Dr. Deborah Birx on Fighting the Pandemic From a Fraught Trump White House: 'I'm Used to Uphill Battles'

The longtime health official spoke to PEOPLE about the pandemic, her time in the White House — and why she didn't speak up more often

President Donald Trump and Dr. Deborah Birx. Photo: Drew Angerer/Getty

When Dr. Deborah Birx was first offered a job at the Trump White House, she refused multiple times before finally accepting the role as response coordinator for the White House Coronavirus Task Force.

She'd been pursued for weeks by her friend Matthew Pottinger, a task force member and President Donald Trump's deputy national security advisor, before she finally agreed, with many hesitations.

"I knew exactly what would happen. I follow data all the time. So I'm like, this is what's going to happen to me: people are going to say horrible things about you," Birx, 66, tells PEOPLE about accepting the job in early March 2020, as the coronavirus was quietly spreading throughout the U.S. and the rest of the world.

"If you say anything positive about Trump, even if it's the truth in that moment, you're going to get killed. And if you say anything negative, you're going to get killed."

But the longtime health official, who has served under multiple presidents and was the U.S. global AIDS coordinator, signed on anyway with one goal, she says: to save lives.

It wasn't long before hard-hitting criticism starting coming from the political left and right, just as Birx had anticipated. During Birx's time on the task force, she came under fire for praising the president in the early days for his ability to process data surrounding COVID-19 and for not doing more after Trump incorrectly (and dangerously) suggested injecting disinfectant to treat the disease. She also became a target of fear and ire as the death toll reached astonishing peaks across the country. (This month, more than two years into the pandemic, more than 1 million Americans have died from COVID-19.)

Though Birx retained her position until the Biden administration took over the White House in January 2021, she says she was in many ways the sacrificial lamb — and treated differently as the only woman on a team of men. "I think they needed somebody both on the right and the left to blame for the [pandemic] response," she says. "But the response is still off the rails."

Birx joined the coronavirus task force not with a political agenda, but with the sole desire to help combat a global crisis, she says. She approached the writing of her book, Silent Invasion, out last month, with the same solution-focused pragmatism. The almost-500 page tome is Birx's in-depth look at the critical missteps — and some bright moments of success, like vaccine development — of the Trump administration, the CDC (along with other health organizations like WHO), the current Biden administration and her own performance as response coordinator.

In her book, Birx illustrates how deadly it was that the Trump administration didn't recognize the importance of asymptomatic spread. She's also critical of the administration's early handling of testing, the lack of coordination with the private sector and the CDC's reluctance to adapt its plan and procure relevant data. In Silent Invasion, Birx reveals just how untenable her position was and, more importantly, what changes need to happen in order to win against the COVID-19 pandemic.

"The fact that we can't see our own flaws as a nation and admit to ourselves that we had the wrong plan [is one of the pieces] I wanted Americans to see," says Birx, who explains that giving more money to health organizations like the CDC "to execute a plan that has already failed us will result in more failure."

"I really wanted people to see that this wasn't a money thing. This wasn't just a who's in the Oval Office thing," she continues. "These are systematic failures that we created ourselves."

Birx hopes her book will inform Americans so they can "force these institutions to change so that we're all better protected."

Fighting Trump's belief: "No one really knows, so nothing matters."

When Birx first entered the White House in early March 2020, she was alarmed by the lack of data and immediately started battling the misconception in the White House and CDC that COVID-19 was similar to the flu, in both danger-level and how it spreads. But at least the president was willing to act on the data the task force was presenting — until that door shut in her face forever in April 2020, she writes.

Birx says she "never really had time" with Trump to fully discuss the disease or how to navigate the pandemic. (In an anecdote that made headlines before her book's release, Birx recounts having less than 30 seconds with the president during their first meeting in early March 2020, before he disregarded both her and the facts she was trying to present. Then he switched the TV channel.)

Despite their short first encounter, days later Trump announced a ban on travel for many people from much of Europe. Birx and others on the task force, CDC director Robert Redfield and Dr. Anthony Fauci, also encouraged Trump to recommend a partial-shutdown, called the "15 Days to Slow the Spread" campaign, followed immediately by a 30-day extension. Then everything shifted for the worst, Birx explains.

Just days after Trump had announced the 30-day extension, he told Birx it would never happen again, she writes in Silent Invasion.

" 'We will never shut down the country again. Never.' President Trump's tone was emphatic, edged with agitation," Birx recalls in her book. "Furrowing his brow, he concentrated his full attention on me. His pupils narrowed into hardened points of anger."

Dr. Anthony Fauci and Dr. Deborah Birx. Tasos Katopodis/Getty

This was a drastic change from early March, Birx explains to PEOPLE.

"Early on, I think the data and the information was convincing him and senior leaders in the White House that their approach of [COVID-19 being] low risk to Americans and treating it like flu, which was the CDC model, was a mistake," she says.

