For the Next Pandemic, Run the Trump Playbook in Reverse
(Bloomberg Opinion) -- As the coronavirus pandemic continues, Bloomberg Opinion will be running a series of features by our columnists that consider the long-term consequences of the crisis. This column is part of a package on public health. For more, see Max Nisen on creating a faster vaccine, Virginia Postrel on the renewed promise of telemedicine and Faye Flam on a grim future for the medical profession.
“Allow me to say as I told her personally today, the governor of Oregon, Governor Kate Brown — her unilateral decision to send 140 ventilators … to New York, to me was in the very highest American tradition of loving your neighbor. And when I talked to Governor Cuomo, Mr. President, he said they never asked Oregon for the ventilators and Governor Brown hadn’t even called him to tell him that she was doing that. It really is remarkable.”
So spoke Vice President Mike Pence during Saturday’s coronavirus briefing, and on one level, he’s right. With ventilators arguably the nation’s most precious piece of equipment, it was remarkable that a governor on the West Coast sent 140 of them to a state in dire need on the other side of the country. The next day, Washington Governor Jay Inslee returned more than 400 ventilators to the federal government so that they could be used in harder-hit states.
“I’ve said many times: We are all in this together,” Inslee said.
On another level, however, the fact that Brown and Inslee had to take it upon themselves to ship unused ventilators suggests something appalling: The federal government, which is the only entity with the resources and capacity to truly manage this crisis, is missing in action.
Yes, there are daily press briefings, in which some facts are conveyed and warnings issued (along with occasional misinformation from President Donald Trump), and they have some limited utility. But if this crisis were being managed properly, the federal government would know where every ventilator in the country was, and it would be able to quickly deploy them to the states where they were most needed.
To put it another way, what the Trump administration should’ve done in late January was to mobilize the entire federal government. That it still hasn’t done so is both inexplicable and shocking.
Federal mobilization is common when disaster hits. Protocols have been in place for decades. After Hurricane Sandy, a half-dozen agencies, led by the Federal Emergency Management Agency, worked together to help the hardest-hit areas recover. A similarly coordinated effort followed the outbreak of the H1N1 virus in 2009. What’s unusual about the current crisis is that it’s affecting all 50 states at once, rather than a single region ravaged by, say, a hurricane. But that’s all the more reason for the federal government to be running the show.
In fact, the government already has a plan in place for dealing with what we’re now facing. In 2005, according to ABC News, President George W. Bush read an advance copy of John M. Barry’s book about the 1918 flu pandemic, “The Great Influenza.” “This happens every hundred years,” he told other officials. “We need a national strategy.”
Over the next three years, prodded by the president, administration officials created a detailed pandemic-response strategy. According to Fran Townsend, Bush’s homeland-security adviser, it included an outline for a global early-warning system, money for vaccine technology and the now-infamous national stockpile for protective equipment, ventilators and so on.
President Barack Obama’s administration confronted outbreaks of the Ebola, Zika and H1N1 viruses. Although these had limited effect in the U.S., they highlighted the very real possibility of a pandemic wreaking havoc here. By the end of Obama’s second term, his National Security Council had developed a 69-page playbook for responding to such threats.
As Obama was leaving office, members of his national-security team conducted a so-called table-top exercise on pandemics for the incoming Trump officials. The reception their presentation received, according to Politico, was “chilly.”
So what should’ve happened once it was clear the pandemic would threaten the U.S.? I spoke to half a dozen officials who have been involved in preparing for and dealing with disasters, including Ashton Carter, the former defense secretary; Juliette Kayyem, the former assistant secretary for intergovernmental affairs at the Department of Homeland Security; and Michèle Flournoy, the former undersecretary of defense for policy. Here are some of the messages I took away from those conversations.
The Department of Health and Human Services needs a seat at the disaster-preparation table. In the Washington Post’s definitive recounting of the Trump administration’s early mistakes, HHS Secretary Alex Azar is portrayed as trying desperately to get the White House to take his warnings about the pandemic seriously. One problem was that Azar had “a strained relationship with the president,” who viewed his warnings as “alarmist.”
But a deeper issue was that HHS has never played a prominent role in disaster preparation. “During any disaster, FEMA plays a big role, and so does the Commerce Department, which knows where all the industrial production is,” said Andrew Philip Hunter, a senior fellow at the Center for Strategic and International Studies. Because the government has generally done disaster-planning with natural disasters in mind, HHS has never been factor. As a result, it lacks employees with the necessary skills.
“There needs to be greater focus on health intelligence,” said Kayyem. “And the health experts need to have access to the national security apparatus, which tends to discount health issues.”
