Not being Donald Trump won’t be enough.
Not being Donald Trump won’t be enough.
P resident-elect Joe Biden will take office this week in the middle of an enormous public-health and economic crisis not of his own making. Our country is in an exceptionally difficult phase of that crisis now, with around 200,000 newly reported cases and several thousand reported deaths from COVID-19 each day. A new variant of the virus may soon yield another surge in caseloads just as the current wave recedes. And we are also in the middle of a massive and complex mobilization of vaccination capacity and reach. There are a lot of problems to fix, a lot of things to do better, and a lot of challenges and setbacks yet to come.
But to succeed in taking on all of that, Biden and his team will need to see that the crisis is not really of his predecessor’s making either. They will confront a powerful temptation to blame the assorted failures and inadequacies of the federal government’s response efforts on Donald Trump, and to define themselves in opposition to what the Trump administration has done. But that temptation could easily obscure more than it reveals about the best path forward.
Some problems have surely been distinct to Trump. A president with no attention span, no capacity to admit mistakes or learn from them, an inclination to imagine that problems can be talked out of existence, and a tendency to mistake loyalty to himself for competence and ability is going to get a lot of things wrong. But by now, neither the federal public-health response nor the vaccine effort are really being led or shaped by Trump personally in any meaningful way. The problems these efforts face are problems that Joe Biden will not be able to overcome simply by not being Donald Trump. Some are inherent to the pandemic itself, and to any massive effort to mobilize resources in our society. And some are functions of inadequacies in the federal public-health bureaucracy that did not start with Donald Trump and will not end with him.
That means that rebranding (as the Biden team is apparently planning to do with Operation Warp Speed) isn’t really going to achieve much, and that the new administration should be careful about claiming that they’ve got a formula for fundamentally transforming the vaccine-delivery effort. A massive mobilization of the sort being undertaken here is inevitably ugly when looked at close up and in real time. There is no way around that. For people waiting for their turn to get a shot, or watching plans crash into reality, it all seems like a colossal screwup, even if in retrospect it will look to have been the most effective public-health mobilization in our history. New leadership can’t really overcome that basic fact.
The Logic of Logistics
Biden’s people surely know this, and some of the signals they’ve sent about their plans reflect that understanding. Even as they rebrand the vaccine-distribution effort and insist that they are inheriting a terrible mess, they are hinting that they basically expect things to continue on their current path.
The Biden transition team has put forward a goal of delivering 100 million vaccines into arms by April 30 — a pace of about a million doses a day. They have done their best to make that goal seem very ambitious, but it’s pretty much the pace that the rollout effort has already reached. More than a million vaccine doses were delivered into people’s arms in the United States on both Thursday and Friday of last week, for instance, according to Bloomberg’s superb vaccine tracker. It’s also roughly the pace achieved in delivering the flu vaccine at the peak of the flu season in each of the past few years. Sustaining this pace for three months would be no simple matter, of course, but absent major setbacks it would be achieved by the system already getting put into place. In fact, given the investment already made in mobilizing delivery capacity, there’s every reason to think that goal will be significantly surpassed. “Avoid major setbacks” is a good goal, but not a particularly ambitious one. It suggests that Biden’s team understands the constraints it will face. And this is good. Let’s reach that goal.
But on the other hand, the incoming team has also hinted at plans to relieve the logistical challenges confronting states and vaccine providers that envision a role the federal government will have trouble taking on. Describing the Trump administration’s effort as a “dismal failure,” Biden himself last week said his administration will break bottlenecks at every level to speed things up. Many of the examples he pointed to (such as “encouraging states to allow more people to get vaccinated beyond health-care workers and move through those groups as quickly as they think we can”) are things the existing federal response has already been pushing. But others vaguely hinted at the notion that federal dollars will dramatically and quickly transform the character of the mobilization effort.
In massive logistical efforts like this, there is a natural tendency to assume that more money will relieve bottlenecks, but this is rarely simply true. The Biden team has unveiled plans to ask Congress to invest more money in the vaccine-distribution effort, and this will surely help in some respects. But the states face challenges rooted in shortages of “space, stuff, and staff,” which don’t simply have to do with a lack of money. They are the eternal challenges of mobilization — the same sorts of challenges our country has faced at every stage of the pandemic response. And in some respects, a huge influx of money, just like a huge influx of vaccine doses, can create bottlenecks itself and not just relieve them. The dollars Congress appropriated in the last relief legislation have barely gotten out the door yet, and new money would take time to reach its targets too, which should shape how public officials talk about what it can achieve. Bottlenecks will be overcome, and the vaccine effort will clearly be a huge success, but it will take time and trial and error, and as that’s happening it won’t look like success.
