claimed he was being misrepresented and that there was no White House policy to achieve herd immunity. But, there seems to be no question that he has pushed for decreasing testing of asymptomatic people even if they have been exposed to someone with covid-19, and has repeatedly pushed for schools and colleges to reopen and for lockdown orders to be lifted.  If Sweden’s approach to “herd immunity” was a failure, trying anything like it in the US, with its patchwork of a healthcare system, and with millions of people without healthcare insurance and living with underlying conditions which predisposes them to serious complications from covid-19, is likely just to pile disaster upon disaster.

We started the year with the President and his circle often saying they were doing everything by the book and doing it well. They claimed that the US has the best testing programme in the world and that everyone who wants a test can get one, even if that isn’t the case. But by August, with Fauci and Birx thrown out of the room where decisions get made, Trump started reading from the book of disease denialism. Now everything they were doing all along, not testing enough, not ramping up production of personal protective equipment, not funding states and cities to ramp up contact tracing and isolation, pushing for the reopening of schools and businesses was all part of the plan all along. As in South Africa, states run by governors from the President’s party have by and large adopted this approach, rejecting mandates for mask wearing, re-opening business prematurely, and downplaying the risk of the disease. All hail the new American disease denialism.

Like in South Africa, we will look back on this time and the hundreds of thousands of deaths we could have avoided with sound, science-based leadership, with a mix of sorrow, anger, and disbelief. Now, like then, the resolution to the dire situation we are in is a political one. Our pandemic future hangs on the election in November. If we’re ever to get rid of the virus, we have to get rid of Donald Trump, send him packing to Mar-a-Lago to tweet at his enemies late into the night, while we rebuild the American public health leadership he has tried so desperately to destroy.

Gregg Gonsalves, assistant professor of epidemiology, Public Health Modeling Unit and Department of Epidemiology of Microbial Diseases, Yale School of Public Health.

Competing interests: GG declares that he is a registered Democrat and has donated to the presidential campaign of Senator Elizabeth Warren.