It does not take much to become an exemplary member of Donald Trump’s Cabinet, that august collection of oil executives, alt-right heroes,and pro-wrestling magnates.

For example: If you understand supply and demand, and if you are aware of the role carbon emissions plays in climate change, you have a keener grasp of economics and science than our nation’s own energy secretary.

So while the bar is admittedly very low, in nominating as the next surgeon general Jerome Adams, the pro-needle exchange health commissioner of Indiana, Trump has made a positive, thoughtful choice that appears to be to most everyone’s immediate benefit.

Maybe it’s all an accident, but some accidents can be happy—and these, we can celebrate.

But. Adams may soon inherit an absolute public-health disaster—not of his own making—but one that he should immediately identify and pressure his soon-to-be boss to avoid at all costs.

Adams, 42, was nominated for the post in late June. In some ways, it’s a typical Trump pick, where loyalty, familiarity and continuity are valued above ability: Adams was appointed Indiana health commissioner in October 2014 by Vice President Mike Pence. (As it happens, another former Indiana health official is in a key post overseeing Medicaid and Medicare.)

But, at least on its face, the pick sends a clear message that the Trump administration is taking the opioid crisis seriously and is willing to reward people who buck convention.

Four months after Adams settled into the job of top doc in Pence’s Indiana, a small, rural town near the Kentucky border suffered a major HIV outbreak: 181 cases out of a population of roughly 5,000, caused mostly by intravenous drug users sharing needles.

Pence was criticized for reacting to the outbreak slowly—and for opposing the common-sense solution of handing out clean needles free of charge.

Needle exchanges are a basic strategy in the fight against AIDS, employed to great success elsewhere in the United States for decades, but also opposed by strict moralists like Pence on purely ideological grounds. (Such diehards recommend, with a straight face, to drug addicts that they try abstinence rather than pick up a clean needle from a nonprofit.)

Adams, too, initially held such reservations, but changed his mind—and, with pressure from the Centers for Disease Control and Prevention, managed to use data to change Pence’s mind. (It bears mentioning that needle exchanges have been forbidden federal funding since 1988, back when the Reagan administration was either denying or downplaying AIDS, absolutely allowing the epidemic to spread.)

On Adams’s recommendation, Pence authorized a 30-day emergency needle exchange program, and later signed legislation legalizing needle exchanges across Indiana.

“We wouldn’t have syringe exchange if it wasn’t for him,” said Carrie Lawrence, a public health researcher at Indiana University, in comments to Kaiser Health News.

Considering Pence was willing to risk impoverishing his state in order to pursue morality-based policy, this is bigger victory than most of us realize.

“Dr. Adams navigated the very ideological political environment that was created by then-governor Pence,” Beth Meyerson, co-director of Indiana University’s Rural Center for AIDS/STD Prevention, told Kaiser Health News. “There’s just no doubt the governor wouldn’t have listened to me or listened to the leaders in the legislature, but he would listen to Jerome Adams.”

Trump first had face time with Adams back in November, well before the president backed a plan to eliminate the massive Medicare expansion under Obamacare that’s currently providing healthcare to millions of Americans, including many in Indiana—and, as STAT News pointed out, the impoverished people of Austin, Indiana, where the HIV outbreak was centered, which had been without free HIV testing since 2013, when a Planned Parenthood clinic closed.

It’s not clear whether Adams will have either the principles or the opportunity to challenge the president if his nomination is approved—and it’s also somewhat discouraging to consider that all it takes to become one of the most progressive, solution-oriented members of Team Trump is to value lives over morals and embrace a proven method supported by virtually the entire public-health community.

The job of surgeon general is mostly that of an advocate.

Past surgeons general have used the job to advocate for gun control, against smoking and against obesity. If Republicans in Congress are successful in their quest to quash Obamacare and leave more than 20 million Americans without health insurance, maintaining public health will be impossible. Opioid abuse and HIV infections will worsen. People will die.

No public-health official who takes his or her job seriously would stand for it. In an ideal world, Adams would refuse the job until such time as the Trump “repeal and replace” was abandoned, or at least until it included “replace.”

How deep are Adams’s scruples? We will find out, and we will know by the body count.

You can keep up with all of HIGH TIMES’ news right here.

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