“What’s this, Michael?” Redfield asked. “Your lymph node is hard. You have to go to the doctor.”
Caputo, fifty-eight, had been under intense stress. He was trying to manage the health department’s communications and to somehow spin a positive narrative for the reelection campaign out of the administration’s failure to control the virus. He had been on the road with Azar, including a visit to Caputo’s hometown of Buffalo in June. They had toured the Roswell Park Comprehensive Cancer Center and promoted, among other things, cancer screenings.
All the while, cancer was spreading in Caputo’s neck and he didn’t know it. On September 12, Caputo returned home to Buffalo and got an ultrasound. That night, his doctor called. “It looks like cancer,” the doctor told Caputo.
Caputo didn’t sleep much that night. The next morning, September 13, he sat on the front porch of his Buffalo house, wearing a T-shirt on a sunny Sunday, and recorded a Facebook Live video for friends on his personal Facebook page. It was bizarre. Caputo talked about seeing long shadows on the ceiling of his Washington apartment when he was alone. He claimed he and his family had been threatened and harassed because of his connection to Trump. He warned that “hit squads” were being trained for an armed opposition to a second Trump term. And he encouraged his friends to stock up on ammunition for their guns because it soon could be difficult to procure. Caputo also accused scientists at the CDC and elsewhere in the government of being part of a “resistance unit” working to foil Trump’s reelection, though he cited no evidence.
“The scientists—the deep state scientists—want America sick through November,” Caputo said. He added, “These people cannot—cannot—allow America to get better, nor can they allow America to hear good news. It must be all bad news from now until the election. Frankly, ladies and gentlemen, that’s sedition. They are sacrificing lives in order to defeat Donald Trump.”
Under mounting pressure in the media over his odd Facebook soliloquy, Caputo apologized on September 16 to Azar and the HHS staff for embarrassing them. He later told friends that he was in a bad headspace during this livestreaming performance because of his likely cancer diagnosis and because just that morning someone had driven past his house yelling, “Caputo, you’re a dead man!” Caputo took a medical leave of absence and moved home to Buffalo to seek treatment for his cancer. His service in the Trump administration was over.
But government scientists still stepped up to help him fight his cancer, despite his insults. Azar arranged for Caputo to get a biopsy at the National Cancer Institute, where the center’s director, Dr. Ned Sharpless, treated him and removed his lymph node. Fauci asked two doctors he knew to offer Caputo their medical opinions. Fauci and Redfield, as well as Stephen Hahn, Seema Verma, and Surgeon General Jerome Adams, called Caputo regularly to check in and wish him well. And Admiral Brett Giroir, the assistant secretary for health who oversaw COVID-19 testing, knew a thing or two about cancer, having served as a scientific advisory board member at the MD Anderson Cancer Center. He gave Caputo a pep talk.
“You have to go into your radiation treatments like you own the machine,” Giroir said. “Don’t go in there weak. Don’t go in there with self-pity. Don’t go in there like you’re gonna die. You go in there like you’re the one who’s going to throw the switch and you’ll get through it.”
Thirteen
Stand Back and Stand By
On September 23, about nine minutes into President Trump’s news conference from the White House briefing room, a reporter asked whether he would commit to a peaceful transfer of power after the election, “win, lose, or draw.” The president’s answer was extraordinary, if not surprising.
“We’re going to have to see what happens,” Trump said. Reviving his assault on mail-in voting, he continued, “You know that I’ve been complaining very strongly about the ballots. And the ballots are a disaster.”
The reporter, Brian Karem of Playboy magazine, pressed further. “I understand that, but people are rioting,” he said. “Do you commit to making sure that there’s a peaceful transferal of power?”
“Get rid of the ballots and we’ll have a very peaceful—there won’t be a transfer, frankly. There’ll be a continuation,” Trump replied. “The ballots are out of control. You know it, and you know who knows it better than anybody else? The Democrats know it better than anybody else.”
This exchange lasted less than one minute but represented Trump’s most substantial threat yet to the nation’s history of free and fair elections and prompted election officials and law enforcement authorities around the country to prepare for an unprecedented constitutional crisis.
Asked about the comments, Joe Biden responded with mocking incredulity. “What country are we in? I’m being facetious,” he told reporters. “Look, he says the most irrational things. I don’t know what to say.”
But the next day, Trump erased any doubt about his seriousness or sincerity by reiterating that he may not honor the results. As he left the White House for a campaign rally in North Carolina, Trump told reporters, “We want to make sure the election is honest, and I’m not sure that it can be.”
So serious were the comments, that even Trump’s Republican allies in Congress, including Senate Majority Leader Mitch McConnell, felt obliged to issue statements declaring that the winner of the election would be inaugurated on January 20, 2021, as the Constitution requires.
That any official needed to affirm that an orderly transition of power would take place meant the United States was in uncharted territory. Never had an incumbent president refused to accept the results of an election or obstructed the peaceful transfer of power.
Despite Trump’s equivocations, some of his aides had begun administering a transition process on his behalf in accordance with the Presidential Transition Act. Chris Liddell, a deputy White House chief of staff, was leading the effort and had begun negotiations with Biden’s transition team. On September 4, the White House issued guidance to all federal departments and agencies outlining transition preparations.
