President Trump has been promising the imminent arrival of a vaccine to halt the spread of the coronavirus, the novel germ that has sickened more than 100,000 people worldwide, killed more than 3,400 and is now spreading in the United States.
Federal health officials have repeatedly pointed out that his timetable is off — that it will take at least a year — but his single-minded focus on warp-speed production of a new vaccine represents a striking philosophical shift. For years, Mr. Trump was an extreme vaccine sceptic who not only blamed childhood immunisations for autism — a position that scientists have forcefully repudiated — but once boasted he had never had a flu shot.
At least a decade before Mr. Trump was elected president, with responsibilities that would include nominating experts to lead the nation's health centres, the hotelier and commercial developer was holding forth with great confidence about medical topics.
When an interviewer would note that physicians disagreed with the dim view he took of vaccines, Mr. Trump remained ever ebullient, impervious and dismissive of scientific authority.
Perhaps that bravado was infectious: As a private citizen and celebrity, Mr. Trump was, somewhat mystifyingly, often sought by the media for his thoughts on vaccines. The absolutism of his thundering tweets that disparaged the childhood vaccination schedule — itself meticulously vetted by experts who would, years later, be answerable to him — only hardened.
Now, as his federal health agencies tackle the rapidly morphing coronavirus epidemic and he and his administration come under fire for serious missteps in managing it, Mr. Trump has had to adjust his messaging. He is now all in on a vaccine and the sooner the better, says the man who in 2015 said that he didn't "like the idea of injecting bad stuff in your body."
But in assessing the threat from the coronavirus, he is clearly picking and choosing among the public health facts that he finds appealing, preferring his own judgment to that of experts, as he always has.
The limits of that supreme confidence showed in press briefings last week. Mr. Trump struggled to understand why a flu shot would not also prevent the coronavirus, and why developing a vaccine that would be used on millions of people worldwide needed to be a painstaking process involving clinical trials to prove the vaccines were safe and effective.
Nevertheless, Mr. Trump is telling crowds that the curbing of the coronavirus is on the horizon. At a rally in Charlotte, N.C. he said, "They're going to have vaccines, I think relatively soon."
"When I was growing up, autism wasn't really a factor," he told the South Florida Sun-Sentinel in a 2007 interview. "And now all of a sudden, it's an epidemic. Everybody has their theory. My theory, and I study it because I have young children, my theory is the shots. We're giving these massive injections at one time, and I really think it does something to the children."
At a press briefing about the fund-raiser, Mr. Trump talked about vaccinating his son, Barron, then almost 2: "What we've done with Barron, we've taken him on a very slow process. He gets one shot at a time then we wait a few months and give him another shot, the old-fashioned way."
The assertion that the measles-mumps-rubella vaccine led to autism was based on a discredited 1998 study in the Lancet that was retracted after the claim was rigorously studied and repudiated.
Mr. Trump's concern about the schedule for young children is a common vaccine question that parents raise.
Currently, children receive about 15 shots over the first 18 months of their life — not one massive injection — to protect them against 14 diseases, including diphtheria and measles. The schedule is reviewed regularly by a panel of experts who report to the Centres for Disease Control and Prevention.
Though modern vaccines immunise against more diseases than older ones did, they are far more benign. According to Dr. Sean O'Leary, a member of the American Academy of Paediatrics' committee on infectious diseases, the current schedule exposes young children to about 100 antigens, the toxins that prompt the body to produce immunities.
In the 1990s, toddlers were exposed to about 3,200 antigens from vaccines for just two diseases — smallpox and pertussis.
2009: 'Very dangerous'
From April 2009 through February 2010, about 12,000 Americans died from an influenza strain known as "swine flu," which spread around the globe and infected at least 42 million people. On April 29, Mr. Trump called in to the Fox News show "Your World with Neil Cavuto," during which they discussed the epidemic.
Mr. Cavuto asked if there was a risk of overreaction, including endorsing vaccines that could do more harm than good. Mr. Trump said there was.
"I think the vaccines can be very dangerous. And, obviously, you know, a lot of people are talking about vaccines with children with respect to autism."
Later in the interview Mr. Trump said that if his children got sick, he would keep them at home from school:
"But I don't think I would inject them with all sorts of vaccines that, really, nobody even right now knows if it works with respect to what they're — what they're looking at right now, Neil."
2012: A 'monster shot'
On Autism Awareness Day in April, Mr. Trump called in to Fox and Friends. The hosts noted that most physicians disagreed with his theory that vaccines cause autism.
"Well, it's also very controversial to even say, but I couldn't care less. I mean, I've seen people, where they have a perfectly healthy child, and they go for the vaccinations, and a month later the child is no longer healthy."