“We’ll do it vastly better than they did” probably isn’t the right message to be leading with on this front. As the vaccine effort reaches into the general population, huge numbers of Americans will become eligible for vaccination but not at first able to obtain it where they are. The new administration should prepare the public for this unavoidable reality that will define the coming months. Otherwise, they will find that their promise of a new path creates intense frustration that undermines their credibility.
Federal Dysfunction
But an even more complicated challenge for the new administration will be the fact that some of the most serious difficulties we confront in both containing the spread of the virus and vaccinating the public have resulted from failures of the public-health bureaucracy, which cannot reasonably be attributed to Donald Trump. An approach that implicitly attributes all past failures to the outgoing president and his political appointees will tend to be defensive of that bureaucracy in ways that could make it difficult to deal with some serious problems.
There has been a tendency both in the press and in public-health circles to treat those failures over the past year as resulting from political interference in the work of the federal public-health system. The Centers for Disease Control and Prevention is the gold-standard in public-health policy, we have been told, but it hasn’t been allowed to do its job. I wish that were true, but the evidence simply doesn’t support that narrative at all. The fact is that the CDC, the federal government’s lead public-health agency, has been utterly dysfunctional throughout this crisis and has made one horrendous and mind-boggling mistake after another, at enormous cost in lives, time, and resources.
It was the CDC, out of some bizarre combination of bureaucratic inertia and arrogance, that set the U.S. back in the race to deploy effective testing for COVID-19 at the outset of the pandemic last year. We have never really recovered from that first awful blunder. And the story of how it happened, which is not a story of political interference, lays bare a set of inexcusable incapacities and failures that still afflict the agency’s work on the pandemic.
The CDC has also consistently failed to provide up-to-date, usable data on the spread of the virus and the state of the U.S. health-system response. Collecting and disseminating such data is absolutely key to the agency’s purpose and function, but the CDC has done that work inexplicably poorly. Even now, a number of academic and even journalistic data-collection efforts provide far more useful data than the agency has been able to offer.
And this fall and winter, the CDC has undermined the effort to quickly vaccinate the American population — taking too long to develop prioritization criteria and then coming up with a set of recommendations so politicized and convoluted that they have already had to be abandoned in favor of relatively simple and commonsense prioritization by age.
In this process, politicization has meant not interference from political appointees but the confusion of vaguely progressive priorities — however noble or high-minded they might be, a debatable point in itself to be sure — for public-health expertise. The delays and confusion this caused kept states from getting their distribution plans together quickly. And subsequent efforts to blame these failures on elected officials or the Operation Warp Speed leadership have amounted to embarrassingly transparent CYA efforts that even the journalists recruited to convey them have been unable to take seriously. This story in Friday’s Wall Street Journal is a classic example.
The even more painful truth underlying these failures is that they are really nothing new. Obviously, there are many good and capable people at the CDC, putting their expertise to work on behalf of the American public under difficult conditions every day. But the agency as a whole has long been dangerously dysfunctional. I saw this close up as a White House health-policy staffer 15 years ago, and it has only gotten worse in the intervening years.
No one who witnessed the CDC’s catastrophic fumbling of the effort to develop and deploy a test for the Zika virus in 2016 could have been surprised by its almost identical failures on the testing front in this pandemic.
No one who has followed the two-decade, bipartisan effort to get the CDC to modernize its data collection and dissemination could have been surprised by the agency’s excruciating failures on that front in this crisis. Back in 2006, in response to pressure from a pandemic-preparedness task force we in the Bush White House launched, Congress enacted the Pandemic and All-Hazards Preparedness Act. Among its provisions, the law required CDC to
establish a near real-time electronic nationwide public health situational awareness capability through an interoperable network of systems to share data and information to enhance early detection of, rapid response to, and management of, potentially catastrophic infectious disease outbreaks and other public health emergencies that originate domestically or abroad.
The simplest way to describe the CDC’s response to this binding legal mandate was that it just ignored it. It did nothing.
Four years later, in 2010, the Government Accountability Office reported that the agency had failed to comply with the law. Even in 2017, when the GAO took another look at the question after Congress repeated the mandate in a reauthorization of the law, it found no meaningful progress and concluded that CDC continued to “lack an effective tool for ensuring that public health situational awareness network capabilities have been established in accordance with all of the requirements defined by the law.” (Joel White and Doug Badger offer a great overview of this multi-decade fiasco here.)
Basically none of this can really be chalked up to political interference. In fact, CDC’s operational dysfunctions are in part the result of almost the opposite problem, which will make them particularly difficult for the Biden administration to take on. Part of the difficulty has to do with the character of the public-health profession, which has long been a strange amalgam of communicable-disease science and progressive social activism. Since the United States thankfully doesn’t have to deal with horrible plagues most of the time, the field leans in the direction of activism most of the time. When a plague does come, the profession naturally finds that some of its muscles have atrophied.
