When discussing politics, the late Michael Uhlmann used to say "when stupidity seems a sufficient explanation, there is no need for recourse to any more elaborate analysis."
That explains quite a bit about what goes on in Washington. In Uncontrolled Spread, Scott Gottlieb makes a compelling argument that stupidity can explain much of what went wrong with America’s coronavirus response, too.
Gottlieb, an American Enterprise Institute senior fellow and former FDA commissioner, is one of the most qualified commentators to weigh in on this issue. With decades of medical, policy, and government experience under his belt, Gottlieb can explain the most complicated facets of the coronavirus pandemic. But while Uncontrolled Spread contains plenty of sophisticated analysis, Gottlieb’s most important conclusions are often the most basic.
From the initial outbreak in Wuhan through the vaccine rollout, Gottlieb shows how outdated systems and bureaucratic incompetence led to the most devastating failures of the pandemic. Along the way, he outlines a forward-looking doctrine for pandemic preparedness that eschews blind trust in "the Science" in favor of a hard-nosed realism.
At the outset, Gottlieb makes it clear that he tries to avoid politics in his analysis of the pandemic. This is not an anemic appeal to nonpartisanship. Gottlieb avoids COVID politics because he doesn’t see the pandemic as primarily a political failure. While he admits that inconsistent messaging from both parties may have arrested the country’s COVID response, he ultimately locates the most "corrosive failures … at the agency level, inside an ill-prepared bureaucracy."
Gottlieb lays much of the blame on the Centers for Disease Control and Prevention. While the agency may have seemed like the appropriate choice to handle the pandemic response, when push came to shove it simply couldn’t hack it. According to Gottlieb, this is largely because the CDC is designed to generate "academically oriented after-action reports in an effort to define new scientific principles."
What this means, in effect, is that the CDC is always preparing for the last pandemic. In the early days of the coronavirus outbreak, the CDC cracked open the playbooks they used to fight Ebola in 2014 and the Zika virus in 2016. The best of these policies simply weren’t effective against the coronavirus, while the worst weren’t even effective against the diseases they were originally deployed to fight.
That level of bureaucratic path-dependency is unsurprising if not forgivable. The same can’t be said about the rest of the CDC’s actions. Clinging to typical flu season procedures, the agency dragged its feet on diagnostic tests and prevented private labs from testing on their own.
When the agency eventually developed their own COVID tests, they were so badly botched that samples of sterile water would test positive for the coronavirus. The CDC knew this, and shipped the tests anyway. And then, for good measure, the agency locked up the intellectual property behind the tests, preventing private companies from manufacturing additional tests. Gottlieb makes it clear that the CDC’s actions "don’t serve an identifiable policy goal," and that the agency was "largely just guarding its turf."
Ironically, while the CDC was pumping the breaks on a full-fledged pandemic response, senior Trump administration officials were attempting to sound the alarm. Gottlieb recounts a January 21, 2020, meeting of the Coronavirus Task Force, in which Dr. Anthony Fauci "pointedly" dismissed Domestic Policy Council director Joe Grogan’s suggestion that "the coronavirus could be spreading without being detected."
This dynamic played out repeatedly in the early days of the pandemic. Political appointees like Grogan and Deputy National Security Adviser Matthew Pottinger were appropriately concerned about the coronavirus, while public health officials like Fauci and leaders at the CDC dismissed their concerns out of hand.
In relaying these stories, Gottlieb is not attempting to vindicate the Trump administration’s pandemic response. Uncontrolled Spread is hardly light on criticism of the former president and his advisers. But this and other anecdotes show why, in Gottlieb’s telling, the United States should not leave pandemic preparedness to public health officials.
Instead, Gottlieb suggests that we enlist the intelligence community to lead the effort. The coronavirus pandemic shows the dangers of relying on the CDC’s scientific assessments and hoping that foreign governments will willingly share information. To be truly prepared, the United States needs to monitor foreign labs and track potential outbreaks much like we do uranium enrichment in Iran and terrorist cells across the globe.
Gottlieb’s call to treat pandemics as national security threats is not merely rhetorical. COVID, he notes, may have changed the calculus that has historically kept our enemies from weaponizing "a pathogen that could easily blow back on them." Seeing how Western democracies struggled to contain the virus relative to authoritarian governments, "terrorists along with more traditional nation-state adversaries may now see that respiratory pathogens are a poor man’s nuclear weapon."
Gottlieb is right that it’s time for the United States to begin treating pandemics as national security threats. But not all of his proposed solutions are so practical.
Although he repeatedly shows how the CDC’s ineptitude and the World Health Organization’s gutlessness imperiled the global fight against COVID, Gottlieb nonetheless calls for new federal and international organizations to prepare us for future outbreaks.
Gottlieb rightly notes that these new bodies will need to reclaim the public’s trust and act with the foresight and fortitude the CDC and WHO lacked, but doesn’t specify how this can be done. It’s precisely this type of blind trust in "experts" and "institutions" that, as Uncontrolled Spread deftly catalogs, lulled policymakers into a false sense of security and dashed any hope of containing the coronavirus early on.
As if to confirm Gottlieb's worst assessments, on Thursday CDC director Rochelle Walensky overruled the agency's Advisory Committee on Immunization Practices panel and recommended coronavirus vaccine booster shots for certain at-risk young people. When even the CDC director seems unwilling to "trust the experts," it's hard to argue the agency should lead future pandemic responses.
Fortunately, Gottlieb’s plan to fight future outbreaks does not rely solely on creating new government agencies. Thorough and engaging, Uncontrolled Spread shows where we erred in our fight against COVID, and explains how we can do better in the future.
Uncontrolled Spread: Why COVID-19 Crushed Us and How We Can Defeat the Next Pandemic
by Scott Gottlieb
Harper, 512 pp., $28.99