Pence's mishandling of Indiana HIV outbreak led to $100 million in health care costs

Donald Trump’s choice of Mike Pence to oversee the nation’s response to the new coronavirus threat is bringing renewed scrutiny to the former governor’s handling of an HIV outbreak in southern Indiana when he was governor.

Pence reluctantly agreed to authorize a needle exchange program in Scott County in March 2015 after the epidemic centered there saw the number of people infected with HIV skyrocket, with nearly 200 people eventually testing positive for the virus that year.

Despite his own misgivings — Pence worried about how the exchanges would affect “anti-drug policy” and had misgivings about providing clean needles to addicts — he initially issued an executive order allowing one in Scott County before later signing a law allowing the state government to approve them for counties on a case-by-case basis.

Greg Millett, director of public policy at amfAR, the Foundation for AIDS Research, said Indiana’s HIV outbreak would have been “entirely preventable” if Pence had acted earlier in response to data that was available to Indiana public health officials and clearly showed an outbreak was imminent.

The outbreak primarily infected intravenous users of the painkiller Opana in an impoverished, rural area with few health resources. The needle exchange Pence finally approved for Scott County successfully curbed the epidemic’s spread by providing clean needles to IV drug users to reduce needle-sharing that spreads HIV, hepatitis C and other diseases.

Pence took credit for the needle exchange during an interview Thursday with Fox News Channel’s Sean Hannity. “We worked the problem early in the year from a law enforcement standpoint, from a health standpoint,” he said. “I don’t believe in needle exchanges as a way to combat drug abuse, but in this case we came to the conclusion that we had a public health emergency, and so I took executive action to make a limited needle exchange available.”

Millett said Scott County had averaged five new HIV cases annually between 2004 and 2013, but between November 2014 and Jan. 11, 2015, it suddenly saw 13 new cases in just over two months.

Quick implementation of a needle exchange program could have stopped that escalation, but new cases continued to surge without one, he said.

“This would have been entirely preventable if Indiana had acted fast with a syringe exchange,” he said. “To have some 200 people become infected over such a short time period was unprecedented.”

Millett, who worked as an epidemiologist with the Centers for Disease Control and Prevention between 1999 and 2013, doing HIV research, said the CDC later determined that Indiana’s outbreak resulted in infections that will amount to $100 million in health care costs — expenses he said could have been reduced or avoided by a quicker response.

Despite his reservations about Pence, Millett said he’s encouraged by Pence’s announcement Thursday that Debbie Birx, the administration’s global AIDS coordinator, will serve under Pence as the White House coronavirus response coordinator. Millett called Birx an effective and respected public health leader.

“She’ll bring in people who are experts in infectious diseases who can mount an effective response,” he said.

But Steven Thrasher, a Northwestern University journalism professor who has studied Indiana’s outbreak as part of his research into HIV and LGBTQ health issues, said Pence’s response as Indiana governor raises real questions about whether he’s the best person to helm the response to the virus.

Thrasher said that while HIV cases were mounting in Scott County — which lies about 30 miles (48 kilometers) north of Louisville, Kentucky — Pence told local officials wondering whether he would approve a needle exchange “that he was going to pray on it.”

“His background shows that he brings religion, a lack of science, and a budgetary mindset to public health matters. In a time of emergency, those are not the safest ways to be approaching what could become an epidemic,” Thrasher said.

Pence’s state health commissioner at the time of the HIV outbreak, Jerome Adams, is now U.S. surgeon general and is widely credited with helping persuade Pence to accept the needle exchange program that now operates in nine of Indiana’s 92 counties.

Pence’s office, when asked for comment by The Associated Press, referred a reporter to Adams. He defended Pence’s actions Thursday, saying the then-governor worked closely with him in responding to the outbreak, including implementing the syringe exchange program “that helped change the scope of the unprecedented crisis.”

“As a result, our efforts became a model for how other states and localities respond to similar crises,” Adams said in a statement.

Joey Fox, who was legislative director for the Indiana State Department of Health during the HIV outbreak, said Thursday that the criticism of Pence is unfair because Indiana’s response to the HIV outbreak went far beyond just authorizing a needle exchange program.

Fox said the state’s response included bringing HIV testing to the small city of Austin — the community at the heart of the outbreak — at a “one-stop-shop” office where the county’s needle exchange was initially based. At that office, people could get tested, enroll in Medicaid to begin HIV medical treatment, get state identification cards and birth certificates and receive other services.

“It’s unfair to criticize the governor,” Fox said. “He was personally engaged with the public health and the public safety of Scott County, and the Indiana government was engaged from day one on the HIV outbreak.

“Before Mike Pence syringe exchanges were illegal in Indiana. When he left office there were programs around the state.”

Democratic Sen. Patty Murray of Washington urged Trump on Thursday to reconsider the choice of Pence, citing his “lack of public health experience and record of putting ideology over science” and his “leadership failure during the Indiana HIV outbreak.”

House Speaker Nancy Pelosi told reporters she spoke to Pence on Thursday morning and “expressed to him the concern that I had of his being in this position.” Pelosi said that while she wants to work with the White House, she told Pence she was wary of his leadership after his track record in Indiana.

Indiana’s needle exchange debate in 2015 was complicated by opposition from law enforcement groups who worried that such programs would enable drug abuse.

Scott County’s current health administrator said the county’s exchange — through which participants swap used needles for clean ones to stem the spread of diseases through needle-sharing — had a dramatic impact on the outbreak.

Since the county’s needle exchange began in early 2015, the number of new HIV cases tied to the outbreak has declined each year, said Michelle Matern, administrator for Scott County’s health department.

“I think the data speaks for itself, that it’s decreasing the transmission of infectious diseases,” she said.

In 2015, there were 187 new HIV cases linked to the same HIV strain involved in the outbreak. Cases plunged to 27 in 2016, 12 in 2017 and 10 in 2018, with a preliminary count of seven new cases last year, Matern said.

Health advocates have long criticized Indiana’s Republican-dominated government for paying scant attention to public health, with the state ranking 47th in public health funding, according to a 2019 study by the United Health Foundation.