Our public health agencies will probably manage the next pandemic as ineffectively as they managed this one

Last update: Tuesday 2/28/23 

The editor of this blog earned a PhD in planning from one of the nation's leading universities. His studies alerted him to the benefits of strategic planning as well as to its inescapable limitations when there are fundamental disagreements within a society as to which goals are the most important to achieve.  In democratic societies, like the U.S.,  disagreements about fundamental goals are resolved by political compromises, with deference given to the goals of the leadership groups that gained the most votes in the most recent elections, deference but not blind acceptance. But in autocratic societies, like China and Russia, disagreements are resolved by strict adherence to the diktats of the elites currently in power; dissent is not tolerated.

Before proceeding further, let's be clear that we are not using the term "pandemic" as defined by epidemiologists, e.g., involving multiple countries. As used in this discussion, "pandemic" means the spread of an infectious disease that is so transmissible and so lethal that efforts to mitigate its spread might require the suspension of normal living for large segments of society on a scale akin to the extensive socioeconomic disruptions required for the U.S. to win a total war, e.g., the Civil War, World War I, and World II. 

In total wars, democratic societies become more autocratic temporarily, i.e., less tolerant of dissent. Thus the executive branch became more powerful under Presidents Lincoln, Wilson, and Roosevelt. But democratic societies extend far less tolerance to autocratic decision making by peacetime managers of pandemics.

Goals, strategies, costs, and benefits

The management of any large scale, complex endeavor, such as a pandemic, requires wrestling with four fundamental questions over and over again:

1. What are our most important goals?
2. Which strategies will achieve these goals?
3. What are the likely costs and benefits of these strategies?
4. Are the benefits worth the costs of achieving the goals?

Disagreements in democratic societies about goals tend to cascade into disagreements about strategies and disagreements about the tradeoffs between costs and benefits. Throughout the COVID pandemic, unresolved disagreements contributed mightily to the dismal performance of the CDC. So the question that must be addressed is straightforward:

Why did the CDC offer little or no compromise about its goals, strategies, and assessments of the tradeoffs between costs and benefits?

The answers to this question are embedded in irony. The GOP was officially the party in power. However the nation's top level pandemic managers were medical and bioscience experts employed by the CDC. These illustrious experts acted on their assumption that their guidance would be followed because of their professional expertise. 

From their perspective, dissent was a dangerous form of political meddling. This damning characterization was reinforced at the end of the Spring 2020 national lockdown when the most vigorous dissenter to the CDC's guidance time and again was their boss, the President of the United States. The CDC experts received further reinforcement in the echo chambers of the nation's mainstream liberal/progressive media that never missed an opportunity to roundly denounce President Trump for his "anti science" political meddling.

The irony, of course, lies in the deepest national divisions since the decades before the Civil War.  Beginning with President Ronald Reagan's election in 1980, the Republican Party has taken an increasingly hostile attitude towards the federal government. One of President Reagan's most oft quoted aphorisms refers to the federal government as the "problem", not the "solution". By the 1990's the GOP had replaced the Dixiecrat Democrats as the party of states' rights. Indeed, the GOP's decades long efforts to repeal Roe v. Wade achieved success via legal challenges from red states that were supported by an ultra conservative Supreme Court dominated by GOP appointees. 

In other words, the CDC experts' expectations that their guidance would be widely accepted without substantial dissent would have been plausible for members of the professional staff of the Chinese Center for Disease Control and Prevention. But in the U.S. their expectations represented dangerously naive failures to perceive the essential role of compromise in a democratic society.

The CDC's COVID Goals

Throughout the pandemic the CDC sought to prevent the coronavirus from inflicting severe illness and death on the U.S. population. To paraphrase Mr. Jefferson's Declaration of Independence, the CDC held these goals to be so self-evident that it quickly invoked the full range of known mitigation strategies to achieve them, beginning with a national lockdown in March 2020. The CDC never produced a comprehensive socioeconomic impact statement or a cost benefit analysis of the potential "side effects" or "collateral damage" that even a partial adherence to its guidance might produce. 

When President Trump shrieked in horror after the stock market tanked and over 30 million workers had filed for unemployment insurance, the CDC merely shrugged. As the nation's "doctor" the CDC felt obliged to continue to recommend the strongest possible mitigations until effective vaccines and treatments were available.

