Editor’s note: Vice President Mike Pence on Wednesday was put in charge of handling the federal response to the coronavirus. Pence has been tasked with handling a deadly infectious disease before — and performed terribly. Stephen Rodrick, in his 2017 profile of the vice president, explored how Pence’s slow and underwhelming reaction to the HIV epidemic in Indiana almost certainly increased its death toll. Read the full story here.
I drove down to Austin, Indiana, a town Pence seems to have avoided. I met two nurses at the town’s one-stop shop for HIV treatment and needle exchange. We piled into an SUV and drove to a nearby neighborhood. This wasn’t Pence’s fabled Indiana. There was a family living in a garage, and a trailer with a Nazi flag in the window, and another one with a black SS flag on a pole snapping in the wind. The neighborhood is the epicenter of an HIV outbreak that happened on Pence’s watch.
We pulled up to one garage-house, and a man piled out of a Jeep he was living in. He looked two decades older than his thirtysomething age. “I got no heat in my Jeep – that’s rough,” he said. He returned some used needles and took a box of new ones. He circled back to retrieve four or five packages of Narcan, an anti-overdose drug. His hands were gnarled and yellow. “Thank you kindly,” he said.
Austin is in rural Scott County, which has a population of roughly 20,000 people and almost 200 cases of HIV infection. Extrapolate that to New York and that would be 80,000 cases for 8 million citizens. Here’s the thing: It didn’t have to happen.
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There was one Republican legislator who saw it coming. I met Ed Clere in New Albany, just over the bridge from Kentucky. A real-estate broker, Clere is a big man with a self-deprecating way. Until about a year ago, he was chairman of the Indiana House Committee on Public Health.
In 2014, Clere saw the opioid crisis laying waste to rural Indiana, just as it was ravaging the rest of small-town America. There was a new scourge: Opana, a potent painkiller. The drug’s manufacturers changed the makeup of the pill in order to make it harder to snort. But junkies are a resourceful group. They figured out if the pill was melted down into a liquid, an addict could get high by injecting it in fractions, often more than 10 times a day.
This meant a staggering rise in the use of dirty needles in Indiana. Clere noticed this and supported legislation in 2014 that would allow needle exchanges, to prevent the spread of hepatitis C and HIV. The committee watered down the bill, asking for a mere study. It passed the House, but the Senate ignored it.
The legislation died without any action taken, almost exactly a year before Scott County began reporting a slew of HIV cases in January 2015. First, it was three cases in December 2014, and then the number quickly grew into double digits. The administration finally acknowledged the crisis in a February 25th press release, but still didn’t take any action. Pence’s office made it apparent to Clere that Pence would veto any bill that legalized needle exchange. “There was no willingness to engage or to work collaboratively on a solution,” Clere told me.
So Clere planned a massive public hearing for March 25th at the Statehouse in Indianapolis, featuring doctors, local officials and activists. That morning, a strange thing happened. Pence announced he would be holding his own hearing an hour earlier, down in Scott County. Late to the game, Pence clearly was now trying to upstage Clere. In Scottsburg, a tiny town a few miles from Austin, Pence listened to community leaders and told his audience that he would pray on the situation. Meanwhile, his deputy health commissioner testified before Clere’s committee that the administration was still opposed to needle exchanges in general, but was considering a limited one for the county.
On March 26th, Pence issued an executive order allowing for needle exchanges in Scott County that would have to be renewed again in 30 days. But soon, draconian restrictions were tacked on: There would be no new state money provided for the program. As for additional counties, potentially equally at risk, needle-exchange programs would have to be approved by both the state and county health boards, and would be given no funding.
Over the next year, the needle-exchange program in Scott County proved effective, and the HIV crisis stabilized. The total number of HIV cases crested at 191, a number that would have been undoubtedly smaller if Pence had taken quicker action.
Meanwhile, nearby Clark County spent more than a year trying to organize and raise funds for its own needle exchange. The county is finally getting a program – one day a week for six hours.
And Ed Clere? While Pence was still governor, Republican leadership stripped Clere of his committee chairmanship mid-term, allegedly for his rudeness toward committee members. No one could remember this happening before in Indiana.