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 that 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 that it did important, apolitical work, but that it was highly competent.
And then came Ebola.
The Ebola outbreak is not exactly enhancing the CDC’s reputation for competence. At first, the agency reassured the public that American hospitals were ready for anything. That 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 that the CDC 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 that she had contracted the virus — the second nurse to do so — Frieden was forced to admit that 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. Perhaps the biggest mistake the CDC made was that its voluntary guidelines for treating Ebola patients were too lax.
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 that because the chances of Ebola being imported to the U.S. were considered low, preparing for it was not considered a good use of scarce public money.
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,” said Laurie Garrett, a senior fellow for global health at the Council on Foreign Relations and the author of the seminal 1994 book, The Coming Plague.
Morale plummeted, and many of its best scientists fled.
Fair enough. But it is also true that the CDC was too hubristic in its approach to Ebola, and the consequence is that its staff now looks like bumblers.
The CDC’s unfortunate habit of saying things as if they were certainties only to have to acknowledge that its judgment was questionable, “can cause people to lose faith in the public health system,” said Dr. Richard Wenzel, an infectious disease specialist at Virginia Commonwealth University.
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, 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.
Joe Nocera is a New York Times columnist and may be contacted through nytimes.com.
