Failures of competence

By Joe Nocera

Tuesday, Oct. 21, 2014 | 2 a.m.

Et tu, CDC?

For years, the Centers for Disease Control and Prevention has been the most trusted agency in the federal government. In 2003, when Gallup did a survey to determine what the public thought of various federal agencies, the CDC topped the list, with 66 percent of respondents describing it as “excellent” or “good.”

Last year, a similar Gallup poll showed the CDC’s approval rating had dropped to 60 percent, which was still better than any other agency. The CDC has seen the country through SARS and the swine flu virus. The general perception was not only did it do important, apolitical work, but it was highly competent.

“I used to call the CDC the shining star of federal agencies,” says Lawrence O. Gostin, a global health expert at Georgetown Law.

And then came Ebola.

The Ebola outbreak is not exactly enhancing the CDC’s reputation for competence. At first, the agency reassured the public American hospitals were ready to handle any Ebola cases that came their way. This has turned out not to be the case. When Thomas Eric Duncan was diagnosed with Ebola in Dallas, the CDC did not immediately fly in an expert team — something its director, Tom Frieden, now says it should have done. Most recently, the CDC appears to have allowed one of the Dallas nurses who helped Duncan to take a flight from Ohio to Texas even though she had a slightly raised temperature. When it became clear she had contracted the virus — the second nurse to do so — Frieden was forced to admit letting her on the plane was a mistake.

Meanwhile, Frieden, a highly respected public health expert, had to walk back some of his remarks. Congress — including Democrats — appears dismayed by the mistakes. Perhaps the biggest one the CDC made was that its voluntary guidelines for treating Ebola patients were too lax. In The New York Times a few days ago, Donald G. McNeil quoted several experts saying the protocols established by the CDC were, in the words of one, “absolutely irresponsible and dead wrong.” One important protocol is having a “site supervisor” watching for errors. The CDC has now included that guideline.

Are there extenuating circumstances? To hear infectious disease specialists tell it, the answer is yes. Like all federal agencies, the CDC saw significant cuts to its funding, thanks to sequestration. Another expert, Marc Lipsitch of the Harvard School of Public Health, told me in an email that because the chances of Ebola being imported to the United States were considered low, preparing for it was not considered a good use of scarce public money.

“The budget cuts,” he wrote, “have directly reduced preparedness.”

In addition, the CDC, like many federal agencies, had its mission transformed after 9/11. Julie Gerberding, an appointee of the Bush administration, changed its emphasis to bioterrorism and other potential security threats.

“She also brought in efficiency experts who were anathema to scientists,” says Laurie Garrett, a senior fellow for global health at the Council on Foreign Relations and author of the seminal 1994 book, “The Coming Plague.”

Morale plummeted, and many of the agency’s best scientists fled.

Fair enough. But it is also true the CDC was too hubristic in its approach to Ebola, and the consequence is its staff now looks like bumblers.

“They never challenged their own assumptions,” says Dr. Richard Wenzel, an infectious disease specialist at Virginia Commonwealth University.

“This is an unforgiving virus,” he added, “about which there is a lot we don’t know.”

The CDC’s unfortunate habit of saying things as if they were certainties only to have to acknowledge that its judgment was questionable, Wenzel says, “can cause people to lose faith in the public health system.”

When you think about it, many of the Obama administration’s “scandals” have been failures of competence. The Secret Service let a man leap over the White House fence and get into the White House. The Veterans Health Administration covered up unconscionable delays in treating veterans. The error-ridden rollout of the Obamacare website was a nightmare for people trying to sign up for health insurance. The Republican right takes it as an article of faith that the national government can’t do anything right. Problems like these only help promote that idea.

And now comes the CDC — the most trusted agency in government — thrust in a role for which it was designed: advising us and protecting us from a potential contagion. With every new mistake, it becomes, in the public eye, just another federal agency that can’t get it right.

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Last Tuesday, I described Mikhail Khodorkovsky’s 10-year imprisonment in a “Soviet penal colony.” I should have written “Russian prison system.” Khodorkovsky spent time in several prisons in Russia; the Soviet Union broke up in 1991.

Joe Nocera is a columnist for The New York Times.