"And so I think we were able to move the White House to a new place," Birx continues, referencing the travel ban and "Slow the Spread" campaigns. "But after that disinfectant moment and after the CEA [Trump's Council of Economic Advisers] memo that went to the president that implied that I was completely wrong in my analysis and numbers, I think the president was like, 'Okay, no one really knows, so nothing matters.' "

During the last year of his presidency, Trump was roundly criticized for at times downplaying the pandemic and openly questioning the effectiveness of other preventative steps like wearing face coverings. But he also proudly touted vaccines and encouraged vaccinations because of his administration's focus on developing them through Operation Warp Speed in 2020.

In November 2021, top public health officials revealed how Trump's administration hindered efforts to communicate and provide guidance to the American people during the COVID-19 pandemic.

Documents collected and interviews conducted by a House committee investigating the coronavirus crisis "have shed new light on the persistent pattern of political interference in the pandemic response by Trump White House officials and political appointees," the committee said in a statement at the time.

The battle against misinformation — and why Birx didn't speak up more

As she recounts in Silent Invasion, Birx was constantly walking a tight rope.

Birx says she never saw Trump in full-blown anger like reports and other White House staffers have recalled in their own memoirs. But she also couldn't approach Trump — who she says believed the last thing that was told to him, be it fact or fiction, and would go on to spin a campaign of misinformation about the extent and impact of the pandemic — with the best plan to combat the pandemic in the same way she would with any other president.

"I was standing on constantly shifting sand, among political players I didn't know and a president who apparently liked his news served good and upbeat, or not at all," writes Birx of her first days on the job. "The right approach here would be as important as the right pandemic response plan — perhaps even more so."

To compound the difficulties of working in the White House, she was facing a swirl of misinformation about COVID-19 that was generated by staffers and perpetuated by the president. Birx soon realized she was also being targeted.

During his presidency, Trump falsely claimed multiple times that children are "virtually immune" to COVID-19, per The Atlantic. On July 4, 2020, he wrongly stated that 99 percent of COVID infections are "totally harmless," per the outlet.

"I'm used to uphill battles," Birx tells PEOPLE. The problem in the Trump White House was that, unlike every experience she'd had before in public health, people couldn't agree on the data.

"People were cherry picking data and cherry picking analyses," she remembers. "So, that was the most difficult piece: tracking down and trying to correct numbers, while at the same time you're trying to battle a pandemic."

Critics questioned why Birx didn't speak out against the president when he would say wildly incorrect statements, such as when he stated on June 17, 2020 that the pandemic is "fading away. It's going to fade away," just before a second spike in infections began, according to The Atlantic.

"Could I have done that?" Birx says of speaking out to the media. "I could have done that once, but then I wouldn't have been able to make the changes that I was able to make in our response, which I think saved literally hundreds of thousands of lives."

Vice President Mike Pence and Dr. Birx. Drew Angerer/Getty

Support from surprising allies

Despite being denied access to the president, Birx made trips to 44 states throughout the country to speak with governors and better the government's response to the pandemic, according to Silent Invasion.

She did so with the support of Vice President Mike Pence and Jared Kushner, Trump's son-in-law and senior adviser. She explains that while President Trump and his aides were sending out messages that downplayed the pandemic, the task force was getting important work done behind the scenes.

"I didn't know them at all. I don't know why they believed me or trusted me, but they did," says Birx of Pence and Kushner. "And I think that alone made it possible to save lives because that's how we got The Defense Production Act done. That's how we got testing expanded. That's how we got therapeutics out. And that's how we got vaccines moving so quickly."

Pence and Kushner's support didn't protect Birx from being attacked by other staffers like Mark Short, Pence's chief of staff, Scott Atlas, a radiologist who had Trump's ear, and Trump's chief of staff Mark Meadows. In Silent Invasion, she recalls often being called a "b----", while both she and Fauci, the White House chief medical adviser, were called "Dr. Doom."

"I believe that I was held to a very different standard than my male colleagues," Birx says of the way she was treated in the White House. "But I found that throughout my whole life."

She says that sometimes insults were said directly to her face, but more often they would be fed to the press.

"Even the press would use derogatory, particularly feminizing weak adjectives like, 'Dr. Birx was distressed,' " Birx recalls. "I'm never distressed. I can be mad, but I am never distressed. I mean, if Plan A fails, I always have a B, C and D. So, I'm never distressed."

The pandemic continues

Even though Birx's book is in part a defense of the decisions she made in the White House, she says her focus isn't on her reputation. Instead, she's concerned that many Americans continue to die, despite having vaccines, "better therapeutics" and even more tests.

"We're still losing way too many Americans. We're still underplaying the pandemic," she says. "Every time we get close to an election, people underplay the pandemic. The pandemic is here. It's predictable."

Birx says that government and health officials know enough about surges, variants and how the virus interacts with the human body to combat it. "We have the tools to confront it in each one of its actions and we're not using them effectively," she explains.

She says that vaccines are only one layer of protection and the full consequences of long COVD aren't known. Mild infections shouldn't be trivialized, she argues. Birx believes that the federal government and CDC could be doing more to fight the pandemic now.

"Until we figure it out, we should be using every hospitalization and every death as a failure of the system," says Birx. "And when you do that, you figure out how to implement the solutions that change that. Will we get to zero? I don't think so, but we can get very close."

Silent Invasion is on sale now.