Former U.S. Sen. Joseph Lieberman says it was as if Paul Revere rode across the country and no one paid attention.

For more than two decades, Robert Kadlec has warned leaders that the United States is not just vulnerable to a pandemic, but doomed by dysfunction if one were to strike.

Several years ago, his warnings gained traction.

Congress passed a law in 2016 mandating a federal plan to protect against contagious diseases.

In 2018, President Donald Trump adopted a National Biodefense Strategy. It largely followed recommendations of a commission founded and directed by Kadlec, a retired U.S. Air Force colonel and physician who has held senior positions at the White House, Senate and Pentagon.

Kadlec was appointed to oversee preparedness and response at the Department of Health and Human Services.

But the document approved by Trump was a blueprint, not a game plan. The ideas weren't implemented before COVID-19 arrived in the United States. And the federal government’s response shows it.

One example: The federal government has been criticized for taking too long to create and distribute tests to detect the virus. There are shortages of medical supplies and equipment such as protective masks and ventilators. Anticipating such shortages, the biodefense strategy calls for setting up excess manufacturing capacity to produce these necessities quickly in an emergency. 

The same biodefense strategy also called for a Cabinet-level committee to oversee protection against contagious diseases. But it never met to discuss the coronavirus outbreak. 

And the Coronavirus Task Force created by Trump one month into the epidemic did not include Kadlec, the person who had been warning of this sort of catastrophe for years.

Today, the nation’s biodefense network remains a labyrinth, according to the Bulletin of Atomic Scientists, with responsibility shared by at least 19 federal agencies, three executive offices, 50 political appointees and all state, local, tribal and territorial governments. Their roles are codified in a dizzying mix of laws, directives and action plans.

The system is so complex, a Department of Energy lab used its policy-mapping tool known as the “Spaghetti Monster” to illustrate the overlapping linkages.

The National Biodefense Strategy is supposed to untangle that mess. Among its sweeping goals: “Ensure decision-making is informed by intelligence, forecasting, and risk assessment.” And “Rapidly respond to limit the impacts of bioincidents." 

But Lieberman and Asha George, executive director of the Bipartisan Commission on Biodefense, said those objectives have not been implemented.

In February, in the heat of the coronavirus pandemic, the Government Accountability Office concluded the national strategy has “no clear, detailed processes, roles, and responsibilities for joint decision-making.”

Even the administration’s messaging about coronavirus seemed to defy principles of the biodefense strategy. It calls for “timely, regular, coordinated, and consistent” communications to the public.

On the same day this month, Trump downplayed COVID-19, saying it is “something we have tremendous control over,” while his top infectious disease expert, Anthony Fauci, said it could kill hundreds of thousands of Americans.

“It really is a Pearl Harbor moment, and are we going to be able to gear up?” Lieberman asked. “Here we are now, it’s a crisis and maybe going to be a catastrophe. … We’d be in a lot better shape if people had acted earlier.’’

A senior administration official, who refused to be identified because he was not authorized to speak publicly, said the biodefense strategy laid out a single, coordinated effort across the federal government for the first time, and its goals are being implemented in response to the coronavirus pandemic.

The administration official said the steering committee outlined in the biodefense strategy was superseded by the coronavirus task force.

The official said Trump created the biodefense strategy to improve response time in situations like the coronavirus pandemic, and it's working.

20 years of warnings about biological threats like coronavirus

In March 2019, Kadlec told Congress the nation’s biological protection system was understaffed by 2,000 workers. “Emerging disease outbreaks, particularly those with pandemic potential, are an international flight away,” he said.

Ten months later the novel coronavirus broke out of China and traveled halfway around the world to the United States. It was an opportunity to put strategy into action.

Over the years, Kadlec sounded his fears in sometimes apocalyptic scenarios. He could not be reached for an interview for this story.

