The pandemic was a test of America's public health bureaucracy. It failed.
Those failures were legion, and they were spread across multiple officials, agencies, and layers of government. But no institution failed quite as abysmally as the Centers for Disease Control and Prevention (CDC), which, through a combination of arrogance, incompetence, and astonishingly poor planning, wasted America's only chance to mitigate the effects of COVID-19 before it spread widely.
The CDC is supposed to be America's frontline institution in the fight against infectious disease. Its job is to analyze viral threats, track their spread and development, and provide the public with relevant information about how to respond to outbreaks. Not only did the agency do this job poorly in the early stages of the pandemic, but it actively hindered efforts that would have greatly improved America's response, and it made planning errors that were both predictable and avoidable. At nearly every stage of the pandemic, the CDC got things wrong and got in the way. Its failures almost certainly made America's pandemic worse.
The CDC's most notorious breakdown came early on, when it was developing a testing system to detect COVID-19. As former Food and Drug Administration director Dr. Scott Gottlieb documents in a scathing new book, Uncontrolled Spread, the agency made multiple critical errors along the way.
First, the Atlanta lab in charge of developing the test departed from the agency's own initial test, as well as the tests produced by other countries, producing a test design that was more complicated than necessary, with three components rather than two. In theory, this was supposed to make the test more accurate. In practice, it introduced an error into the early stages of the testing process during the early months of 2020, when America could least afford it.
The test kit, it turned out, was contaminated. And the part that was contaminated was the third component the CDC had decided to add at the last minute. What's more, the contamination happened at least in part because the CDC had decided to produce the test in-house, at a lab not suited for the project, rather than contract it out to private firms with more experience and more rigorous quality controls.
The contamination was not discovered until the CDC sent the botched kits out to other labs. And even as those labs increasingly reported that the system was producing obviously unreliable results, the CDC, according to Gottlieb, continued to insist in communications with the White House and the Food and Drug Administration that the tests worked. The agency eventually admitted there was a problem, but it insisted on a slow and painstaking process of updating the bad kits themselves—actively blocking private labs from taking over. So not only did the agency botch the process, but it blocked others from stepping in to fix its errors.
Eventually, private contractors were brought into the process, but only after days of dickering over various licensing and usage issues; the CDC wanted to preserve total authority over the process. As Gottlieb writes, "the agency may have created the conditions for failure by overengineering its test for COVID and then being wedded to that more complicated design even after the problems arose."
Meanwhile, COVID-19 was spreading.
The testing foul-up has been widely recognized as a critical failure. What's been less discussed is that even if the agency had avoided the contamination fiasco, it was actively impeding the build-out of mass testing capacity during the pandemic's early days—because true mass testing would have meant allowing testing that was out of the CDC's control.
In late March 2020, after much of the country had shut down, the CDC went so far as to "edit an article that was slated for publication in a science journal, to remove a passage inserted by a Washington State public health official that called for widespread testing at senior assisted-living facilities," Gottlieb writes. Senior living facilities were, of course, among the communities where COVID was most deadly. Yet even there, the agency resisted mass testing. It resisted was because that state official had "encouraged more testing than the CDC was prepared to allow or was able to handle at the time." In an editing comment on the article, according to Gottlieb, a CDC official explicitly cautioned: "I would be careful promoting widespread testing."
This wasn't entirely unprecedented or unexpected. In 2016 and 2017, the CDC had similarly mishandled the development of a Zika test kit. As with COVID-19, the CDC's unwillingness to provide diagnostic tests to commercial labs was at the root of the problem.
Thus, the agency's COVID failure wasn't just foreseeable; it was foreseen. A Government Accountability Office report from 2017 noted that the CDC distributed diagnostic tests for Zika to public health labs but not to other manufacturers. The underlying process was murky at best. "Without a clear and transparent process for distributing CDC diagnostic tests," the report warned, "the agency may not be able to develop the capacity of the commercial sector to meet the needs during an outbreak." Despite the warning, this was exactly how the COVID pandemic played out.
Widespread testing from the early days of the pandemic wouldn't have stopped COVID completely. But it might have enabled a more tailored response, with mitigation measures limited to certain geographic regions and times. Because policymakers and the public were initially blind to the scale of the outbreak, we shut down the entire country instead, to disastrous results. No single organization is more to fault for that early blindness than the CDC.
The CDC continued its run of failures as the pandemic proceeded. It promoted arbitrary guidelines based in shoddy science, like the rule calling for six feet of distance between people interacting indoors, which made it maddeningly difficult to reopen schools in the fall of 2020. The agency didn't update that guideline to three feet until March 2021, despite months of evidence indicating that three feet was safe enough.
So the CDC was not just wrong when it mattered; it was stubborn about its wrongness. It also often refused to explain its decisions, or to provide useful, practical information on which officials and private individuals could base their decisions. And when it did provide information, as Zeynep Tufecki has noted, the info was often confusing, full of vague or impractical advice and conflicting pronouncements.
The root of the problem is the agency's self-conception: It sees itself as the ultimate arbiter of what is true and what to do on all matters of infectious disease. In essence, the CDC believes there is no other authority besides the CDC, so it shuts out private labs from the testing process, insists that its faulty tests actually work pretty well long after problems arise, sticks with overly complicated plans that bog down processes, and resists calls to update its guidance, even when that guidance makes living ordinary life difficult or impossible. In a pandemic, where information is scarce and evolves rapidly—and when hundreds of millions of people have to make decisions right now—the agency's preference for deliberative slowness and absolutist pronouncements would be a problem even if it were largely competent. And as it turns out, the agency isn't that competent at all.
At this point, the CDC's cultural dysfunctions are endemic. Given its performance during the pandemic, the agency as we know it today should be scrapped. That isn't politically realistic right now, but at a minimum it should be reformed. Gottlieb wants to see a special infectious disease unit modeled after U.S. intelligence services, which are more comfortable with ambiguity and which recognize the need for rapid processing and updating of information that changes rapidly.
A CDC that's organized around faster, more humble, more practical forms of information processing would be an improvement. But what we need most is to downgrade the CDC's importance and influence, to focus on distributed systems rather than centralized information hoarding. Among other things, that means a far higher reliance on the private sector. Private labs and manufacturers might have made some mistakes during the test kit development process, but a distributed system wouldn't have been brought to its knees by a single point of failure.
The same goes for information distribution and guidelines. Rather than act as if the CDC is the be-all and end-all of wisdom about infectious diseases, officials and individuals should be more open to a variety of less bureaucratic information sources.
Indeed, those following various public debates about COVID-19 were reasonably well-informed throughout the process, understanding quickly that it was spread through aerosols, that ventilation was much more important than physical distance, that unmasked outside activity was basically safe, that schools could safely reopen in 2020 with some reasonable precautions. The CDC's pronouncements, meanwhile, were sometimes basically right, sometimes badly wrong, sometimes just muddled—and almost always far too late.
The agency's understanding of its role doesn't allow for much systemic self-criticism. But officials who have the authority to demand accountability and reform should do so. And a good place to start is with Gottlieb's book. As always, the first step to healing is diagnosing the disease.