The top U.S. agency charged with preparing for a pandemic and overseeing the medical stockpile spent years bracing for potential attacks on the Korean Peninsula and was ill-prepared for the coronavirus crisis that continues to surge, according to current and former government officials.
Robert Kadlec handed out old business cards to staff when he started in 2017 as chief of the office for the Assistant Secretary for Preparedness and Response. They were labeled, “Kadlec’s Rules of Military Medicine.” One rule: “The next war is tomorrow.”
It was—just not the one he’d planned for.
Under Dr. Kadlec—a decorated, retired U.S. Air Force colonel and veteran of two wars—a priority for the agency became preparing for an attack from North Korea on the Korean Peninsula. Code-named “Able Papa,” the plan involved moving as many as 100,000 Americans out of a nuclear or biological zone in South Korea and repatriating them to the U.S.
But his agency, which operates within the Department of Health and Human Services, also was supposed to plan for other medical crises, such as a pandemic—an explicit mandate from Congress when it was created 15 years ago. ASPR nevertheless became so mission-driven on possible military threats that it was caught off guard when the coronavirus hit, according to current and former government officials familiar with the planning.
Initial shipments of a coronavirus treatment went to hospitals that didn’t need it, hospital executives said. A decision to repatriate infected cruise-ship passengers to the U.S. led to a standoff with U.S. public-health officials who said it was too risky. ASPR had spent hundreds of millions of dollars filling the U.S. Strategic National Stockpile with drugs for anthrax and smallpox. Meanwhile, federal officials said, supplies of personal protective equipment for health workers, such as masks, had dwindled.
Now, the agency’s ability to oversee the coronavirus crisis remains critical as some states reopen while cases continue to surge, with confirmed Covid-19 infections in the U.S. surpassing 3 million less than a month after crossing the 2 million mark, and a nationwide death toll that exceeds 131,000.
In an interview, Dr. Kadlec said he worked with the funding he was allocated and had to prepare for nuclear, radiological and chemical attacks alongside pandemics. An HHS spokeswoman said there was no separate pandemic funding provided beyond supplemental pandemic funding expended in 2018.
Robert Kadlec, far right, joined a briefing by Vice President Mike Pence on March 6. Before the pandemic hit the U.S., Dr. Kadlec acknowledged holes in some areas of planning.
Photo: Manuel Balce Ceneta/Associated PressDr. Kadlec disputed in the interview that the agency was ill-prepared for the pandemic. “We have to balance those things with all the other things we have to do, like pandemic planning,” Dr. Kadlec said. He argued that ASPR has responded effectively to the Covid-19 crisis, saying the agency doesn’t publicize its work and success.
Under federal law, ASPR is the lead operational and coordinating body for public-health emergencies. Federal plans designate ASPR—which had a budget of $2.6 billion for fiscal 2020—as the agency to oversee all health-related responses, such as coordinating with impacted hospitals.
Despite its clout, ASPR isn’t as publicized as other federal agencies. The better-known Centers for Disease Control and Prevention, for instance, acts as a detective agency, following clues to a disease and issuing scientific advice, while ASPR operates more like a fire department tasked with getting supplies to fight the disease.
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ASPR is driving work on a critical coronavirus vaccine. It is also in charge of vital coronavirus drugs, including distributing remdesivir, a Covid-19 treatment with limited supplies.
Before the pandemic, however, ASPR’s priority was a possible bioweapon, chemical or nuclear attack. Just before the virus began spreading, Dr. Kadlec met with drug-company executives and consultants and acknowledged there were still major holes in other areas of planning.
“We’re waiting for the next big thing to happen, because you know it will,” he told them in October 2019. “It could be a coronavirus, for which we don’t have countermeasures.”
Dr. Kadlec spoke alongside Anthony Fauci, the government’s top infectious-disease expert, on Feb. 18. Despite its clout, the agency Dr. Kadlec leads isn’t as well-known as other federal agencies.
