When Vice President Mike Pence was governor of Indiana, he apparently missed the chance to prevent most of the 215 HIV cases diagnosed during the 2015 outbreak among people who inject drugs (PWID) in Scott County. The HIV infection cluster was first detected among PWID in the county in November 2014 and peaked at about 126 cumulative people around January 2015, according to researchers. Pence’s response, including granting temporary permission for the establishment of a syringe services program, began two months later. Several years earlier, local public health leaders had warned of expanding opioid use in Indiana and an emerging hepatitis C virus outbreak in Scott County. The HIV outbreak could have been limited to an estimated 56 or fewer people if Pence’s administration had taken action in January 2013 or to 10 cases or fewer if a response had been initiated in April 2011.