A timeline of the HIV outbreak, the worst in state history , reads like a roadmap of what to do if you want to create a public health crisis.

Pence slashed state health spending.

Pence first laid the groundwork for Indianas HIV outbreak as a member of Congress back in 2011, when the House passed his amendment to defund Planned Parenthood . Then, in 2013, Pences first year as governor of Indiana, Scott Countys one Planned Parenthood closed in the wake of public health spending cuts. Since that particular Planned Parenthood was also the countys only HIV testing center , there was no longer a place for the countys 24,000 residents to get tested.

Nearly 20% of Scott County residents lived below the poverty line. Injection drug use there was a major problem, increasing the risk of HIV outbreak.

Fast-forward to 2015. Local health officials began to report HIV cases linked to intravenous prescription opioid use in Scott County. Scott County residents were sharing needles to inject their opioids, and nobody was getting tested.

The situation quickly spiraled out of control. At the height of the outbreak, 20 new cases of HIV were being diagnosed each week, reaching a total of nearly 200 cases by the time the outbreak was finally under control.

Pence was dangerously wrong about needle exchanges.

During that time, Pence dragged his feet. Although the outbreak was identified in late January of 2015, it took Pence until April of that year to allow a temporary needle exchange in Scott County. It was a big shift for the governor, who was morally opposed to needle exchanges and believed they promoted drug use.

This position is dead wrong, according to health experts.

People think that if you give someone a syringe, it means theyre going to go out and inject drugs, and if dont give them syringes, they wont inject drugs, Robert Childs, executive director of the North Carolina Harm Reduction Coalition, told HuffPost in 2015.

But the thing is that if you dont give them syringes, they share them, and then people will start getting HIV and viral hepatitis C .

And beyond humanitarian or public health reasons, opposing harm reduction isnt a fiscally sound policy. These are extremely costly diseases, and theres no reason to get them if people can get access to clean syringes an incredibly cheap product, Childs said.

Pence reversed his needle exchange stance for now.

After Pence finally reversed his stance and instituted Scott Countys temporary exchange, four other Indiana counties followed suit , according to the Indianapolis Star.

The program has largely been a success. Over the past year, the syringe exchange program in Scott County has had a tremendously positive and dramatic impact, Dr. R. Kevin Rogers, Scott Countys health officer, told the Star.

But a temporary needle exchange focuses too much on solving this specific outbreak, instead of instituting a permanent public health fix for those who are going to use drugs, Hannah Cooper, an associate professor at Rollins School of Public Health at Emory University, told HuffPost in 2015. Instead, she said, the county needs a permanent program.

This is not a closed environment, Cooper said of Scott County. People can move freely. New infections will come in, and people need to be able to protect themselves.

Pences public health record in Indiana often seems to be overlooked nowadays a frustrating oversight, considering nearly 200 people contracted HIV while Pence twiddled his thumbs over harm reduction and de-emphasized public health spending.

So the question remains: Do we really want to see Pences public health judgement replicated? Our collective health may depend on that answer.

This article has been updated from its original publication in October 2016.