Photo: Chip Somodevilla/Getty ImagesA confidential report prepared a year earlier by a consulting firm hired by ASPR, which was viewed by The Wall Street Journal, concluded that the agency was “drastically” underfunding medical measures to counter pandemics while the federal government was spending vastly more to prepare for cybersecurity threats and on missile defense.
An HHS spokeswoman said Congress has continued to underfund the strategic national stockpile’s minimal requirements.
The Journal analyzed the federal government’s emergency-preparedness contracts and found that spending on threats from terrorist groups and hostile nations has far outstripped the allocations for potential pandemics and influenza outbreaks. In fiscal years 2016 through 2018, 12.5% of the budgets for drugs and the Strategic National Stockpile—an emergency cache of supplies now run by ASPR—went toward flu and pandemic preparedness, while countermeasures for anthrax alone ate up nearly 21%, according to the Journal analysis of federal data.
Another 29% of those budgets was dedicated to countermeasures for smallpox and attacks featuring chemicals, botulinum toxin or nuclear or radiological weapons, the Journal analysis found.
Some of Dr. Kadlec’s allies said he needed to push the agency toward doing more on biodefense to prepare for large-scale terrorist events. North Korea had conducted missile and nuclear tests in 2017 and 2018, they said, so the ASPR focus on that potential risk and repatriation of U.S. citizens made sense.
Dr. Kadlec was long preoccupied with the threat of biological weapons. He taught classes on military strategy at the National War College and wrote about the dangers of biological weapons as a contributor to books like 1995’s “Battlefield of the Future: 21st Century Germ Warfare.”
He recruited a medical-school friend, Kevin Yeskey, who oversaw bioterrorism at the CDC during the 9/11 and anthrax attacks of 2001, to come on as his deputy.
The new leadership in the fall of 2017 planned to shape ASPR into a military-inspired logistics operation.
Still, a primary ASPR focus remained addressing an overseas terrorist attack—a decision made inside the agency rather than by the Defense Department or elsewhere in government, according to people familiar with the planning.
Dr. Kadlec brought military-style management to the effort. He began holding team meetings in a “sensitive compartmented information facility,” or SCIF, typically reserved for classified briefings, which was unusual at ASPR.
Using military code names like “Able Papa” and classifying materials was a sharp departure for an agency that had been operating as a civilian public-health-coordinating body filled with doctors and Ph.D.s, former employees said.
In the interview, Dr. Kadlec said the Korean Peninsula planning effort was coordinated with the Defense and State departments. An HHS spokeswoman referred questions to the Defense Department or White House on whether threats from North Korea were also a priority. The White House and Defense Department declined to comment.
Drs. Kadlec and Yeskey argue that planning for extreme situations was helpful to ASPR’s broader mission.
“North Korea had the ability to launch missiles and build a nuclear weapons program,” said Dr. Yeskey. “What a perfect scenario to build on and try to get people to plan for.”
People in Seoul watched footage on March 9 of a North Korean missile test. An ASPR plan code-named ‘Able Papa’ focused on a potential attack on the Korean Peninsula.
Photo: jung yeon-je/Agence France-Presse/Getty ImagesEarlier in his tenure, Dr. Kadlec wrested control of the U.S. Strategic National Stockpile from the CDC, giving him unprecedented decision-making authority over this emergency safety net of medical-equipment supplies. At times, he overruled advisory groups that recommended against certain purchases, according to former staffers and people familiar with the decision-making process.
The contracts ASPR began awarding, especially for the stockpile, also reflected the focus on biodefense at the expense of pandemic preparedness, according to people familiar with the decision making.
Dr. Kadlec planned to use $1 billion to stockpile an anthrax treatment largely sourced from India even though top White House, Food and Drug Administration and ASPR employees argued the large purchase was wasteful, according to people familiar with the discussions.
Dr. Kadlec and HHS went ahead nonetheless. An HHS spokeswoman said the purchase was coordinated with other government entities involved in emergency response.
Meantime, ASPR didn’t act quickly after the consulting firm it hired to study its operations concluded the agency still was underfunding measures to counter pandemics, according to contracting data.