The Centers for Disease Control and Prevention should be overhauled. Remember how disastrously FEMA performed following Hurricane Katrina in 2005? After it was over, the agency, embarrassed by its performance, worked to right itself — and did so with very little additional funding. The coronavirus crisis is the CDC’s Katrina.
First, the agency should’ve been much more forceful in alerting the country to what was coming. Its flip-flop on whether to wear masks in public damaged its already strained credibility. And then there’s the issue of testing, which is at the heart of what the CDC is supposed to do in a pandemic. The agency insisted on coming up with its own Covid-19 test even though the protocols for a perfectly good one had been published by the World Health Organization. When the CDC’s test turned out to be faulty, federal officials took weeks before allowing academic and private labs to develop alternate versions.
This lag is perhaps the most important reason why even now, there aren’t nearly enough tests being conducted — and why the U.S. has had to practically shut down instead of relying on the “contact tracing” that worked so well in South Korea.
Invoking the Defense Production Act should be a priority, not a last resort. Just about everybody I spoke with was mystified that Trump has been so reluctant to use the DPA, which gives the president expansive authority to “instruct everybody to do anything that is in service of our national security,” as Carter put it.
What’s more, it is used routinely, mainly when the government wants to prioritize its own production needs over a company’s commercial needs. Companies are used to it, and know how to deal with it. And it’s not just about manufacturing. A government mobilization might include using the DPA to require FedEx Corp. or United Parcel Service Inc. to ferry emergency equipment. It might require having Amazon.com Inc. use its cloud services as a repository for critical data. It might mean that private hospitals have to act as public ones during emergencies. And so on.
What makes no sense is using the DPA the way Trump has — as a means of embarrassing and punishing companies he’s annoyed with.
Industry needs to be involved in federal pandemic planning. There is something inspiring about the way companies small and large have pitched in to help. Last week, I spoke to Karen Atta, who runs her own commercial sculpture studio in New York City. Because her firm deals in plastics, she realized she could make face shields for the hospital workers caring for Covid-19 patients. She and her six employees have since made 1,000 of them, she told me, and hospitals have eagerly snapped them up.
The problem is that she hasn’t been able to get through to state or city officials, so they have no idea that she’s doing this. She’s also had to use GoFundMe to pay for the effort. This isn’t how it should work. The federal government should have a list of companies with the capability to shift production to the materiel the country needs, and the companies should know that they might be called on in an emergency. That requires a great deal of advanced planning and coordination. But it’s a must.
Logistics matter. On Friday, Canadian Prime Minister Justin Trudeau announced that the government had contracted with Amazon Canada to deliver critical medical supplies. He was showing that he understood the supreme importance of logistics in surviving a national pandemic. In the U.S., there are three logistics-related issues that need urgent attention.
The first is that the federal government needs to be the sole entity purchasing the equipment the country needs. What’s happening now — with states trying to outbid each other for masks and ventilators — is insane.
Second, the government needs to know where all the equipment resides, whether in the national stockpile or in private hands. That will require a reasonably sophisticated database — but really, it’s nothing Big Tech can’t handle.
Finally, it will require access to planes, trains and trucks to move the equipment where it’s most useful. This could be done by the armed services, which have extensive logistics experience, or by delivery companies that are pressed into service.
There can only be one person in charge. And that person shouldn’t be the president. Yes, have a task force, but it should only consist of leaders with genuine expertise — in infectious diseases, logistics, manufacturing, communication and so on. The person in change needs to be an expert in managing disasters. “You could take a senior person in industry or a retired military officer and say `Here’s a chance to serve your country for a limited period of time,’” said Flournoy. “And then really empower that person.”
As for the president, he or she should be the chief communicator, but shouldn’t be the one deciding which companies should be making ventilators.
The most successful mobilization in U.S. history was during World War II, when President Franklin Roosevelt followed exactly this approach: He put General Motors president William Knudsen in charge of military production and gave him tremendous authority. By the war’s end, 30% of America’s manufacturing capacity had been turned over to defense needs, with Ford Motor Co. making bombers, Chrysler making tanks and so on.
When the next pandemic hits — and can anyone doubt that it will? — we’ll need a mobilization that will once again be equal to the task, just as in World War II. The good news is that many of the necessary elements are already in place. But a tremendous amount of additional planning will be required, involving industry, federal health officials, Army logistics teams, technology companies and others.
It can’t start soon enough.
This column does not necessarily reflect the opinion of Bloomberg LP and its owners.
Joe Nocera is a Bloomberg Opinion columnist covering business. He has written business columns for Esquire, GQ and the New York Times, and is the former editorial director of Fortune. His latest project is the Bloomberg-Wondery podcast "The Shrink Next Door."
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