In 1998, Kadlec envisioned an anthrax assault on New York City. “Conservative estimates put the number of deaths occurring in the first few days at 400,000,” reported the Vancouver Sun. “Beyond the immediate health implications of such an attack, the potential panic and civil unrest would create an equally large response.”

In 2001, Kadlec was at it again, anticipating a genetically modified disease. “It’s not your mother’s smallpox,” he warned. “It’s an F-15 Stealth fighter – it’s designed to be undetectable, and to kill. ... We are flubbing our efforts at biodefense.”

His mission began with the Defense Department in the 1990s. He moved to the White House during the 2000s as director of biodefense on the Homeland Security Council and as a special assistant to President George W. Bush.

Kadlec repeatedly told Congress that U.S. biodefense plans were disastrously flawed. No central leadership. Muddled national strategy. Insufficient money, supplies and manpower to handle a lethal contagion — whether it was naturally occurring or the result of biological warfare or terrorism.

In 2014, he founded a nonprofit organization, the Blue Ribbon Study Panel on Biodefense, to attack the problem as a civilian. Kadlec persuaded Lieberman, an independent and former Democrat, and ex-Homeland Security Secretary Tom Ridge, a Republican, to co-chair the effort.

That panel, later renamed the Bipartisan Commission on Biodefense, completed a scathing report in 2015 and sent it to then-president Barack Obama. “The Nation lacks the leadership, coordination, collaboration and innovation necessary to respond,” the commission wrote.

It proposed a blueprint for biodefense with clearly defined roles and the vice president in charge. It warned that pandemics carry “the possibility of millions of fatalities and billions of dollars in economic losses.”

The report caught the eye of lawmakers. Just before Obama left office, Congress passed a law mandating the creation of a plan.

Trump released the National Biodefense Strategy in September 2018. By then, he had appointed Kadlec as an assistant secretary of Health and Human Services, in charge of preparation and response.

Essentially, Paul Revere was tagged as the point man.

Untangling the nation’s plans for an epidemic

Over the past few decades, epidemics, terrorist attacks and natural disasters have spurred an onslaught of statutes, plans and directives from the nation’s capital.

Efforts to fend off public health threats gained urgency with the anthrax attacks of 2001, when letters laced with the deadly disease were sent through the U.S. mail, killing five and sickening 17 others.

In 2004, after the Severe Acute Respiratory Syndrome (SARS) outbreak, then-president Bush signed a directive that focused on biological weapons and addressed how to contain and treat infectious diseases.

Five years later, following the H1N1 epidemic, Obama issued his own strategy with measures to combat “infectious diseases of natural, accidental, and deliberate origin.”

After Americans who traveled to West Africa contracted Ebola in 2014, responsibility for biodefense was still spread across Washington bureaucracies.

Members of the blue-ribbon panel studied the system for a year, gathering testimony from dozens of experts. They concluded the nation’s risks from biological threats had reached “critical mass.”

The first of its 33 recommendations in 2015 called for centralized command. Kadlec had argued for years that biodefense directives must come from the top — above Cabinet secretaries — and from someone who could take an active role.

“The Nation lacks a single leader to control, prioritize, coordinate and hold agencies accountable,” the commission's report said. “Leadership of biodefense should be institutionalized at the White House with the Vice President.”

Former Homeland Security and Counterterrorism Adviser Lisa Monaco said the Obama administration agreed with the spirit of that recommendation, though not the letter. Near the end of his administration, Obama created a unit within the National Security Council assigned full-time to disease preparedness.

“In 2018, unfortunately, that structure was dismantled,” Monaco said, referring to Trump’s decision to eliminate the White House pandemic office. Monaco is now a member of the Bipartisan Commission on Biodefense and a public health adviser to former Vice President Joe Biden, who’s seeking the Democratic nomination for president. 

Instead of putting the vice president in charge of the biodefense strategy, Trump assigned that role to himself, with National Security Council staff overseeing policy and Health and Human Services coordinating pandemic response.

