Monday, April 6, 2020

Planning for the Next Pandemic...

Dan Balz, "Once again, government is caught unprepared"
President Donald Trump downplayed the coronavirus threat, was slow to move and has delivered mixed messages to the nation. The federal bureaucracy bungled rapid production of tests for the virus. Stockpiles of crucial medical materials were limited and supply lines cumbersome. States and hospitals were plunged into life-or-death competition with one another.

When the public looked to government for help, government sometimes looked helpless or frozen or contradictory - and not for the first time.

The country and its leaders were caught off guard when terrorists on hijacked airplanes attacked the homeland on Sept. 11, 2001. The financial crisis of 2008, which turned into a deep recession, forced drastic, unprecedented action by a government struggling to keep pace with the economic wreckage. The devastation from Hurricane Andrew in Florida in 1992 and Hurricane Katrina in New Orleans in 2005 exposed serious gaps in the government's disaster response and emergency management systems.

"We always wait for the crisis to happen," said Leon Panetta, who served in government as secretary of defense, director of the CIA, White House chief of staff, director of the Office of Management and Budget and a member of the House. "I know the human failings we're dealing with, but the responsibility of people elected to these jobs is to make sure we are not caught unawares."

In interviews over the past two weeks, senior officials from administrations of both parties, many with firsthand experience in dealing with major crises, suggest that the president and his administration have fallen short of nearly every standard a government should try to meet.

Repeated crises have shown that government is rarely, if ever, fully prepared. Nor is government as flexible as it needs to be to respond as quickly or creatively as conditions often demand. Many factors contribute to what appear to be chronic weaknesses that can compound problems and reduce public confidence. Lessons learned after the fact solve past problems without necessarily anticipating future ones.

Leadership is important, and President Donald Trump will have on his record what he did and didn't do in the early stages of this particular crisis. But the problems go far broader and deeper than what a president does. Lack of planning and preparation contribute, but so too does bureaucratic inertia as well as fear among career officials of taking risks. Turnover in personnel robs government of historical knowledge and expertise. The process of policymaking-on-the-fly is less robust than it once was. Politics, too, gets in the way.

Long ago, this was far less the case, a time when the United States projected competence and confidence around the globe, said Philip Zelikow, a professor at the University of Virginia who served in five administrations and was executive director of the 9/11 Commission.

"America had the reputation of being nonideological, super pragmatic, problem solvers, par excellence," he said. "This image of the United States was an earned image, of people seeing America do almost a wondrous series of things. . . . We became known as the can-do country. If you contrast that with the image of the U.S. today, it's kind of depressing."

- - -

Government officials have worried about the threat of a pandemic like the coronavirus for many years. In the fall of 2005, President George W. Bush tasked Fran Townsend, his homeland security adviser, to develop a national pandemic strategy. What prompted the directive was not an imminent threat to which he had been alerted by advisers; it was because he had read John Barry's book, "The Great Influenza," about the flu pandemic of 1918.

Townsend recalled that when she convened an interagency meeting to launch the project, she met significant resistance from Cabinet officials who said they had far more urgent problems to deal with. Only with prodding and presidential insistence did the pandemic strategy get put together, and it was part of the Bush team's handoff to the administration of Barack Obama during that transition.

The Obama administration ended up dealing with a series of virus threats, and that experience shaped the transition handoff to the Trump administration three years ago.

On Jan. 13, 2017, Lisa Monaco, who was White House homeland security and counterterrorism adviser in the Obama administration, convened a meeting in the Eisenhower Executive Office Building. The session brought together the members of the outgoing Obama Cabinet with the Cabinet designees in the incoming Trump administration.

Attendees included the outgoing and incoming secretaries of homeland security, Jeh Johnson and John Kelly, who later became White House chief of staff. Tom Bossert, who was to be Monaco's successor as White House homeland security adviser and who has since left the Trump administration, acted as co-chair.

