Just before the first cases of the novel coronavirus began popping up in the U.S. around this time last year, public-health agencies’ biggest concern seemed to be e-cigarettes.
In January 2020, the Food and Drug Administration announced stringent bans on many of these nicotine-vapor products, teenagers’ use of which former FDA director Scott Gottlieb called an “epidemic.” That same month, the Centers for Disease Control ended its months-long recommendation that all Americans avoid e-cigarettes, after mistakenly blaming them for causing several thousand cases of lung injury nationwide. Other CDC initiatives in 2019 had included examining what foods should be sold at highway rest stops, encouraging urban planners to build more walking-friendly cities, and trying to influence how Hollywood portrays epidemics.
For all this activity, though, the CDC was failing in its core public-health functions. Despite an $11 billion budget, the agency had never produced useful modeling of how a novel virus might spread and be contained. In March 2020, Anthony Fauci, the nation’s top public-health official, was telling Americans not to wear masks. CDC arrogance and bureaucracy led to contaminated and delayed testing. A recent Reuters investigative report highlights how the agency missed early opportunities to identify asymptomatic spread of Covid-19.
The restrictions that public-health officials have put on American public life have been ad hoc and ineffective. How are liquor stores essential, but not schools? Despite imposing some of the nation’s strictest Covid lockdowns, California has a 45 percent higher hospitalization rate than Florida, which has remained relatively open.
When President Trump promised that a Covid vaccine would be developed within months, the nation’s top public-health experts scoffed. “At the earliest, a year to a year and a half, no matter how fast you go,” said Fauci last March. Private pharmaceutical companies proved the naysayers wrong—but then public-health officials botched the vaccine rollout, contributing to even more suffering and death.
U.S. public health must return to its core function of protecting Americans from transmissible diseases—not from themselves. A downsized CDC should rebrand under its original name, the Communicable Disease Center, and stop trying to control behavioral health decisions like vaping.
Bureaucracies always resist reform, but philanthropy can play a role here, funding innovative private alternatives to public health. Ample historical precedent exists for such an effort. Philanthropy played a role in building the nation’s public-health infrastructure. A local businessman’s idea and generosity led to the founding in 1912 of Tulane’s School of Hygiene and Tropical Medicine, the first institution of its kind. The Rockefeller Foundation founded the nation’s second, the Johns Hopkins School of Hygiene, once known as the “West Point of Public Health.” The Milbank Memorial Fund helped model municipal health departments, including Syracuse’s. Before these foundations existed, wealthy individuals built public baths, clinics, and dispensaries in impoverished neighborhoods of major cities.
Philanthropists can once again lead the way in remodeling our public-health institutions. The effort might start with a nonpartisan citizens’ committee to engage in a military-style “after-action” analysis of the pandemic response to identify shortcomings and fixes. Such a report might identify problems like the CDC’s monopolization of testing and lack of early contact tracing as targets for future philanthropic efforts.
A new infectious-disease school—devoted to science rather than fashionable political causes—could also catalyze a renaissance in the theory and practice of public health. More ambitious philanthropy could support private alternatives to the CDC or even to the feckless World Health Organization.
We can’t control when the next pandemic will strike, but we can vastly improve our response by empowering private institutions to bolster, if not surpass, our sclerotic public-health bureaucracy.
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