Over at ABC News, Matthew Mosk tells the story of the huge government-wide pandemic-preparation effort of the George W. Bush administration in 2005-06.
As a White House health staffer in those years, that work took up an enormous amount of my time. We produced a general strategy document, a more detailed implementation plan, and a number of follow-up documents, ran several table-top exercises with senior officials to get a sense of the decisions they would confront in a major outbreak, and worked with Congress to fund various stockpiles and preparation programs, at least for a few years. I learned (and have since forgotten) more about ventilators than I ever imagined there was to know.
Bush’s speech at the release of our first report in November 2005 is worth watching now. It is eerily relevant, and takes up many of the major points you’d want to raise today. In retrospect, those very serious preparations (backed and funded by a bipartisan group of pretty engaged members of Congress) got a lot right, though there is no question that if America had faced a pandemic back then we would also have been overwhelmed and gotten a lot wrong.
One way to interpret a story like this is as a rebuke of the leaders who followed Bush, and who didn’t keep up this work or even really retain what their predecessor had done. But I read it differently. I think it is better understood as a story about the immense array of problems and threats that every president has to face, and the enormous difficulty, indeed near-impossibility, of being prepared for freak events.
The fact is that many of us involved in the Bush-era effort wondered why we were doing it, and whether it was a good use of time and energy. Fran Townsend, who was Bush’s chief Homeland Security advisor, has this to say in that ABC story about her first reaction when Bush approached her about pandemic preparedness:
“My reaction was — I’m buried. I’m dealing with counterterrorism. Hurricane season. Wildfires. I’m like, ‘What?'” Townsend said. “He said to me, ‘It may not happen on our watch, but the nation needs the plan.'”
I have to admit that a lot of us more junior folks involved in the effort had the same sense. The work was very intensely driven by Bush himself. He had read John Barry’s then-new book The Great Influenza, about the 1918 Spanish Flu, and was focused on the challenges an outbreak like that would pose to a modern government, and on the sorts of hard decisions he as president would face if it came.
That attitude, that sense of profound personal responsibility for decision-making in a crisis, is one of the things that stands out most to me about Bush, particularly now in retrospect. It was enormously impressive. But to those of us at a much greater distance from that personal responsibility, the focus on pandemic preparedness was hard to understand. We were doing a huge amount of work to be ready for one particular sort of danger that didn’t seem any more likely than a very great many others that could just as easily arise unexpectedly. In retrospect, for instance, thinking harder in early 2005 about the problems that could result from a major hurricane striking a major city would have been useful too. And there are all sorts of other contingencies we might have prepared for.
There wasn’t a major global pandemic in 2006 or 2007, as we feared there might be. There wasn’t one until 2020. So in the interim, two administrations left the Bush-era preparations to the side and went on to other priorities.
It’s easy now to say that was reckless. But I think a more reasonable reading of the evidence is that it’s practically impossible to guess correctly about what sudden emergency our government will need to be prepared for, and it makes sense to gird for the unexpected and build as much all-purpose mobilization capacity as reasonably possible. More than anything, it’s a lesson in how difficult and daunting the president’s job, regardless of who occupies the office, really is.