The session dealt with terrorism and cyber and various other threats, but because the Obama administration had been through H1N1, the Ebola crisis and the Zika virus, Monaco included a discussion of what she regarded as the nightmare scenario: a new strain of flu that was a respiratory illness for which there was no vaccine and that because of globalization and travel patterns would be nearly impossible to contain.

"I don't want to give an impression that we bestowed the answer key for dealing with such a challenging and unprecedented crisis," Monaco said. "But the idea was to identify issues that would say these are the kinds of things you need to be planning for and thinking about now."

What does it mean for the federal government to be prepared? "Oftentimes, the gauge is no mistakes, no criticism, just complete smooth sailing," Monaco said. "That to me is not the definition of what it means to be prepared."

She argued that preparation means planning ahead of a crisis, and having structures and organizations that can move quickly and principles that guide decision-making. "I think it's about trying as best to minimize the chaos, particularly at the beginning," she said.

Almost by definition, a crisis is something no one has or can prepare for fully. As Zelikow put it, what government is least prepared for is to do things "different from what it did yesterday." Then the question becomes whether government is agile enough to figure out what to do next. On that measure, the record is not encouraging either.

Joshua Bolten, who served as White House chief of staff in the administration of George W. Bush, said, "It's especially hard for government to be prepared for the unexpected or the unpredicted. That was certainly true in 9/11. When you think back to 2001, if you had said that, while it looks like there's enhanced risk of terrorist activity in the United States, I don't know that you necessarily would have checked on who was enrolling in flight schools."

- - -

It isn't that government doesn't do planning. The Pentagon has contingency plans for wars, conflicts and disasters - "for anything everywhere . . . for everything," as Panetta put it. But federal domestic agencies don't have the same culture as the Pentagon.

"The Pentagon bureaucracy has the resources to do that. There's a deputy secretary for everything," said Johnson, who served as general counsel at the Pentagon before going to DHS. "Homeland security is a relatively new concept. The headquarters bureaucracy at DHS is still a work in progress."

But plans by themselves are not a measure of preparedness. When Stephen Goldsmith, a professor at Harvard's Kennedy School, was deputy mayor of New York, his portfolio included emergency management. When he would ask about potential disasters, "They'd take out a black three-ring notebook and they'd say, 'We have a three-ring notebook for that.' " That was only partially reassuring, he added, "because the chances of something happening not in a three-ring notebook is really high."

Goldsmith assesses the situation this way: "I think we've gotten relatively good as a country - local, state and federal government - at the professional performance of routines. Our ability to accomplish the important routines of government on a daily basis is very high."

But there are limitations, he said. "One is, are they conducive to imagination? Second, do they value the exercise of discretion throughout the system? And third, are they good at calculating the risk across agencies? What are the trade-offs of closing a country?"


The culture of plans on shelves can carry government officials only so far when disaster strikes. What then becomes more important are the systems in place that allow for quick action, improvisation and the rapid creation of systems to deal with the unexpected.

Andrew Card Jr. was secretary of transportation in the administration of President George H.W. Bush. When Hurricane Andrew hit Florida and there was criticism of the federal response, Bush tapped Card to go to Florida and take charge. He spent seven weeks there.

He found resistance within the bureaucracy to bend the rules. "I found that FEMA is a great organization, but they were all afraid to do things that weren't, quote, by the book," Card said. "FEMA was always being challenged . . . second-guessed after a disaster."

Card learned through that experience and later as White House chief of staff to President George W. Bush during 9/11 and Katrina the obstacles that the combination of fear and bureaucratic inertia can impose when immediate and innovative action is required.

"Each bureaucracy has its own momentum," he said. "The challenge in dealing with a disaster is addressing the momentum or the inabilities. If something's not moving, it takes a lot of effort to get them to move."

Lack of integration - public health with emergency management with economic assistance - across the government creates other obstacles. So too does turnover in personnel or vacancies in key positions, which has been a continuing problem particularly in this administration.

