INDIANAPOLIS (AP) — President Donald Trump’s choice of Vice President Mike Pence to oversee the nation’s response to the new coronavirus threat is bringing renewed scrutiny to the former governor’s handling of an HIV outbreak in southern Indiana when he was governor.

Pence reluctantly agreed to authorize a needle exchange program in Scott County in March 2015 after the epidemic centered there saw the number of people infected with HIV skyrocket, with nearly 200 people eventually testing positive for the virus that year.

Despite his own misgivings — Pence worried about how the exchanges would affect “anti-drug policy” and had misgivings about providing clean needles to addicts — he initially issued an executive order allowing one in Scott County before later signing a law allowing the state government to approve them for counties on a case-by-case basis.

Greg Millett, director of public policy at amfAR, the Foundation for AIDS Research, said Indiana’s HIV outbreak would have been “entirely preventable” if Pence had acted earlier in response to data that was available to Indiana public health officials and clearly showed an outbreak was imminent.

The outbreak primarily infected intravenous users of the painkiller Opana in an impoverished, rural area with few health resources. The needle exchange Pence finally approved for Scott County successfully curbed the epidemic’s spread by providing clean needles to IV drug users to reduce needle-sharing that spreads HIV, hepatitis C and other diseases.

Millett said Scott County had averaged five new HIV cases annually between 2004 and 2013, but between November 2014 and Jan. 11, 2015, it suddenly saw 13 new cases in just over two months.

Quick implementation of a needle exchange program could have stopped that escalation, but new cases continued to surge without one, he said.

“This would have been entirely preventable if Indiana had acted fast with a syringe exchange,” he said. “To have some 200 people become infected over such a short time period was unprecedented.”

Millett, who worked as an epidemiologist with the Centers for Disease Control and Prevention between 1999 and 2013, doing HIV research, said the CDC later determined that Indiana’s outbreak resulted in infections that will amount to $100 million in health care costs — expenses he said could have been reduced or avoided by a quicker response.

Despite his reservations about Pence, Millett said he’s encouraged by the vice president’s announcement Thursday that Debbie Birx, the administration’s global AIDS coordinator, will serve under the vice president as the White House coronavirus response coordinator. Millett called Birx an effective and respected public health leader.

“She’ll bring in people who are experts in infectious diseases who can mount an effective response,” he said.

But Steven Thrasher, a Northwestern University journalism professor who has studied Indiana’s outbreak as part of his research into HIV and LGBTQ health issues, said Pence’s response as Indiana governor raises real questions about whether he’s the best person to helm the response to the virus.

Thrasher said that while HIV cases were mounting in Scott County — which lies about 30 miles (48 kilometers) north of Louisville, Kentucky — Pence told local officials wondering whether he would approve a needle exchange “that he was going to pray on it.”

“His background shows that he brings religion, a lack of science and a budgetary mindset to public health matters. In a time of emergency, those are not the safest ways to be approaching what could become an epidemic,” Thrasher said.

Pence’s office, when asked for comment, referred a reporter to a former Indiana government worker, Joey Fox, and the Surgeon General’s office, which did not immediately return a request for comment.

Fox, who was legislative director for the Indiana State Department of Health during the HIV outbreak, said Thursday that the criticism of Pence is unfair because Indiana’s response to the HIV outbreak went far beyond just authorizing a needle exchange program.

Fox said the state’s response included bringing HIV testing to the small city of Austin — the community at the heart of the outbreak — at a “one-stop-shop” office where the county’s needle exchange was initially based.