Fauci: I believe we're going to be able to get there, and as you mentioned on the run-in to the show, we're going to do that by having a change in strategy. Rather than having mass vaccination units, we want to get on the ground to that recalcitrant group of people who don't want to get vaccinated, and make it really easy for them to get vaccinated. … Have trusted members of the community that are messengers that people, regardless of their political affiliation, would listen to. Those could be people in the clergy, those could be a family doctor, or those could be media and sports and entertainment figures. …
Ruhle: But isn't that part tricky? Because just last week, we had a well-known media figure spreading mis-information. So don't we need to listen to the experts, because when non-experts who are influencers spread mis-information we say 'oh, don't listen to them, they're not a doctor'.
Fauci: No, I said trusted messengers (laughs). I used the word trusted.
I'm watching Dr Anthony Fauci react to Stephanie Ruhle's admonition after finishing Michael Lewis' latest book, The Premonition: A Pandemic Story. It is a Star-Wars-like tale of a group of rag-tag doctors and rebel health officials fighting to restore the republic. The story includes a brief but heartbreaking re-telling of an episode at the CDC, when the idea of "listening to the experts" began to come under attack.
At the end of the Ford Administration, the Director of the CDC was Dr David Sencer. In the spring, as the flu season began to ebb, a number of soldiers fell ill and one died. Army doctors determined that over five hundred others were infected with some form of flu virus, similar to viruses that caused pandemics in 1918, 1957, and again 1968 – approximate death tolls of fifty million, four million, and four million. As this was 1976, it seemed about time for another. Dr Sencer made the difficult decision to rapidly manufacture a vaccine and deliver it into the arms of the American populace. But then, after forty-five million vaccinations, the pandemic fizzled.
The vaccine program was suspended in December, and Dr Sencer was left to explain about fifty deaths resulting from the rushed roll-out. In January, President Carter took office, and a few days later, Dr Sencer was 'fired' from the CDC. At the time, the Administration would not have had the authority to simply fire the Director, but Dr Sencer stepped aside. In order to justify the move, HEW Secretary Joe Califano commissioned a report that implicated both Dr Sencer and Dr Theodore Cooper, Assistant Secretary of Health. The report was later published as a book (The Swine Flu Affair), and made Dr Sencer notorious.
Thereafter, the position became further politicized. During the Reagan Administration the new Director of the CDC, Dr William Foege, could not testify to Congress without being managed by handlers. Reports on the AIDS Epidemic had to be vetted by the White House; research on children's aspirin was scrapped due to pressure from pharmaceutical companies. After two years of Reagan, Dr Foege had had enough, and resigned in 1983.
After Dr Foege's resignation, President Reagan ("I'm from the government, and I'm here to help.") changed the Directorship from a civil service post to a political appointee – and our journey to the dark side was complete.
As for Dr Sencer, Lewis writes:
Before he was fired, David Sencer had run the CDC for more than a decade and might have imagined running it a decade more. The event flipped a switch inside him. He went from drinking socially, to drinking too much, to being treated for alcoholism. For a decade he’d served as a sort of mayor to the public-health village in Atlanta, but he no longer felt comfortable there. He took a job in New Jersey with a company that made medical devices but hated it. His heart wasn’t in business. He applied and was hired for the job of New York City health commissioner. The New York Times uncovered the fact that he’d been treated for alcoholism and ran an article about his failure to disclose it. “I’ve got a disease and I’m treating it,” he said in response, but it felt like a second humiliation. His wife would never fully recover from it. Sencer declined so many opportunities to visit Atlanta that it felt to his son, Steve, as if he had exiled himself. When Steve asked him why, he’d say, “You can’t go home again.”
Lewis' tale of the 1976 flu scare reads like an elaborate variant of the trolley problem: a trolley, out of control, is about to kill five people, you have the power to switch tracks, but the trolley will still kill one person. If your jury or community hadn't seen or understood the threat to the five, you will be harshly punished for the death of the one.
It is, perhaps, government's basic and primary role: to judge large-scale threats and describe a course of action. As Chris Hayes reminds us (above podcast, 29:08), these threats are generally wars and pandemics. The government should also help the community see the bigger picture, else the enterprise and the decisions used to guide it won't be appropriately valued – especially the well-intentioned 'mistakes'. In a democracy, that creates a slow-motion death spiral: angry, uninformed 'victims' electing manipulative candidates, who make poor, ideological choices, creating more angry 'victims'. So, instead of an instrument sharpened to solve problems, government devolves into a partisan tool patched together to avoid or apportion blame.
The US Government has a military-industrial complex to deal with a war. What does it have to deal with a pandemic? My immediate answer would have been the CDC, but after reading Lewis' narrative on the CDC's actions during this pandemic, I question that choice. As described by Lewis, the CDC seems to exist to collect data and publish reports after a pandemic has already taken hold. In the words of Dr Charity Dean, one of the main characters in The Premonition:
They really should just change the name. It shouldn’t be the Centers for Disease Control. It should be the Centers for Disease Observation and Reporting. That’s what they do well.
So perhaps the CDC are 'here to help'; we see the bigger picture, though it's a politicized and less accurate picture. In terms of the trolley problem, the CDC are philosophers not engineers, writing the story and asking important questions, but staying away from the action. And the people with their hands on the track levers, making life-saving decisions, like Dr Dean, are the local public health officers: five deaths versus one.
Dr Charity Dean working at her desk with Star Wars posters, from 60 Minutes, CBS News
Lewis is interviewed on 60 Minutes, along with the book's three principals; it's great to be able to put a face and a voice to a name. And it's great to read, essentially, the sequel to The Fifth Risk (from this blog post). The Fifth Risk chronicles the transition from the Obama Administration to the Trump Administration, and the cynical indifference applied to government staffing by the latter. The Premonition is a case study in that indifference, our loss of faith in government and in 'experts', and the consequences of that loss.
However, Lewis tries to leave us with hope. We have not lost the courage to pull the levers; that courage resides within our community, with civil servants like Dr Dean. We only lack the trust, and that is a deficiency that can be corrected. Like the news anchor asks, "But isn't that part tricky?"
cases: 155,662,149 global • 33,304,490 USA • 833,102 Portugal
deaths: 3,250,408 global • 592,931 USA • 16,983 Portugal
UPDATE (May 20): Fascinating interview with Maya Shankar, a cognitive scientist and former Obama-era political appointee, and Michael Lewis. They discuss ideas to restore courage and trust in government; here they are talking about the CDC:
Shankar (asking a question from the online audience): Krista wants to know what do you view as the biggest mistakes made by the CDC in response to COVID-19? …Lewis: … It's not a 'one thing'. It's a drift in the institution to the point where it was unable to stand up to Donald Trump. It just caved. So it became a mouthpiece for lots of false stuff. The process by which it lost its ability to be brave is the other side of this.
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