"If you do not have people who do not remember the lessons learned and you don't have people who have navigated these enough to have relationships across the government, you can be hampered," said Mark Harvey, former senior director for resilience policy at the National Security Council. "You never want to be exchanging business cards at a disaster scene."

Andrew Natsios, a former administrator of the U.S. Agency for International Development and current director of the Scowcroft Institute at the Bush School of Government and Public Service at Texas A&M University, said time is the most precious asset when dealing with disaster. "How fast you move will determine whether you control the course of events or whether you lose control," he said.

Even presidents are constrained in their power to make things work. No president is fully capable of managing a crisis, which means having to rely on leaders in agencies who can help implement policies on the fly. In this moment, Trump is hampered by not having fully staffed the political positions across the government and by rhetoric that has denigrated career officials.

"President George H.W. Bush had more control over the federal bureaucracy than any president in the last 40 years," Natsios said. "He developed a large following of loyal people. He had control so when he gave an order we did it. When I got an order from the White House, I did it. Part of his effectiveness was appointing people to control this very complex federal system that tends to ignore the president."

The Trump administration has been particularly weak in that regard, with scores of long-standing vacancies in critical positions, hostility toward career officials who are vitally important in times like these and with an indifference to the importance of selecting competent political appointees, rather than presidential favorites, that began during the transition and has plagued the government ever since.

Success goes beyond a president's capacity to engage and move the bureaucracy. A top-down system inhibits quick action when needed. Experts in disaster management suggest that a functional system empowers officials farther down in the government to act without having been ordered to do so. Coordination must be at higher levels of government; response should be at a much lower level.

- - -

No plan survives its first brush with reality. What worries some people who have studied the issues of preparedness and government action is a long-term deterioration in the federal government's capacity to do large-scale, improvised planning.

"It doesn't mean it's now uniformly bad, it varies. But the quality has deteriorated," Zelikow said. "I think we've some illustrations in this crisis and I think we'll see more, I'm sorry to say. People who want to can always turn these into partisan arguments, and there are some particular individuals one can criticize. But there are deeper problems at work."

Zelikow pointed to an earlier era when the world looked at the United States as being capable of almost anything. He cited the Marshall Plan that helped save Europe after World War II and creation of the Berlin Airlift in 1948 when the Soviet Union shut off ground access to Berlin, which threatened the well-being of residents there. In that case, improvisation quickly turned into a system that eventually forced the Soviets to relent and reopen the city.

One case where such policymaking worked better was in the Bush White House after 9/11. Bush ordered the creation of a domestic consequences policy committee to oversee economic and other issues that needed to be dealt with, apart from responding to the terrorist threats, from reopening financial markets to putting airplanes back in the skies to compensation for families of victims.

"It certainly wasn't smooth, but I recall that process working reasonably well," said Bolten, who was White House deputy chief of staff at the time and chaired the committee. "People knew who the decision-makers were and where to go, both short of the president and how to get to the president on a decision."

The Obama administration earned generally good marks for the way officials dealt with the Ebola crisis in 2014, consolidating decision-making under one person, Ron Klain, who had previously served as vice presidential chief of staff. He later recommended that he be the last disease-specific czar, that government needed a permanent expertise within the White House.

Improvisation in the midst of a crisis requires one set of skills, both in terms of leadership and the capacity for creative policymaking. "It's really hard for government to understand every different collateral consequence that will occur until you start to experience it," said former New Jersey governor Chris Christie, whose state was devastated by Hurricane Sandy in 2012.

But how can government prepare for the next crises, which seem to come at a faster and faster pace? As Harvey noted, "This is a once-in-a-century event. We're also at the point where this is our fifth or sixth once-in-a-century event in the last few years. Wildfires in California. Hurricanes in Caribbean and the Southeast. Floods in Midwest. Volcano in Hawaii and now this. Even before covid-19, we were in the midst of spending $149 billion on eight simultaneous large-scale recovery efforts when we'd only done one at a time before."