“That’s a real problem because the secretary of health has absolutely no authority to push other cabinet members,” said Dr. Kenneth Bernard, a former assistant surgeon general who wrote the 2004 biodefense plan under Bush. “That was, I think, a major, major error.”

Coronavirus puts the strategy to the test

Once a biodefense strategy was adopted, it was only a matter of time before it would be tested.

Trump had designated a cabinet-level steering committee to oversee its implementation. But that committee has never met to confront COVID-19 issues.

Instead, on Jan. 29, a day before the World Health Organization declared a global emergency, the president announced a Coronavirus Task Force. That arrangement isn’t mentioned in the Biodefense Strategy.

By Feb. 26, the virus had reached 37 countries outside China and established a foothold in the United States, with more than 50 known cases and countless undiagnosed due to a shortage of test kits.

That day, Trump named Vice President Mike Pence to lead the Coronavirus Task Force.

Jeremy Konyndyk, who served in the Obama administration as director of U.S. Foreign Disaster Assistance, said that seemed “pretty striking.” Although Trump’s biodefense strategy said Health and Human Services would lead the effort, “in an actual crisis the leadership is back at the White House, where it should have been in the first place.”

“We’re playing catch-up,” Lieberman said. “It is really, profoundly disappointing to me.”

The unnamed senior Trump administration official said Pence’s experience as a governor made him a perfect point person as the administration expanded its efforts to combat the virus. The official said before Pence's appointment, the president had already taken a “range of decisive actions reflective of his whole-of-government approach,” including imposing travel restrictions.

Lieberman and George noted that the Coronavirus Task Force is dominated by White House advisers and Health and Human Services administrators, with one name noticeably missing: Robert Kadlec, the federal health official responsible for preparedness and response. However, his boss, Health and Human Services Secretary Alex Azar, is on it.

The Department of Health and Human Services did not respond to questions and an interview request.

On March 2, Kadlec was named to lead Health and Human Services' response.

'Hung up in the bureaucracy'

The next step after creating the biodefense strategy, George said, was to implement it and actually untangle all those laws, policies and duties. That got “hung up in the bureaucracy.”

“It didn’t really work,” she said, referring to the strategy. “I don’t know if ‘dismayed’ is the right word. But I look at what’s going on right now and I just think, geez, there’s so much that could have been done in advance.

“It bothers me that people are going to get sick and die because we didn’t have plans and policies.”

By mid-March, Americans were panic-buying at supermarkets, wiping out supplies of toilet paper and pasta. Major cities shut down gathering places, and some ordered residents to shelter in place.

And, then, another change in the administration’s approach: FEMA was announced as the lead federal agency in coordinating the federal response to COVID-19, something at least one former FEMA official thought would have happened earlier.

The decision came five days after Trump signed a national emergency declaration, and eight weeks after coronavirus was first diagnosed in the United States.

On Sunday, asked on ABC News’ “This Week” why FEMA hadn’t taken the lead earlier and wasn’t part of the coronavirus task force, FEMA administrator Peter Gaynor said he wasn’t going to discuss “what should have been done, what wasn't done.”

“The public health medical mission — that authority lies with HHS,” he said. “My mission, FEMA, prior to this, (was) natural disasters and those catastrophic events that happen. Now it's a different world.”

Amid this turmoil, the GAO completed a review of the National Biodefense Strategy that it had begun in 2018, well before COVID-19 emanated from a wet market in Wuhan, China.

As the disease continues to spread, the GAO said in a report to Congress, “the federal government must take necessary steps to protect the American public. … However, the Strategy is only as good as its implementation.”

Friday, Trump defended the nation’s response to the pandemic: “This administration inherited an obsolete, broken, old system that wasn't meant for this. We discarded that system. ... And we’re very proud of what we’ve done.”

To which Bernard, the former assistant surgeon general, replied: “If it was broken, why didn’t you fix it two years ago?”

Contributing: Bart Jansen, David Jackson, Ledyard Kin