Shaky COVID response lays bare a decadeslong crisis in government

Focus

Days before Donald Trump became president, Obama administration officials hosted a “tabletop exercise” for the incoming Trump team. One of the hypothetical challenges: dealing with a novel strain of influenza that was sweeping the globe.

Cases were appearing in California and Texas, according to the simulation. It could be the worst flu pandemic since 1918. There would be shortages of essential equipment like ventilators. A “whole of government” response would be needed.

Some 30 Trump appointees attended the meeting. Today, only eight still work for the president, according to a Brookings Institution tally. 

In the rearview mirror, of course, everything can look crystal clear. As President Trump’s former spokesman, Sean Spicer, who attended that January 2017 tabletop exercise, said: “There’s no briefing that can prepare you for a worldwide pandemic.”

Some federal actions have been widely applauded. Mr. Trump’s decision in late January to ban flights from China is one. The president’s initial support for states’ economic shutdowns – and his signing of emergency legislation providing payments to individuals and businesses in an effort to prevent an economic collapse – wins praise even from some critics. 

But other aspects of the Trump administration’s early pandemic response have met with harsh pushback. The U.S. government had been warned in early January of the deadly new virus in China, and should have been better prepared for its arrival on American soil, critics say. When it did arrive, a combination of conflicting messages and a lack of a clear leadership structure delayed the adoption of safe practices to contain the spread, they add.

Even allies of President Trump take issue with aspects of the federal government’s response. “There will be 600-page books on the mistakes that were made,” says conservative economist Stephen Moore, an informal adviser to the president.  

Much has been made of the turnover and turmoil of the Trump presidency – including the 2018 closure of the White House office on global biothreats.

But as the nation’s economy slowly reopens, with cases beginning to pick up again in at least 20 states, and the U.S. death toll now over 115,000 and rising – the highest tally in the world – a larger question hangs over the crisis: Is America’s complex, multilayered system of government itself simply too outmoded – too cumbersome, overly partisan, ill-equipped to keep up with the pace of global change – to capably handle a once-in-a-century pandemic? 

In other words, despite all the stumbles of the Trump team, would another administration necessarily have done all that much better? 

“We have a legacy government that hasn’t kept up with the world around it,” says Max Stier, president and CEO of the nonpartisan Partnership for Public Service. “This is a long-standing problem, but it creates more impact when something really bad happens.” 

History repeating itself

In the perpetual battle to protect the nation from biological threats, Kenneth Bernard has seen history repeat itself over and over. 

Under former President Bill Clinton, Dr. Bernard ran the National Security Council’s office on global health threats, only to see it close when President George W. Bush took office. In late 2001, after anthrax-laced letters were sent to people in 17 states, Dr. Bernard was brought in to reopen the office.

President Barack Obama closed the office and then reopened it when Ebola struck. In 2018, President Trump’s new national security adviser, John Bolton, closed it again, though administration officials say its “medical health preparedness” functions were kept in other parts of the National Security Council.  

A Washington Post fact-check article examining whether the 2018 closing of the NSC biothreats office hampered the Trump administration’s early response to the coronavirus came to no firm conclusion.

But the early days of the pandemic were obviously key. While American governance is by design decentralized, with many decisions left up to the states, the White House plays an essential coordinating role, says Dr. Bernard, an epidemiologist and retired rear admiral in the U.S. Public Health Service. 

“A truly critical pandemic like this, where it affects everyone’s life in America, is by its very nature a federal national problem,” says Dr. Bernard. “What you’re looking for from the White House is leadership.” 

The first head of the White House Coronavirus Task Force was the secretary of health and human services, Alex Azar. But that assignment was inappropriate, says Dr. Bernard, because the HHS secretary has no ability to coordinate departments like State, Treasury, and Defense. 

By late February, Vice President Mike Pence was put in charge of the task force. But in the modern era, the vice president fulfills broad functions, and thus is ill-equipped to operate as a full-time “czar” on a major health emergency, Dr. Bernard says. 

A more effective option, he adds, would have been for the president to appoint a special presidential assistant who focuses solely on the pandemic – someone who can coordinate all the necessary agencies as the anointed presidential representative, as Ron Klain did for President Obama during Ebola. 

One of the most eye-opening aspects of the federal response to COVID-19 has been the apparent sidelining of the Centers for Disease Control and Prevention in Atlanta. Its early test kits for COVID-19 didn’t work. The CDC director, a virologist named Robert Redfield, has not played a major role in public messaging. Technology problems hindered timely collection of data in the early days of the pandemic, as Americans streamed back into the United States from overseas. 

Problems at the CDC predate Dr. Redfield. The agency, once looked to as a global leader on public health, has long been hampered by antiquated technology and a slow-moving bureaucracy that’s particularly ill-equipped to handle a fast-moving crisis. 

“The CDC is the poster child for an undermined, under-engaged workforce,” says Paul Light, a professor of public service at New York University. 

Add to this picture an administration with conflicted views toward science and deep angst about the damage done to a once-vibrant economy. 

“There are legitimate areas where you have to balance the economy and public health,” says James Curran, dean of the Rollins School of Public Health at Emory University in Atlanta and a former longtime CDC official. “We just need to get all the public health facts out, interpreted by the very best minds we have, and if they don’t always do the job, the answer isn’t to shut out the agencies. The answer is to make them better.”

Some Trump allies now believe the economic shutdowns were a huge mistake. 

“The economic costs and the costs of human suffering caused by this lockdown have been multiple times greater than any benefit,” says Mr. Moore. 

Mr. Moore thinks “we could have been much smarter” – limiting lockdowns to the most at-risk areas and populations like nursing homes. He also faults both parties in Congress for making it more lucrative for unemployed people not to work than to work. 

