WASHINGTON — A senior Democratic senator has demanded that President Donald Trump explain why his administration is sending thousands of ventilators to other countries without approval from Congress, questioning whether politics are affecting decisions on international aid to combat the COVID-19 pandemic, according to letters sent Wednesday and obtained by NBC News.
"I write to express concern about the absence of clear guidelines for providing ventilators to foreign countries," Sen. Bob Menendez of New Jersey, the ranking Democrat on the Foreign Relations Committee, wrote in a letter to Trump.
Menendez said the administration has yet to offer "an adequate rationale" for waiving legal requirements to notify Congress about the assistance, and he asked the White House to explain the criteria for deciding which countries should receive ventilators.
In a separate letter, Menendez told John Barsa, the acting head of the U.S. Agency for International Development, or USAID, that he was concerned that the White House National Security Council's influence on decision-making on ventilator assistance "interjects political agendas into how USAID allocates its Global Health and Emergency Reserve Fund resources."
Acting USAID spokesperson Pooja Jhunjhunwala acknowledged that the agency had received the letter and said, "We always work closely and cooperatively with Congress and seek to be as timely and responsive as possible to their requests for information."
U.S. assistance is tailored to each country's needs, she said. "This includes working with frontline workers to slow the spread, care for the affected, and equip local communities with the tools, such as ventilators, needed to fight COVID-19."
The administration has told Congress that it plans to spend about $202 million to buy 7,582 ventilators to distribute to up to 40 countries. Trump's national security adviser, Robert O'Brien, has said the president is committed to donating or selling 14,000 ventilators abroad.
Some career staff at USAID are frustrated, saying public health experts at the agency have been shut out of the deliberations, two government officials familiar with the issue said. The officials said USAID staffers are concerned that poorer countries might need other, more basic items, such as personal protective equipment, more than they need ventilators and that they may lack staff trained to operate the machines.
"There are no criteria," one of the officials said. "This is totally driven by the president and by the White House."
The White House and USAID were not immediately available to comment.
But a senior administration official said the U.S. is providing medical supplies and ventilators to countries that need them, rejecting the idea that the decisions are arbitrary. The decisions are not unilateral but based on conversations between the president and other heads of state, the official said.
"With the United States now on track to produce over 100,000 high-quality ventilators by the end of the July 2020, by far the highest production of ventilators in history, the President continues to reach out to our partners and allies around the world to ensure they can have access to high-quality, America-made, life-saving ventilators to meet their medical needs," the official said.
But some public health experts said ventilators are not the most urgent items for impoverished countries.
"Ventilators are not what lower-income countries need most. They need support for their health systems, personal protective equipment, testing and contact tracing," said Lawrence Gostin, a professor of medicine and law at Georgetown University and head of the O'Neill Institute for National and Global Health Law.
Dr. Craig Spencer, director of global health in emergency medicine at Columbia University Medical Center, agreed. "It's worse than swatting a fly with a sledgehammer," Spencer said, because most poorer countries "need much more basic tools, like running water or a supply of oxygen."
In his letter to Trump, Menendez asked whether the National Security Council "is instructing USAID to procure or purchase ventilators from specific vendors or manufacturers, and whether you, members of your family, or any senior White House officials hold stock or control shares (either directly or through mutual funds) in the companies USAID is purchasing ventilators from."
The Trump administration has come under scrutiny for how it has managed buying and distributing crucial medical supplies inside the U.S. since the COVID-19 outbreak started in January. NBC News has previously reported that senior political appointees made decisions on federal contracts and the allocation of scarce medical resources based in part on personal relationships and partisan loyalty.
Early on in the outbreak, public health and hospital officials worried that the U.S. faced potentially dire shortages of ventilators for critically ill patients, citing Italy as a worst-case scenario where doctors had to ration them. After initially having resisted the idea, Trump eventually used presidential authority under the Defense Production Act to order companies to manufacture large numbers of ventilators.
Critical care doctors, meanwhile, have increasingly chosen less invasive ways to help patients breathe, viewing ventilators as a last resort. A recent medical study concluded that using the machines more sparingly would save the lives of COVID-19 patients. National Institutes of Health guidelines call for instituting a phased-in approach for patients with breathing problems and putting off using ventilators if possible.
'King of ventilators'
In comments at briefings and in tweets since April, Trump has mentioned plans to send ventilators to various countries, boasting that the U.S. is now the "king of ventilators."
"Just spoke to President Juan Orlando Hernandez of the Republic of Honduras. We work closely together on the Southern Border. Will be helping him with his request for Ventilators and Testing," Trump tweeted.
Guatemala, however, was absent from the presidential tweets related to Central America, and the administration has announced no plans to send ventilators to it. Guatemala has more than once suspended deportation flights from the U.S. after dozens of deportees tested positive for the coronavirus upon arriving from the United States.
Guatemalan President Alejandro Giammattei complained about a lack of U.S. aid — and ventilators — last month.
"Guatemala is an ally of the United States, but I don't believe the U.S. is an ally to Guatemala, because they don't treat us like one," Giammattei said May 21 during an Atlantic Council conference via Zoom. "We've seen how they've assisted other countries with ventilators, and we haven't even gotten a dime from them — not even one single mask from the United States. We don't feel appreciated."
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Michael Kozak, the acting assistant secretary for state for Western Hemisphere affairs, told reporters last month that there was no correlation between pandemic assistance and Guatemala's approach to deportation flights and U.S. immigration policy.
"There isn't some hard linkage here between cooperation on removals and ventilators," Kozak said. "We're trying to get medicine and medical supplies to anybody who needs them, including countries that we have not particularly good relations with."
The senior administration official told NBC News that "the Government of Guatemala and the Guatemalan people have no greater friend than the United States.”
“The U.S. Development Finance Corporation previously signed a $1 billion financing arrangement with President Giammattei during his inauguration, and yesterday the State Department announced an additional $250 million for Guatemala and the region to build secure and prosperous futures for their citizens at home,” the official said.