- - -

Planning for the next crisis takes money. Political leaders know there are rewards from citizens for successful response to a disaster but little support for taking preemptive action, especially when the cost is high.

"Governments have a very hard time securing money, for spending money for things that might not happen," said Kathleen Sebelius, secretary of health and human services in the Obama administration and former governor of Kansas. "So any time that we are preparing for an unknown, to secure that in a tight budget year, to make sure dollars are set aside, was a battle in my time of government. There was always a more pressing priority."

Even if the money is available, determining how to spend it can defeat the purpose of having it. As threats of terrorism were growing in the late 1990s, the intelligence community sought more money, but the funds were distributed without a strategy or clear priorities, such as building up Arabic-language skills within the government.

"If you examine the pre-9/11 run-up and how well government adapted to rising of terrorism," Zelikow said, "the fundamental institutions adapted hardly at all. I think this is partly because this is not a partisan issue. It transcended both Democratic and Republican administrations."

The absence of capacity for real planning could be especially damaging in the context of a threat farther out on the horizon. Tyler Cowen, a professor of economics at George Mason University, looks at what has happened with the coronavirus pandemic to speculate about how the government might deal with threats from climate change.

"In the United States, as you know, we had a solid two months' warning and did nothing. And even now, in terms of getting testing and masks set up and the like, there are incredible delays," he said. "So we might finally overcome those problems. But, you know, with climate change, you need a 20-to-30-year ramping up for it to work."

Cowen said it's inexplicable why the federal government, given all the warnings and evidence from China of a spreading pandemic, did not move more rapidly.

"You know, Trump was terrible, but you can't just pin it on him. It's far more systemic than that. The NBA [which suspended its season on March 11] really gets so much credit. I would put the NBA in charge of fighting climate change at this point."

"The question for me is, does government retain a certain baseline level of preparedness . . . and then whether government is nimble and agile enough to take a baseline and put it on steroids when something occurs," said Janet Napolitano, former secretary of homeland security in the Obama administration.

The performance by the Trump administration and the government as a whole in responding to the coronavirus pandemic will be thoroughly examined. The president's handling already is a focus of criticism, and his reelection could hinge on how the public assesses his leadership next November. A national commission similar to that which was created after 9/11 could follow with a thorough exploration of what has happened.

Lessons will be learned and changes will be made, as they have after other disasters. Anyone looking for a few simple fixes - a fuller stockpile of material, more funding for public health, a designated agency to deal with the next new virus - will quickly find themselves disappointed. Those changes alone, however needed, will not have solved the underlying problems of a governing and political culture that, for all the good they can do when called upon, have limits, especially when officials are caught unawares and forced to act in new and unfamiliar ways.

"I've often wondered if democracy writ large is designed to be responsive rather than preemptive," said Tom Ridge, the nation's first secretary of the Department of Homeland Security. "One of the lessons perhaps as a result of this is we'll be a little more inclined to be preemptive. With election cycles every two years, there is not a lot of credence given to people who take a longer view."

26 comments:

The Prophet Dervish Z Sanders said...

The Obama Administration was prepared. Dotard ignored Obama's warning. Similar to how gwb ignored Bill Clinton's warnings (re OBL). Lesson? Government FAILS when republicans are in charge.

-FJ the Dangerous and Extreme MAGA Jew said...

lol! I saw that they fact checked Obama not restocking all the masks they used for H1N1 and ebola...and labelled it TRUE.

-FJ the Dangerous and Extreme MAGA Jew said...

Stupid IS as Stupid DOES!

The Prophet Dervish Z Sanders said...

Trump Falsely Claims He Inherited "Empty" Stockpile. (excerpt) Greg Burel, who was the director of the Strategic National Stockpile for more than 12 years until he retired in January, recently told CBS News: "We didn't receive funds to replace those masks, protective gear and the anti-virals that we used for H1N1" [from the republican-controlled Congress]. [end excerpt]

Dotard has had three years. Why didn't he restock the masks? For the first 2 years of his administration republicans had total control. But cutting taxes for the wealthy and corporations ALWAYS takes priority when republicans take control.

