At The Hill Carl Schramm remarks on a report from the Senate Committee on Homeland Security and Governmental Affairs, chaired by Michigan’s Democratic Sen. Gary Peters, on the Centers for Disease Control’s (CDC) performance during the COVID-19 pandemic:
Despite being in the spotlight, the CDC has yet to demonstrate any improvement in stopping recurring waves of COVID, nor has it generated confidence that it can prevent either monkeypox or RSV. Worse, there is concern that mRNA vaccines may be tied to fatal adverse effects. If so, the question of why the Food and Drug Administration and CDC did not require randomized clinical trials for the most recent COVID boosters to establish safety will be hard to avoid.
Thankfully, an extraordinary effort by Sen. Gary Peters (D-Mich.), who chairs the Committee on Homeland Security and Governmental Affairs, may have provided the nation with the next best thing to a commission report. Last week, committee staff delivered a remarkably comprehensive report, 242 pages long, on the government’s response to COVID-19. Its title gives up the game: “Historically Unprepared.â€
This is the kernel of the piece:
Peters, a Democrat, is hard on President Trump. The president’s daily commentary offered little comfort and, more than once, useless, even dangerous, advice. Consider, however, the president was bound to rely on the CDC, an agency that consistently failed to provide him or the public with timely and accurate advice on the nature of the virus or steps that might contain its spread. Dr. Anthony Fauci, the government’s official spokesperson, promoted a constantly changing list of largely ineffective actions. Sanitizing grocery carts did not slow COVID’s spread and some studies say social distancing didn’t help and masking with up to three masks(!) might not have either.
The linked articles on social distancing and masking are interesting, the latter in particular. It could be summarized: “they couldn’t hurt” which is roughly my view. The studies on which the article reliess have a basic flaw: comparing Italy, France, and the United States (which did not adopt masks early on) with China, South Korea, and Japan (which did) does not disaggregate the effectiveness of masks from the heightened immunity due to prior exposure to similar viruses.
I think this passage should be underscored:
Without fundamental reform, it is a leap of faith to believe that the CDC can do a better job with more resources. Peters’ report recalls that past heads of the agency failed to take even the basic steps necessary to have checked the spread of COVID, despite explicit recommendations by previous review panels. Political appointees seldom prove equal to the task of reforming their agencies. Tenured underlings know how to wait them out.
The CDC doesn’t need more money. We need civil service reform, governmental reorganization, and a greater consciousness of the realities of bureaucracies, especially that in a bureaucracy those who are dedicated to the organization itself inevitably gain ascendancy over those who are dedicated to the notional goals of the organization.
I feel I should add that I am less sanguine about the private sector than the author for a simple reason: the federal government likes to deal with big companies and the bureaucracies in big companies have the same issues as those in the federal government.
You have paragraph quoted twice.
I’ll read the report summary when I get a chance, but I still the fundamental problem was that the administrations (both Trump and Biden), pawned-off political decision-making to the CDC to avoid criticism. That’s how the CDC ends up consulting with teacher’s unions and other political actors on the “science-based” recommendations they gave, or suddenly changing recommendations when it became clear they would have a big and negative impact.
The CDC is supposed to be an input to policy decisions, not the decider. Tasking them with making political and social calculations would inevitably corrupt their recommendations and their credibility. They have no expertise in making policy tradeoffs and so it’s not surprising they sucked at it.
The policy decisions should have been handled by the Covid Czar with input from the CDC, all the other stakeholders, and political and social realities. But that wasn’t done because of political cowardice.
Its not even clear to me the CDC is good at being the “input”.
Example, the testing fiasco at the beginning of the pandemic, or taking better part of a year to figure out the vaccines doesn’t give life long immunity.
Andy, I have corrected the duplicated passage. Thanks.
