The editors of the Washington Post want a “reset” of the CDC:
How the CDC reached this point is clear. Political pressure and manipulation by the Trump administration early in the pandemic played a role, as has deep polarization in American politics, which has fostered greater skepticism about science and debate over whether public health interventions infringe on personal freedom. But the trouble also lies in how the CDC is structured, funded and directed. These deficiencies can be fixed in the wake of the pandemic, and the CDC could come out of it stronger and more nimble. The nation needs a more robust CDC — not a smaller one, as former Food and Drug Administration commissioner Scott Gottlieb recently called for in a Post op-ed.
They point to a report by the Center for Strategic and International Studies.
Every bureaucracy, public or private, has many of the problems they identify. The larger the bureaucracy the more endemic the problems. Can the CDC by improved? Definitely.
IMO there are three umbrella objectives:
- Focus
- Reduce overlap with other agencies
- Increase accountability
The CDC originally began as a mosquito abatement agency. While I don’t think it needs to go back that far, it should focus more narrowly on domestic public health. It shouldn’t have international programs—that should be under the State Department. It shouldn’t do research or issue grants for research except as it relates directly to public health. Basic research should be within the province of the National Institute of Health. It shouldn’t be in the approvals business—that should be the Food & Drug Administration.
Professional management might help.
I don’t have insider knowledge on how to increase accountability but that’s obviously an issue. The CDC isn’t alone in this regard.
One last observation. If they’re looking for rapid response, IMO they may want to try the military (although I’m beginning to have doubts). Large civil bureaucracies just aren’t built for rapid reponse.
Public health people are used to providing a rapid response. When there is food poisoning or an outbreak of STD, among other problems, they need to track it down quickly. One of the biggest problems facing the CDC was that their leader was not really a public health person, having been selected for political reasons. His boss, our POTUS, did not provide leadership or insist upon accountability. Note that the CDC performed pretty well with Ebola and H1N1.
That said, its size does provide for issues. I think we need to do the following. First, we are more likely to die from a pandemic illness that we are from a terrorist attack. Pandemic preparedness and response needs an important, permanent seat in the Exec. branch. It cant be spread out among other offices. They need to have quick access to POTUS and they need to have funding sufficient to maintain being prepared. Second, CDC needs its own team within CDC. Third, CDC needs to have management with expertise and management of public health issues. The pandemic team should pretty much act as its own division and have immediate access to the CDC Chair.
Steve
I don’t know that I disagree with anything in your second paragraph but I do think that you’re underestimating how stultified a large bureaucracy can come.
I strongly suspect you’d be surprised at how old many of the people in the top echelons of the federal bureaucracy are (hint: they’re no Millennials). I also suspect that if Ebola had spread asymptomatically billions would have died already and we’d already have lynched the head of the CDC. You can’t really compare 2009’s CDC with today’s. There’s been a generation shift.