"Stupid is as Stupid does" explains your vote for Dotard.

Quote: On February 7, the WHO warned about the limited stock of PPE. That same day, the Trump administration announced it was sending 18 tons of masks, gowns and respirators to China". Poltifact rating: TRUE.

-FJ the Dangerous and Extreme MAGA Jew said...

He received funds but bought vaccines instead. He had no skin in the game.

-FJ the Dangerous and Extreme MAGA Jew said...

And stopping the vaccine IN Cchina EARLY saved millions of lives, world wide. Thanks DJT

-FJ the Dangerous and Extreme MAGA Jew said...

Speaking of stupid...

The Prophet Dervish Z Sanders said...

If Dotard stopped a vaccine his actions COST lives and he is a mass murderer who should be executed for his crimes. "Skin in the game" has got to be your 2nd most typed phrase. Behind "LOL".

The Prophet Dervish Z Sanders said...

If you're referring to Dotard's China travel ban, he deserves no "thank you" because his actions did not "save millions of lives".

Quote: President Donald Trump has repeatedly boasted of travel restrictions on China that he suggests he decided on his own over the objections of health experts and saved "thousands" of lives. His claims aren't substantiated. ... Trump's order did not fully "close" the U.S. off to China, as he asserts. It temporarily barred entry by foreign nationals who had traveled in China within the previous 14 days, with exceptions for the immediate family of U.S. citizens and permanent residents. Americans returning from China were allowed back after enhanced screening at select ports of entry and for 14 days afterward. But U.S. scientists say screenings can miss people who don't yet show symptoms of COVID-19; while symptoms often appear within five or six days of exposure, the incubation period is 14 days. [end quote]

Additionally... Nearly 40k flew to U.S. from China after Trump's coronavirus travel ban. Quote: 279 flights from China have arrived in the U.S. since Trump's travel restrictions were announced, "and screening procedures have been uneven" ... "Thousands of them flew directly from Wuhan", the original epicenter of the COVID-19 outbreak... [end quote]

Joe Conservative said...

You'd not allow US nationals to return? Racist!

The Prophet Dervish Z Sanders said...

The KEY sentence (from my quote above) is "screening procedures have been uneven". Let them back in with proper screening, dipshit. Racism isn't a factor.

-FJ the Dangerous and Extreme MAGA Jew said...

Screening procedures were "uneven" because the state of knowledge relative to COVID-19 has been incomplete and in constant need of supplementation having nothing to do with Trump's decisions or your racist fear of the Yellow men.

The Prophet Dervish Z Sanders said...
This comment has been removed by the author.
The Prophet Dervish Z Sanders said...

A "US National" can be an ethnicity other than Asian. The fear is directed (or should have been) at people carrying the virus, regardless of ethnicity. Yet Dotard stood down and allowed the virus to come in (on Putin's orders?). And Dotard (by referring to the COVID-19 as the "Chinese virus") is encouraging "racist fear" of Asians. The result being magaturd violence directed at Asian-Americans.

Quote: ...for Asian Americans, the virus has stirred up another threat: a wave of verbal and physical attacks. ... "The biggest fear I have now isn't just widespread acts of individual bigotry. It's a concerted campaign on the part of the Trump administration to sharpen the blade of racialization, to assign this blame in such a way that Chinese people are perceived to be the threat", Jeff Yang (host of a podcast about being Asian in America) said [end quote]

The Prophet Dervish Z Sanders said...

Dotard welcomed the virus in with open arms! "We have to fight them over there so we don't have to fight them here" was the Obama Administration strategy. But Dotard said NO to that strategy (why he fired our expert on the ground in China). First Dotard colluded with Putin to steal the presidency, now he colludes with the coronavirus to KILL Americans. He is a traitor to America and a Manchurian Candidate working to bring down our nation from the inside.

-FJ the Dangerous and Extreme MAGA Jew said...