The CDC handled the Ebola crisis very well. Many people went into panic but they didnt. H1N1 was handled pretty well. So the problems, and there were some, were not problems with the thousands of people who worked for the CDC, it was problem with CDC leadership. They had a guy in charge (Redfield) who was chosen because he was anti-abortion and it pleased the GOP base. He didnt have the skills to manage an emergency. He answered to the executive branch which was really where the authority rested in generating any policy at the national level, though most was done at the state level. The executive branch gave mixed messages and didnt remove Redfield when he didnt perform. Note that many states and many locales within state pretty much ignored CDC recommendations. Note that the states with the highest per capita death rates are those that were least compliant with CDC guidelines.
There will be a lot fo resistance to this idea but please note that the people who think the Elon Musk is either able to rehabilitate and rescue Twitter or destroy it are tacitly conceding the importance of leadership and what it can do.
Also, to be fair, this was the first real respiratory pandemic since 1918. You just arent going to be that good at stuff, at least initially, that you only do once every 100 years. Compare our success with other countries and we dont look so bad, especially if you look at states that were more likely to follow CDC guidelines. OWS was pretty much a success in developing the vaccine though no one planned much for distribution.
I am very skeptical that we can address this issue. The CDC leader will remain a politically appointed person. We wont be willing to spend the money to stay adequately prepared. Mostly we will be dependent on whoever is elected to office to determine how well we respond.
Steve
I both agree and disagree with your comment above, steve. I agree that Trump and his political appointees were incompetent, largely because they didn’t understand the law, government, or bureaucracy. I think you overestimate the influence of the political appointees at the tops of large bureaucracies and underestimate the role of the bureaucracy itself.
Like most other things in life it’s multi-factorial. IMO the difference between H1N1 and COVID-19 is instructive. Since H1N1 lots of Silent Generation and Baby Boomers have retired. A lot of those left are not self-starters. They are more inclined to be clockpunchers, prating about work-life balance and quality of life than their predecessors. Coincidentally, they aren’t are prepared to deal with an actual emergency.
As to Ebola I suspect that if it were as easy to contract as COVID-19 and, as is the case with COVID-19, and it didn’t conform to Koch’s first postulate, Ebola would be endemic in the U. S. right now.
I didnt want to write War and Peace, but there are underlying issues. The CDC is mostly set up as a research institution. They arent set up to work fast. That said, with good leadership there are things they could have done much better. S Korea, Germany and other countries had viable tests much faster than we did. That is something which CDC could have done but leadership screwed. They needed to make sure the lab people prioritized speed and didnt try to develop a test for multiple pathogens, with the inherent higher risk of failure.
On messaging they normally have essentially no time limits for what they write. During early covid things changed rapidly and they needed to write quickly.
I think you underestimate the problems from not doing this very often, ie once every 100 years. We might be able to be prepared and function better if we had say 1000 full time staff at CDC who were devoted to prep for pandemics. If those people had the authority to require drills with other members of CDC and with state level politicians and public health officials. If we were willing to devote the money and space to maintain adequate supplies. If we were willing to devote the time and money to maintain adequate personnel, training and space in private hospitals. IOW, if we were willing to spend at least what we are willing to spend on preventing terorism but you know as well as I do that after a few years with no pandemic that spending gets cut or goes to some other project. And, all it takes is for a false alarm or two to have the program cut.
Steve
“The CDC is mostly set up as a research institution. They arent set up to work fast.”
And that’s one of the big reasons why I think the main problem is giving them too much decision authority rather than utilize a task-force construct where they are an input to the process. Someone has to be set up to work fast because a pandemic emergency can’t wait for bureaucratic wickets.
Why? That’s not what its empowering legislation says—it was originally set up as a mosquito abatement agency. It’s pretty strictly a public health agency. The NIH is a research institution. Nearly all of the CDC’s budget is distributed as grants. This sounds like an enormous failure both of executive management and Congressional oversight.
It sounds very much like an egregious example of mission creep. There’s a lot more glamor and potential for lucrative private employment in research than in straight public health.