Republican vs. Democratic Voters' Goals

President Trump was not the only Republican who shrieked. His resistance to the CDC's assumption that managing the virus should take precedence over all other national goals was shared by millions of GOP voters in the November 2020 elections; but his resistance was also rejected by millions of Democratic voters.

The following question was included in the report "National Exit Polls: How Different Groups Voted" that was published by the NY Times on 11/3/20 after the 2020 elections. The designation 'Dems" for Democrats or "GOP" for Republican merely indicates how a person voted, not their party registration.

• Which is more important? 
  Containing the coronavirus now, even if it hurts the economy ==> Dems (79%), GOP( 19%)
  ... or ...
  Rebuilding the economy now, even if it hurts efforts to contain the coronavirus ==> Dems (20%), GOP (78%)
  

In other words, Republican voters were far more risk tolerant than Democratic voters with regards to COVID. Whereas most Democratic voters accepted the CDC's goals and strategies, most Republicans wanted other options, options that would also stabilize the economy and allow their children to attend regular face-to-face classes ... but did such alternative strategies exist?

The Florida "Compromise"

Governor Ron DeSantis was first elected in 2018 in a vote that was so close that a recount was required. In January 2021, he began to implement an alternative pandemic management strategy that would prove to be so acceptable to Republican and independent voters in Florida that he was reelected in November 2022 by a landslide of historic proportions. What did he do?

Governor DeSantis opposed all mandates, e.g., masks and remote classes. Instead, he mobilized his state's considerable resources to provide extensive opportunities for his state's oldest, most vulnerable residents -- the 65+ age group --  and their caregivers to be vaccinated ... opportunities, not mandates

In other notes on this blog, the editor presented tabulations of CDC data about vaccinations and deaths by age groups in California, Texas, Florida, and New York. The DeSantis strategy enabled Florida to attain the same high vaccination rates per 100,000 members of its 65+ residents as California. These high vaccination rates enabled Florida to attain the same low COVID death rates as California, the nation's epicenter for COVID mandates..

The CDC also data showed that in 2020, before vaccines were available, only a very small percentage of COVID deaths occurred among persons under 40; indeed, COVID deaths were exceedingly rare events among persons under 18. So the governor's vaccination strategy was based on his estimates that COVID deaths among the state's middle aged residents, 40 to 64, would be low enough that Florida's electorate would regard these losses as acceptable costs for the benefits of returning to normal living in 2021 ... and he was right.

• "Elections 2024 ... Risk averse Democrats vs. risk tolerant Republicans ... Part 2 (Age groups and vaccinations)", Last update: 6/8/22
• "Florida's Governor Ron DeSantis: COVID Rebel or Pioneer??? (Part B)", Last update: 7/3/22

A more recent note on this blog used the same CDC data to conclude that the GOP governor of Texas might have saved 20,000 lives in the 65+ age group in his state had he implemented the DeSantis vaccination strategy, a strategy that Governor DeSantis had proven to be far more acceptable to GOP voters than the extensive mandates and other mitigations propounded by the CDC

• "Saving thousands of lives in red states; Governor Ron DeSantis, an imperfect messenger", Last update: 2/11/23

The heading of this section refers to "compromise" in quotes because real compromise requires mutual consent. But the CDC and its mainstream media supporters never acknowledged the effectiveness of the DeSantis strategy in red states. They never encouraged other Republican governors to employ a strategy that was more acceptable to Republican voters. So they forfeited opportunities to save thousands of Republican lives in red states.

Unfortunately, the inane antics of Governor DeSantis in his ruthless pursuit of the presidency have made him a very imperfect messenger for plausible policy alternatives. Even more unfortunately, the narcissistic antics of President Trump raised his imperfection as a messenger to demonic heights. Nevertheless, both of these imperfect messengers embodied an undeniable truth: compromise is mandatory in a democratic society wherein there is substantial disagreement about fundamental goals. Priorities among fundamental goals can not, must not be dictated by subject matter experts, no matter how well intended they may be.

So how will the CDC and our other public health agencies manage the next pandemic? Probably as ineffectively as they mismanaged this one and for the same reasons. Managing a pandemic in the context of extensive national divisions about fundamental goals is an inherently political process in a democratic society, a process that demands repeated compromise. Unfortunately, the CDC's professional staff and their colleagues in other public health agencies regard all politics is "anti-science", so they would rather be "right" than effective.

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Links to related notes on this blog:  

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