But he doesn’t blame Mr. Trump. 

“There was just a sense of total crisis and fear,” he says. “I don’t think the president had any other choice.” 

A highly politicized system

When crisis hits, conservatives say, the “mission creep” that besets bureaucracies is most evident. Multiple agencies with overlapping agendas can conflict with each other, such as the CDC, National Institutes of Health, and the Food and Drug Administration. 

“It’s axiomatic that an overly bureaucratized government response to anything is going to be a challenge,” says Charmaine Yoest, co-executive director of the conservative Heritage Foundation’s National Coronavirus Recovery Commission.

But challenges to effective governance today are not just in the executive branch; they’re also in Congress and even the for-profit private sector. And they start with a system that is highly politicized and encourages short-term thinking. 

One example: Cabinet departments and other federal agencies are topped by some 4,000 political appointees, and out of those, some 1,200 are Senate-confirmed. 

“No other democracy has anything close to that level of political infiltration in the institution of the government,” Mr. Stier says.

That, in turn, results in a top echelon of leaders who don’t necessarily know what they’re doing, he says. 

In Congress, hyper-partisanship has led to dysfunction in budget-setting, leading the government to run increasingly on a form of funding autopilot known as “continuing resolutions,” punctuated more and more by government shutdowns. Oversight can be ineffective or nonexistent; Senate confirmations slow. 

Adding to the challenge is a half-century decline of public trust in the federal government, as charted by the Pew Research Center. For decades, presidential rhetoric and scandals have made Americans increasingly cynical about government and wary of its messages.

But few presidents over the years have been willing to invest the political capital needed to make major governmental reforms. 

“We haven’t had a major reorganization of government in decades,” says Professor Light. “It just ain’t sexy.” 

Through the decades, Mr. Light has watched history repeat itself many times. Between 2000 and 2015 alone, he counts 48 breakdowns in federal governance, including the Sept. 11, 2001, terrorist attacks and the botched rollout of the “Obamacare” insurance website in 2013. 

The details vary from crisis to crisis, but Mr. Light keeps coming to the same conclusion: We keep having breakdowns, because “we just don’t pay much attention to how organizations work.” 

Early in his presidency, Mr. Trump assigned senior adviser and son-in-law Jared Kushner to overhaul the federal bureaucracy by applying business principles, but the initiative appears to have stalled. 

Historically, significant government reorganizations are rare. Former President Herbert Hoover ran major commissions on reform in the 1940s and ’50s. Efforts by President Jimmy Carter in the 1970s had less impact. In the 1990s, President Clinton tasked his vice president, Al Gore, with “reinventing government,” an effort that reduced the size of the federal workforce by 300,000 people. The 9/11 attacks led to creation of the Department of Homeland Security. 

The Clinton-Gore effort reflected a bipartisan consensus – now defunct – that “big government” was a problem. The technology revolution undergirded the reforms.  

President Clinton felt that “if Democrats wanted to have an activist government, you had to first convince people that government could work efficiently and take care of their tax dollars,” says Elaine Kamarck, who managed the initiative.

Unique strengths and weaknesses 

Dr. Curran of Emory University sees unique strengths and weaknesses in the U.S. as it faces down COVID-19. 

“We’re the wealthiest country in the world, but we also have some of the greatest health disparities,” Dr. Curran says. “And we have the most disorganized health financing system of any major country.” 

The U.S. doesn’t have a national health service, and the entire health community can’t be mobilized to do whatever the government wants. The American public health system is also poorly understood. Yet the U.S. is seen as having some of the best hospitals, specialists, and researchers in the world. 

These paradoxes can be maddening, but they can also be sources of hope. There’s plenty to build on.

In a public health crisis, “assessment and surveillance are a key government responsibility, as is interpretation of the surveillance,” says Dr. Curran, referring to the painstaking collection of data about caseloads. “We’re starting to see more of that from the CDC than we did.”

Dr. Curran sees the current turmoil as an opportunity to think about how the functions of government can be improved to meet public needs. 

“We’re not going to reform totally our federalist system, but we should think about that, too,” he says. “What are the national responsibilities versus the state responsibilities? And that’s not just about health; it’s related to everything else.”

Ms. Kamarck, a senior fellow at the Brookings Institution, has already mapped out three proposals for government reform, post-pandemic. All three, she says, are things the military already does routinely: (1) better scenario planning for potential crises; (2) building more “surge capacity” in personnel to deal with such crises; and (3) applying dual-use principles to health care technology. 

“None of this will happen without competent leadership,” she adds.

It’s worth noting that despite all the breakdowns in governance, there are agencies and employees who make “miracles” happen every day, says Mr.  Light.

Take Beth Ripley, a Veterans Health Administration radiologist in Seattle. When the coronavirus crisis first hit, Dr. Ripley swung into action. She had already developed a network throughout the VA that uses 3D printing to help surgeons. By late March, as the need for personal protective equipment soared, Dr. Ripley had pulled together three federal agencies – the VA, the Food and Drug Administration, and the National Institutes of Health – to rapidly boost stocks of PPE via 3D technology. 

By mid-April, through a quickly organized public-private partnership, face shields and masks suitable for medical personnel had already been designed and were being tested.

It’s the kind of government success story – demonstrating ingenuity, collaboration, and speed – that could turn a cynic into a believer. Now she’s a finalist for a “Sammie,” the annual awards by the Partnership for Public Service honoring outstanding federal employees. 

Mr. Stier, the partnership president, clearly relishes talking about the good news in government at a time of historic challenge. “There are many examples,” he says, “where people can creatively achieve impact in the government.”