As Bill Barr said at a September 22 news conference in Milwaukee, “What this country has going for it more than anything else is the peaceful transfer of power, and that is accomplished through elections that people have confidence in. And so we should be doing everything to support that confidence.” But the attorney general’s conventions fell on the president’s deaf ears.
As he watched Trump undermine the legitimacy of the upcoming vote, Senator Mitt Romney couldn’t help but recall his conversations with Trump nearly four years earlier, when the then president-elect was considering him to be secretary of state.
“Every time we met, and we met twice in person and we spoke on the phone more than once, each time he would begin with, ‘You know, I won the popular vote because of all the illegals that voted in California,’ and, ‘I won New Hampshire,’ ” Romney recalled. “He said there were hundreds of buses from Massachusetts that took people to New Hampshire and they voted up there. I didn’t argue with him. I just listened and thought this was something he was doing to convince himself.”
Both claims were false, of course. In 2016, Hillary Clinton carried New Hampshire and won the national popular vote by nearly three million votes. There was no evidence of widespread fraud in California or New Hampshire or in any other state. As Trump sowed doubt about the 2020 election, Romney naively assumed the president was again trying to satisfy his own outsized ego. He could not imagine Trump was laying the groundwork to actually subvert the election.
“When I heard him say, if I lose to Joe Biden, the worst candidate in the history of the earth, it will be because the election is ‘rigged,’ I just presumed that’s in that category of something he’s going to say to himself and a few other people will perhaps believe him and he’ll therefore be comfortable at Mar-a-Lago with himself and with his ego in the event that he loses,” Romney said.
As for Trump’s re
fusal to commit to a peaceful transfer of power, Romney called this “dangerous for the country and very troubling.” When Romney had run for president in 2012, President Obama had authorized his administration to cooperate fully with Romney’s transition team, led by former Utah governor Michael Leavitt, because it was important for the country that there be a smooth transition in the event that he lost reelection. But Romney said he suspects Trump, who was superstitious, was afraid to jinx his chances by making an affirmative statement about a presidential transition.
“As I heard that comment, I thought to myself, oh, he thinks that if he participates in a transition that he’s going to get jinxed and that might mean he would lose and that he has to make sure that he doesn’t do anything that suggests he can do anything but win,” Romney said. “I marked it up to his psyche, but recognized that this comes at a cost in the event he loses.”
* * *
—
By early fall, Trump’s concerns about vaccine approval morphed into outright paranoia. He imagined a phalanx of powerful officials and institutions aligned to prevent him from announcing a safe vaccine before the election. He suspected that government scientists—and even some of his appointees, including Stephen Hahn—were conspiring to delay the vaccine rollout, and that pharmaceutical companies were in on the con.
There was no evidence of this, but that didn’t stop the president venting to advisers and, on occasion, the public. As Trump had told Alex Azar over the phone in August, “These drug companies and Hahn and the FDA. They’re going to keep us from having a vaccine before the election. They’re going to delay this. You’ve got to stop them.”
“Sure, Mr. President,” said Azar. The health secretary had never believed it was possible for manufacturers to develop an effective, fully tested vaccine and get FDA approval before the election, but he sometimes chose to listen to the president rather than challenge him.
Azar was by now familiar with Trump’s antipathy toward pharmaceutical companies, which he had long blamed for unfairly driving up the costs of prescription drugs. The president many times had asked Azar to have the government set drug prices—an ironic request considering Azar was a former pharmaceutical executive. “Just like the U.K.,” Trump would tell Azar. “Socialize it.”
And back in July, Trump had fumed during a meeting about the $2 billion the government had recently agreed to pay Pfizer to buy its coronavirus vaccine. “These evil drug companies,” Trump had said. “Why are we giving so much money to these drug companies, who I can’t stand?”
Trump ratcheted up his pressure on Azar over vaccines into September. In one conversation, Azar tried to give the president a reality check.
“We are not going to get a vaccine before the election,” Azar said. “If we get it by the end of the year, it will be a miracle.”
Azar went over the timing for vaccine trials, something he had explained to the president several times before. Patients were chosen randomly. They were given doses in controlled settings. They were carefully monitored. The data tracking their reactions were carefully transcribed and studied.
But the president was impatient. “Putin approved Sputnik and then got the data later,” Trump said.
Azar said that scientists worldwide agreed Russia’s coronavirus vaccine had been dangerously rushed. It had been approved for widespread use before large trials had been conducted to test reactions from patients and measure the drug’s efficacy.
“Mr. President, if we do that, nobody will take the vaccine,” Azar said. “We’re putting vaccines in people’s arms. We have to have the data. If career people at FDA don’t sign off on this, we have something people will literally never take.”
Dr. Paul Offit, a member of the FDA’s vaccine advisory council who served as director of the Vaccine Education Center at Children’s Hospital of Philadelphia, observed at the time, “The one thing you can’t do—and it’s what everybody fears, it’s what the pharmaceutical companies fear, it’s what everybody on the inside fears—is that the government would, because of political purposes or because other countries put a vaccine out before us, truncate the normal process you’d accept for a safe and effective vaccine.”
