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A look behind the scenes: Dr. John Fleming recounts his time in the West Wing, Coronavirus Taskforce

Dr. John Fleming has had quite the extensive career in Washington D.C. After representing Louisiana’s 4th district as a Member of the U.S. House of Representatives, he went on to serve for two years as Deputy Assistant Secretary for Health Information Technology Reform and then served as Assistant Secretary of Commerce for Economic Development from March 2019 to 2020.

Recently Dr. Fleming received a medal from Christopher Miller, the Secretary of Defense under the Trump administration, for his distinguished public service. 

In early 2020, before the pandemic had fully struck, Mark Meadows was selected to be Chief of Staff in the Trump administration. Being former colleagues, Meadows extended an offer to Dr. Fleming to take up a position with him in the West Wing of the White House in order to lend a hand in maintaining the responsibilities of the department.

“A good friend and colleague of mine, Mark Meadows, was brought in as the President’s Chief of Staff in March of 2020. And so he asked the President to bring me in as his Deputy Chief of Staff. My official title was Assistant to the President for Planning and Implementation. But basically my function was deputy chief of staff,” said Fleming.

Shortly after accepting, the United States was coordinating most of its efforts to try and combat the virus, and in turn Fleming found himself with a spot on the Coronavirus Task Force led by former Vice President Michael Pence.

It’s been a full year now since he United States shut down, and given his first hand experience on the task force, Dr. Fleming shared some of his experiences, during those first few volatile months, as well as how the United States has adapted in order to better fend off future pandemics. 

“When I got there on March 23, the whole issue was obviously getting very, very important. The task force started out as a small little group that was supposed to be led by the head of HHS, but by the time I got there, within a week or so before I arrived, everybody had determined this far too important,” said Fleming.

“So then the President appointed the Vice President, Pence, to head the task force. And he brought in the heads of different departments, everybody from Ben Carson at HUD to the head of FEMA, the head of Homeland Security, the Head of Agriculture, and obviously, Health and Human Services and the agencies within that. So by the time I got there, they were meeting at least three or four times a week, sometimes on the weekends.”

Fleming was also on a team tasked with doing a lookback analysis on the pandemic and seeing the areas where the U.S. could improve in order to ensure it can better combat the next one. Fleming went on to detail some of the issues they had early on when dealing with the then new and unknown virus, and how they worked to improve the U.S. ‘s capabilities in handling future pandemics. In particular he noted the early struggles obtaining accurate testing, the supply chain for PPE, and the ability to transfer data quickly and efficiently.

“At the very beginning, we really had no way to test for the infection. That was left to go to the CDC, and they failed on that. They wasted about six weeks and finally, finally came up with something. But until we asked the private laboratories to develop you, we were really flying blind when it came to testing,” said Fleming. 

On top of the tests, the amount of available PPE was also lower than what they would have liked given the oncoming pandemic. 

“So here was our situation. Virtually all of that stuff is made overseas. Much of it, particularly the masks, are all made in China, and China had the same problem as us. So there were literally ships on their way to us already which were ordered pre pandemic that China turned around in mid-ocean and sent back because they knew they needed them more than us,” said Fleming.

So number one, we learned that we need to reassure our capabilities so that in the next pandemic, we can source those from us and our friends or be positioned where we can ramp up quickly. And that’s true both of the shielding, the protective devices, the gloves, the masks, the gowns and all that, but also the ventilators.

“Number two, that we go to a dynamic stockpile so that we have slack in the system where we have excess inventory, but the inventory is continuously being turned over through normal use. That way, if we have to call upon, you know, a billion face masks, we can do it and respond to it quickly. Not going to a warehouse necessarily, but in the sort of usual supply chain,” said Fleming.

“That would be difficult for the private sector to do by itself. But the government is saying, look, you know, 20 percent of your inventory, we’re just going to flat out pay for it and keep turning it over. But on the other hand, when we need it, we’re going to call upon it. We’ll take that 20 percent, and in the meantime, you can ramp up your production and we’ll pay for that, too. So that’s the sort of the modern stockpile and supply chain that we’re hoping to develop.”

Fleming went on to talk about the problems early on with data collection. When trying to keep up to date with infection rates that change on the daily, it is important that information comes in quickly so the people making decisions have the best and most up to date information to make the best possible decisions. 

Fleming stated that at the time, the methods used to get information delivered was out of date.

The main thing that’s important is we found that our ability to provide data, both at the state level and the federal level for decision making was very, very poor, very archaic. Snail mail, faxing, phone calls. You would think in this day and time we’d be electronically connected so that a doctor’s office here in Minden might report directly to the CDC or to Baton Rouge or maybe even to the local health unit. And then it goes on from there,” said Fleming.

“That capability just was extremely poor, very limited and virtually non-existent and very slow. So Dr. Birx who’s an epidemiologist whose job was to track everything that was happening around the country, she didn’t have any real solid methodology to do that. So they had to build that on the fly and got really good at it.”

“So that one of the things that came out is how we need to totally rebuild and create a system of communication where this data can be collected and reported in real time immediately. So that day by day, we know exactly what those numbers are.”

While there was come catch-up to be played, Fleming also noted how the U.S. was able to accomplish the feat of getting safe and effective vaccines in under a year.

“That’s the true miracle about the vaccines. As far as I know, we’ve never developed vaccines in less than a year for distribution,” said Flemming.

“Some people question that, because if we’ve never done it before or what corners are we cutting to do this? The truth is that normally when a vaccine is developed, you have two things that make it very slow. Number one is the cost. It’s a risk for a company to develop a vaccine. It may or may not work, and they have to plow millions of dollars into that, and so they’re going to do it slowly and carefully.”

“Then when they do get to the stage of testing it on human subjects, it’s not how long you test it, it’s how many people you test. And with many infections, you have a limited number of people, whereas with covid you have millions of people with it simultaneously.”

How the U.S. counteracted these roadblocks to a speedy vaccine was by fronting the bill, incentivising companies to start producing a vaccine if it looked promising, that way if it was effective and approved, they could immediately start shipping out doses.

“So what we did that was unique was, number one, once we had the candidates for testing, the drug companies began to produce them immediately. They were able to do that because we provided them the front line for billions of dollars. So they didn’t have to take the financial risk as they would ordinarily,” said Fleming.

“We figured one or two of them are going to prove out to be good, but we’re going to put money behind anything that’s promising and produce it. Because we could take months to produce it after we have a good candidate.”

“So you had all of these candidates being tested first on lab animals and then on a few subjects and more, but then it was being produced in the factories simultaneously. Then we went to the next phase where you go to human subjects and you typically for something like this, you would maybe have five or ten thousand subjects. For most of them, we had 20 to 30 thousand subjects and they were pretty easy to find, obviously, because the infection is spreading all over the world.”

So the decisions to fund companies to produce vaccines earlier on top of the large amount of human subjects for testing were the two key factors in a speedy development of the vaccine.

Dr. Fleming’s time in the West Wing included more than just managing aspects of the pandemic through the Task Force. A continuation of this interview covering the other aspects of his time in the White House will be published at a later date.