He didn't ship COVID19 supplies to China? I thought your comment on 4/7 was that he did "fight it over there"...

Make up your mind. I can't tell which side of your mouth you are talking out of.

The Prophet Dervish Z Sanders said...

Did the PPE Dotard send to China stop the virus dead in it's tracks? PPE isn't fighting the virus. It's protection for people fighting the effects of the virus. Protection for our health care professionals WE could have used.

You're the one talking out both sides of his mouth -- by first criticizing Dotard for signing the stimulus legislation (and criticizing a UBI) and now praising him for signing it -- because (you incorrectly assert) it includes a UBI (which it doesn't).

-FJ the Dangerous and Extreme MAGA Jew said...

PPE isn't fighting the virus.

Then why all the fuss over the lack of it? And how's the pandemic in China NOW? Where are the tens of millions of bodies?

I'm with the Swedes. The virus scare is a pathetic joke.

The Prophet Dervish Z Sanders said...

PPE is protection for the health care professional fighting the EFFECTS of the virus. I'm with the Kiwis. They responded swiftly with a strict lock down and are reaping the rewards of competent leadership (1 death in New Zealand versus 20k and counting in the US).

The Prophet Dervish Z Sanders said...

The estimate (for the US if we did nothing) is 2 million dead. Every government (to varying degrees) is doing something, therefore there won't be "tens of millions of bodies". Because no government is as stupid as the imaginary Kekistan government (if a real country the Kekistan death toll would be staggering).

Thersites said...

lol!

The Scandinavian country that locked down least has the lowest case rate. Why?

Any time a country hits peak cases and infections recede, the public health community and the media give credit to government measures that preceded it. This is merely the fallacy of post hoc, ergo propter hoc; after this therefore because of it. We may as well blame Kobe Bryant’s death on Donald Trump’s election.

Moreover, seemingly every epidemiologist who gets quoted or published regarding the coronavirus ignores the most basic rule in epidemiology called Farr’s Law (dating to 1840 and before any public health organizations), that says epidemics peak and decline on their own. That’s not to say that proper actions cannot reduce overall infections – or improper ones increase them. During bubonic plague outbreaks people sometimes blamed and killed cats – that of course were actually beneficial in controlling plague-spreading rats. There’s a lesson there.

Both Farr’s Law and the Scandinavian experience show it may not be necessary to destroy the world economy to save the world.


But aside from a few countries, we’ve seen too little balancing. Instead it seems fanaticism has reigned—a tunnel vision focused on combating this disease through coercive means, at the cost of untold economic devastation and ruined lives.

Perhaps it’s time to rethink that strategy.

The Prophet Dervish Z Sanders said...

Sweden's Relaxed Approach to the Coronavirus Could Already Be Backfiring (excerpt) ... in Sweden, where there are 9,141 confirmed cases and 793 people have died, experts worry weaker measures may be leading to a more severe outbreak in the country of just 10 million citizens.

Sweden has a relatively high case fatality rate: as of April 8, 7.68% of the Swedes who have tested positive for COVID-19 have died of the virus. Neighboring countries, like Norway and Denmark, have case fatality rates of 1.46% and 3.85% respectively. [end excerpt]

Sweden Coronavirus: 10,483 Cases and 899 Deaths [posted as an update to the death total in the article above].

Joe Conservative said...

lol!

They aren't even near the top of the list. And they've done nothing...

The Prophet Dervish Z Sanders said...

7.68% of the Swedes who have tested positive for COVID-19 have died of the virus. Very high.

Joe Conservative said...

They were very sick BEFORE they caught COVID19 label. It's what comes from only testing people already on respirators and nobody with a slightly elevated temperature who will certainly survive.

The Prophet Dervish Z Sanders said...

So, they were "only testing people already on respirators and nobody with a slightly elevated temperature who will certainly survive" in Sweden and that explains Sweden's much higher fatality rate? Sounds like yet another imaginary Minus FJ conspiracy to me.