But at least as big a problem is the CDC’s peculiar relationship to the rest of the government. The agency is too isolated from the politically appointed leadership of the Department of Health and Human Services, and this has kept its culture too insular and even oppositional — simultaneously leaving it undefended against political intrusion and irresponsible to political oversight. The CDC is located in Atlanta, not in Washington. Unlike the people who run the FDA, NIH, and pretty much every subagency of the Department of Health and Human Services, the CDC’s director is not a Senate-confirmed official, for reasons that no one seems able to explain. And below the appointed director there are only about five political appointees in the entire agency at any given time, overseeing about 20,000 career government employees.
The result is not professional neutrality but bureaucratic dysfunction. That’s because political appointees in federal agencies are not ideological compliance czars but essential two-way conduits between the sources of public accountability and the sources of professional expertise in government. They represent the agency’s views and priorities to the president’s senior team at least as much as they convey the president’s views and priorities to agency staff, and in both cases they perform an essential function that strengthens the agency they work in. Obviously political oversight can go too far. But it is no less obvious that a shortage of it can be debilitating, and the CDC has long been the prime example of that particular form of management failure at the federal level.
This presents an enormous challenge to the Biden team, because in order to improve the government’s performance in its fight against the virus, and in order to draw lessons from the past year too, they will need to aggressively take on the deeply rooted failures of the CDC. And yet they will face a powerful incentive to treat those failures as functions of Trumpist political interference. Seeing beyond that shallow impression will require real work and an in-depth understanding of the federal health bureaucracy.
The Need for Serious Leadership
There are clearly people on Biden’s team who have such understanding and experience. But some of the leading figures he has named so far should raise alarms for those who want to see his team succeed in this effort. The most alarming figure is, unfortunately, also the most senior official on that team: Biden’s proposed HHS Secretary Xavier Becerra.
Becerra has been California’s attorney general since 2017. Before that, he served in the House of Representatives for more than two decades. He’s not a political neophyte, to put it mildly, and by all accounts he is an able and intelligent man. But he is also a radical progressive social activist with essentially no experience in health care, public health, or human services and with very little experience with the department he has been nominated to run. His most direct experience with HHS has involved suing the department to weaken religious-liberty protections extended over the past four years.
His nomination is presumably a sop to progressive activist groups. That would be an understandable, if still irresponsible, move in normal times. HHS has a lot of say over social policy, and you can see how a friendly secretary would appeal to the Left’s activists, and how a president who might strike those activists as too moderate would want to give them a serious prize.
But these are not normal times, and Becerra does not seem well-equipped to lead HHS through the extremely difficult year ahead — as the nation gets through a dark winter surge in spread and mobilizes to vaccinate as many Americans as possible. His lack of experience with the issues involved means he is likely to face a steep learning curve. His unfamiliarity with the immense HHS bureaucracy suggests he does not come in with strong or informed views about how to handle a challenge like the CDC’s incompetent pandemic response. And his political profile will make it difficult for him to be the face of the vaccine drive.
The very people most inclined to view Becerra as a threat to their churches, civic institutions, and ways of life are those who may need the most persuading about the safety and value of the vaccine. His leadership of the department could easily be a positive hindrance to the work to be done. There are surely other important and influential jobs Becerra could hold in the new administration. At this moment of crisis, HHS is simply too important to be treated as an ideological prize.
Most Republican senators are likely to reject Becerra’s nomination anyway. His history of hostility to religious liberty, his extremism on abortion and related issues, and his attitude toward the civic sector more generally are reasons enough, as NR’s editors have well argued. I would certainly have opposed Becerra’s nomination even if there were no public-health crisis.
But his unsuitability to lead the department in this moment of grave crisis in particular should trouble Democrats no less than Republicans. His appointment is very much at odds with the Biden team’s otherwise serious approach to the pandemic. Generally speaking, senators should be willing to give the president the cabinet he wants, but there are exceptions. There is a reason the Senate has a consent and oversight function in this area, and this nomination is a great example of that.
The Senate should reject Becerra and give the new president an opportunity to appoint a leader for HHS who is suited to the gravity of this moment, even if only on a temporary basis. The long-serving NIH director Francis Collins, for instance, would make an ideal HHS secretary through the end of 2021. His expertise and his regard for the expertise of others, his manner, his experience running a complex bureaucracy, and his reassuring and moderate public profile are exactly what the nation needs at the moment. There are bound to be other promising candidates too.
Biden’s incoming team faces an immense and complicated challenge. As they take it on, they should have the sympathy of every American, and they deserve some patience and some slack as well. Many of them are experienced, serious, and public-spirited people who are well positioned to succeed. But they deserve honest criticism and pushback too. Let us hope they can make the most of both, for the country’s sake.