He continued: "It happened to somebody that worked for me recently. I mean, they had this beautiful child, not a problem in the world, and all of a sudden, they go in, they get this monster shot — you ever see the size of it? It's like they're pumping in, you know it's terrible, the amount, and they pump this into this little body, and then all of a sudden the child is different a month later. And I strongly believe that's it."
That same year, Mr. Trump was tweeting those views.
2015: 'Meant for a horse, not for a child'
Throughout 2014, Mr. Trump's tweets associating autism and vaccines and challenging the early childhood schedule escalated in intensity and number.
The next year he announced he was running for president.
During a CNN debate among Republican presidential candidates that September, Mr. Trump said he supported vaccinations generally, but again disputed the early childhood schedule and cited a child of someone who worked for him:
"If you take this little beautiful baby, and you pump … I mean, it looks just like it's meant for a horse, not for a child, and we've had so many instances, people that work for me, just the other day, 2 years old, 2½ years old, a child, a beautiful child, went to have the vaccine and came back, and a week later got a tremendous fever, got very, very sick, now is autistic."
A month later, Mr. Trump called in to the "Opie With Jim Norton" radio show. He was asked if he got the flu shot every year. Mr. Trump replied:
"I've never had one and that's why I've never had the flu. I don't like the idea of injecting bad stuff into your body, which is basically what they do."
2019: 'Have to get their shot'
Outbreaks of measles, a disease readily preventable by vaccines, were appearing in pockets across the country and the world last year, reigniting volatile debates about parental choice, child safety and the well-being of the community at large.
In the White House driveway, Mr. Trump replied to shouted questions from reporters about whether parents should get their children vaccinated:
"They have to get the shot. The vaccinations are so important. This is really going around now. They have to get their shot."
In September, Mr. Trump signed an executive order to ensure access for Americans to safe, effective modern flu vaccines.
2020: 'A flu shot for this'
The novel coronavirus had reached the United States, the stock market was quaking, and federal health officials were trying to prepare Americans for a likely epidemic. Mr. Trump, traveling in India, downplayed concerns about the spread back home.
Returning to Washington, he called a news briefing to reassure the public:
"It's a little like the regular flu, that we have flu shots for, and we'll essentially have a flu shot for this, in a fairly quick manner."
At another news briefing a few days later, on Feb. 29, Mr. Trump was asked whether he had, in fact, had a flu shot himself.
"I did," he replied.
On March 2, he met with drug company executives. He told them he had not realised how high the number of flu deaths in the United States was — 34,200 during the 2018-19 flu season, according to the C.D.C.
He asked the executives: "You take a solid flu vaccine — you don't think that would have an impact or much of an impact on corona?"
No, the executives told him, probably not.
Apparently trying to manage Mr. Trump's expectations, Dr. Leonard Schleifer, the chief executive of Regeneron, a biotechnology company, delicately suggested that an essential truth about scientific research is that success is cultivated from a large mound of failed experiments.
"We have a group of people around this table, myself included, who are in an industry where optimism is an essential part of the tool kit," Dr. Schleifer said. "But realism is that, you know, 95 percent of what we all work on doesn't go too far. So we — that's why it's so important to have so many different approaches."
Like other drugs, vaccines go through phases of rigorous trials, first on animals, then on humans, to determine safety and efficacy before they can be approved and disseminated widely. As the executives pitched the efficiency of their companies' vaccine development processes, they discussed how quickly a test vaccine could be ready for initial trials. Some suggested three months, others two.
Apparently Mr. Trump thought they were referring to the time frames for producing a completed vaccine. He turned to Dr. Anthony S. Fauci, director of the National Institute of Allergy and Infectious Diseases, and said:
"I've heard very quick numbers — a matter of months — and I've heard pretty much a year would be an outside number. So I think that's not a bad — that's not a bad range. But if you're talking about three to four months, in a couple of cases, and a year in other cases — wouldn't you say, Doctor, would that be about right?"
Dr. Fauci turned to the executives and officials around the table, and repeatedly tapped the polished wood surface for emphasis. "Would you — would you make sure you get the President the information that a vaccine that you make and start testing in a year is not a vaccine that's deployable. So he's asking the question, 'When is it going to be deployable?' And that is going to be, at the earliest, a year to a year and a half, no matter how fast you go."
The executives said they could have therapeutic medications to ease symptoms ready more quickly, which seemed to assuage the president.
Later that night, at a rally in Charlotte, N.C., Mr. Trump was still heralding the quick arrival of a vaccine to solve the coronavirus problem.
"Today we met with the big great pharmaceutical companies and they're really working hard and they're working smart," he said. "And we had some — we had a great meeting today with a lot of the great companies and they're going to have vaccines, I think relatively soon."
Written by: Jan Hoffman
Photographs by: T.J. Kirkpatrick
© 2020 THE NEW YORK TIMES