“Present funding levels will leave America unable to cope with one or more pandemics arising from natural causes like influenza, anthrax, smallpox, Ebola or other viral hemorrhagic disease,” the nonpublic 2018 report said.
A federal office building in Washington, D.C., was decontaminated on Oct. 25, 2001, following an anthrax attack.
Photo: Greg Mathieson/Mai/The LIFE Images Collection/Getty ImagesThe HHS spokeswoman said Dr. Kadlec had flagged chronic emergency-preparedness underfunding to Congress.
ASPR at times has taken on tasks that have seemingly little to do with its mission. Last year, HHS directed ASPR to help with the reunification of immigrant children with their families after they had been separated under the Trump administration’s controversial “zero tolerance” policy on illegal immigration.
As the pandemic unfolded this year, Dr. Kadlec fumbled some key decisions in the response, according to government officials. Following a staff request for a disaster-leadership meeting, Dr. Kadlec wrote on Jan. 18 that he was “not sure if that is a time sensitive urgency.”
In a March 19 email, White House economic adviser Peter Navarro criticized Dr. Kadlec for failing to put someone in charge of handling contracts. “I cannot have these kind of bullshit delays at HHS,” Mr. Navarro wrote to Dr. Kadlec. “Your shop is now officially a bottleneck.”
An HHS spokeswoman didn’t directly address the accusation of delays, but said ASPR was required to use a contracting division.
In the interview, Dr. Kadlec denied moving too slowly in recognizing and acting on threats, pointing to early meetings with National Security Council officials and early work repatriating Americans from Wuhan, China, where the coronavirus originated, and from infected cruise ships.
“We’re a work horse, not a show horse,” Dr. Kadlec said in the interview. “We don’t have a brand we’re trying to promote.”
The cruise ship repatriation didn’t go smoothly. In mid-February, 328 Americans aboard the Diamond Princess, a cruise ship with a coronavirus outbreak, were stranded in Japan.
Dr. Kadlec sent a consultant to the country to aid in the repatriation but soon learned 14 of the Americans who were scheduled to fly back and had boarded transport buses had tested positive for Covid-19.
Buses carried Americans stranded in Japan on the Diamond Princess cruise ship on Feb. 17 before they were flown back to the U.S. at Dr. Kadlec’s insistence, despite CDC concerns.
Photo: Carl Court/Getty ImagesCDC officials said the infected Americans shouldn’t fly back with healthy passengers because the disease was highly transmissible. Dr. Kadlec insisted it would be OK for them to fly together, separated by plastic, though top administration public-health experts warned it couldn’t be done safely, according to people familiar with the decision.
In his office late on Feb. 15, Dr. Kadlec spoke by phone with CDC and State Department officials while busses filled with Americans waited at an airport for word.
Dr. Kadlec, raising his voice, insisted that infected Americans should get on the plane, according to several people who witnessed or were briefed on the call. Several passengers on that flight who hadn’t been infected later tested positive.
Dr. Kadlec said any later infections were likely people who were harboring the virus but hadn’t yet tested upon boarding. The official also said the repatriation work in Japan did help because he knew passengers who were infected could be safely flown back without spreading disease if certain precautions were taken.
The HHS spokeswoman said leaving Americans behind at that stage of the operation wasn’t acceptable.
More recently, Dr. Kadlec has overseen shipments of Gilead Sciences Inc.’s remdesivir, the promising coronavirus treatment. Some hospitals initially complained that shipments were failing to reach those who needed the drug most. Some doses spoiled when hospitals didn’t know the medication needed to be refrigerated, according to a senior administration official.
Dr. Kadlec said ASPR didn’t have a good way of collecting data from hospitals on which needed what and when. He denied that any of the drugs were spoiled. The HHS spokeswoman said no remdesivir was wasted.
—Tom McGinty contributed to this article.
Write to Stephanie Armour at stephanie.armour@wsj.com and Alexandra Berzon at alexandra.berzon@wsj.com
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