This was also something that worried Mark Esper, whose office became crucial to Operation Warp Speed. The defense secretary had chosen Army General Gus Perna, whom he had worked with before and trusted totally, as the operation’s logistics chief. Esper and Azar agreed on the plan. When a set of companies hit upon promising vaccines, they would immediately begin mass producing at least two or more vaccines in hopes the drugs would later secure FDA approval after clinical trials. The two men accepted up front that they risked wasting hundreds of millions of dollars on shots that didn’t meet the final standard. But they figured they would rather lose money than have to explain to Congress they would need another four months to produce enough vaccine doses for the country. In four months, how many people might die waiting for the vaccine?
By early summer, the plan had been working beautifully. Esper was initially delighted when Perna told him he was authorizing contracts to produce two promising vaccines, and that in preliminary tests they were more than 80 percent effective, far outperforming projections. But the secretary’s ebullience then turned to concern. If the president learned they had millions of doses produced, would he or a White House adviser start demanding they administer them to the public before the vaccine had been fully vetted by the FDA?
At the FDA, Hahn had been thinking hard about how to restore people’s faith in his agency following the botched August announcement on convalescent plasma. On September 22, Laurie McGinley reported in The Washington Post that the FDA was going to set a stricter standard for approving coronavirus vaccines. The FDA would require manufacturers to monitor patients enrolled in late-stage clinical trials for sixty days after they received their second dose of the vaccine, before approving the drug. The scientific goal was to carefully assess long-term immunity. But the political result was that vaccines were unlikely to be approved before the election.
Within thirty minutes of McGinley’s story publishing on the Post’s website, Mark Meadows called Azar and yelled.
“It’s going to take FDA sixty days to rule on an application as a result of this!” Meadows said. “This is going to delay things by sixty days.”
“Listen, Mark, this is something FDA leaked before sending to OIRA at OMB,” Azar said, referring to the budget office and its regulation-review division, the Office of Information and Regulatory Affairs. “Hahn sent this to manufacturers weeks ago. Then he briefed the media on this guidance before I knew about this.”
Azar knew the change had been discussed with Pfizer, Moderna, and other manufacturers in August, but hadn’t realized the political impact of the sixty-day monitoring requirement.
“Mark, I told Jared and Brad about these letters weeks ago,” Azar said, referring to Jared Kushner and Brad Smith, a coronavirus adviser who was close to Kushner.
“They are not the chief of staff to the president of the United States,” Meadows said.
On September 24, at a coronavirus task-force meeting in the Situation Room, Trump complained about the FDA guidance and said the scientists wanted him to fail. He believed that Hahn, having been blasted mercilessly by the scientific community as a Trump enabler over the FDA’s convalescent plasma approval, was raising the bar for vaccines—and raising it unfairly high. This was horrible, he said.
“We need a vaccine before the election and this guidance is going to delay that,” Trump groaned.
Azar figured Trump had shown incredible leadership in pushing for the fastest vaccine development in history, something about which he could crow, regardless of when the FDA-approved shots were going into arms.
“Mr. President, I need you to understand this,” Azar said. “There is no physical way there will be an FDA-approved vaccine by November third. It simply cannot happen. We
may get data by then. Then that will be a successful vaccine and you can own that. The pharmaceutical companies will be bragging to heaven about that. That’s your win.”
Azar told Trump that it wasn’t worth griping about the FDA. They had to keep their eyes on the prize: approving a reliable, gold-standard vaccine. “They are the least of our concerns,” he added.
The president took it in. He kept his arms folded and nodded. The matter was settled—for now, at least.
As they left the meeting, Smith, the head of innovation at the Centers for Medicare & Medicaid Services, said to Azar, “Mr. Secretary, thank you so much for doing that. That was a home run.”
Azar even received praise from his archrival, Seema Verma. “You did a great job on the FDA issue,” she wrote him in a text message. “Not easy but hopefully made a big difference.” Azar was so bowled over he showed the message to aides.
Trump’s fury over the FDA may have subsided, but his rage over Robert Redfield’s testimony about the vaccine timeline had not. The president was not alone. Meadows and Azar were angry with Redfield as well. On September 25, CNN reported breaking news: Trump had lost patience with Redfield and he may soon fire the CDC director.
The next morning, just before 7:00, Trump called Redfield on his cell phone. The director was at his home in Baltimore, feeling a tad apprehensive about the conversation to come.
“Are you listening to the news?” Trump asked him.
“I’ve seen a little,” Redfield said.
“Well, it’s fake news,” Trump said. “You’re doing a great job.”
Redfield let that soak in. He had a little joke in store for the president.
“You mean, I’m not being fired?” Redfield said, his tone a little impish.
“No, you’re doing a great job,” Trump insisted.
Redfield looked over at his wife, Joyce, who was listening to the conversation on speakerphone.
I Alone Can Fix It: Donald J. Trump's Catastrophic Final Year Page 31
