Lessons from the pandemic: the need for a national COVID commission

This is Part 6 (and the final installment) in our “Lessons from the Pandemic” video interview series. Access the full series here.

In the final episode of a series of video interviews on lessons from the COVID-19 pandemic, Brink Lindsey speaks with diplomat and historian Philip Zelikow of the University of Virginia. Zelikow previously served as executive director of the 9/11 commission and also directed the earlier Carter-Ford commission on federal election reform; he is presently directing the Covid Commission Planning Group that is trying to establish a national commission on the pandemic. Lindsey and Zelikow discuss the commission planning efforts and the prospects for authorizing legislation, how a commission could set the stage for better pandemic preparedness in the future, and insights gleaned from the planning group’s substantial preparatory work on how and why the U.S. pandemic response fared so poorly.

Transcript

Brink Lindsey: Okay, great. Hello. I’m Brink Lindsey, a vice president at the Niskanen Center. Welcome to the latest in a series of video interviews on lessons from the COVID-19 pandemic. This series is part of a larger Niskanen Center project on rebuilding American state capacity. I’m delighted to have as my guest today, Philip Zelikow, who is a professor of history at the University of Virginia. He taught previously at Harvard’s Kennedy School, and he has served in five different presidential administrations from Reagan through Obama in various capacities in the White House, State Department and Pentagon. He served as the executive director of the 9/11 commission, as well as the director of the Carter-Ford commission on election reform in the wake of the contested 2000 election. He is the author of numerous books and, most relevant for present purposes, is the director of the COVID Commission Planning Group, a private organization attempting to prepare for and establish a national commission on the COVID-19 pandemic. Philip, thank you so much for joining me today. Welcome.

Phil Zelikow: I’m glad to be with you.

Brink Lindsey: So tell me why you got involved with the COVID Commission Planning Group. You have experience in running big national commissions, so you clearly think this vehicle can accomplish certain purposes. Why do you see this as something that’s a necessary part of preparing for next time? How can a commission help us to improve our game? I mean, we’ve spilled millions of words from government reports and academic studies, NGOs, think tanks, lots of analysis, lots of postmortems. What can a national commission bring to the mix?

Phil Zelikow: Yeah, let me first clarify that this wasn’t my idea. Actually at the end of 2020, a group of foundations led by Eric Schmidt and his foundation approached me and said, “We think it’s obvious that there should be a national commission that will investigate what really happened in this crisis and issue recommendations. And do you have ideas as to how that should be done?” And I gave them some ideas and then they asked me, “Would you please run a group to plan such commission?” I said I would if I can get a lot of people who actually know stuff to help me. And so I then recruited dozens of really outstanding experts in various disciplines and if you go to covidcpg.org, you can see who these experts are and who the folks involved are. So then what we then began doing is developing work plans and interviewing people to kind of map the landscape of the crisis and give us a good, preliminary understanding of what happened to plan a large investigation. We’ve actually now interviewed more than 300 people about the crisis over the last year and a half.

Brink Lindsey: And who has done all that interviewing? Do you have staff?

Phil Zelikow: I’ve interviewed all those people myself.

Brink Lindsey: Oh wow.

Phil Zelikow: And we actually have written records of almost all of these interviews. Often the interviews were group interviews in which a number of our advisors would also take part and there would be lively colloquy in the chats and exchanges of citations and other things. So it’s actually a pretty interesting body of work already. I’ll add that there is a Senate bill creating a national COVID commission. They call it a national task force. And that bill has already cleared committee, the Senate health committee, with a wide bipartisan margin. But that bill, which is the PREVENT Pandemics Act, has not yet gotten to the floor. And I don’t know whether Senator Schumer’s going to give it adequate floor time or not, or when that will happen. And if it does get floor time, I think it’ll pass. And then I don’t know what will happen in the House. So the point is there is actually bill to create, they don’t call it a national COVID commission, but it’s the same thing that has wide bipartisan support, including the leaders on the Senate health committee.

Brink Lindsey: It’s co-sponsored by Patty Murray and Richard Burr, the PREVENT Pandemics Act.

Phil Zelikow: Correct.

Brink Lindsey: Is there any corresponding bill in the House yet or are they just waiting for something to happen in the Senate?

Phil Zelikow: No, not yet. And we don’t know if there will be one. There are some Republicans, especially on the House side, who don’t want a commission for various reasons and partly because when they take control of the House, they’ll just run their own investigation, thank you. About whatever it is they want to look into.

Brink Lindsey: Yeah. I know that there had been previous efforts the year before to have legislation on a national commission and Republicans were clearly not interested at that time. They thought it was just going to be, the focus would be on what Trump did wrong. Now there’s a much larger track record. There’s plenty of things the Biden administration’s arguably done wrong as well. There’s also as a kind of carrot for getting bipartisan interest. I take it there’s an explicit mention that this commission would look into the origins of the novel coronavirus as well, but still….

Phil Zelikow: That’s all correct.

Brink Lindsey: Yeah. But whether it’s happening or not is still up in the air.

Phil Zelikow: There is bipartisan interest in the origins issue. So now as to the value of such a commission. It depends on how well the commission is done. If the commission is done really well, it will develop a body of knowledge that goes far beyond any individual journalist’s account and would have significant access to relevant federal, state, and local records. We’ll interview people on a systematic scale. That’s an order of magnitude beyond what people can do in the books and provide a much more authoritative foundational record of what happened. Also, it can really try to reconstruct the choices people made. So the commission is valuable first, if it’s done well, which is hard, to provide a much more authoritative record of what happened. The commission is also valuable because in a way it’s an indispensable bridge to any policies to make America stronger, to make America better. If the commission does its job well, it’ll create a bipartisan momentum pointing towards legislation or other policy moves that will try to rebuild key institutions, for instance, our public health system, which is not in very good shape.

The commission is almost an indispensable prerequisite to rallying bipartisan support for an agenda like that. And I’ll add one more thing, which is, I think if the work is done well, it’s actually going to change what the agenda is about. Right now, there is a highly polarized partisan agenda connected to the crisis that is mainly a polarized argument and discourse about what are called NPIs, non-pharmaceutical interventions, or to put it in common language, a very polarized partisan argument about lock downs, masks, school closures, in which, basically, you’re either for or against that, or for or against Trump. I think a good investigation will reveal a whole set of issues that mostly bypass that argument. And those arguments I think are of interest, but I think they will turn out to be of relatively marginal importance for understanding this crisis. I think there are a number of other issues that are, as time passes and we get more perspective and do a good investigation, that there are all sorts of areas to look at and work on that mostly bypass that argument and on which there are not clear partisan lines that have been drawn and in which you could actually potentially get a broad agenda in which people could support change while they still have their cultural argument about did you like lockdowns or not.

Brink Lindsey: So in your experience with the 9/11 commission, did you find that – I mean, of course was, the subject matter was intentionally controversial and there was partisan conflict over it. Did you find that that the report, having that authoritative bipartisan commission report, changed our understanding of 9/11 in important ways? And do you see that then as a kind of precedent for what you could achieve with the COVID commission?

Phil Zelikow: Yes, absolutely. We now take for granted a baseline knowledge about 9/11 that is actually a product of mainly the commission’s work, even down to the details of what happened on the morning of 9/11, the details of the air response, the United 93 story actually had been badly garbled before our commission did its work. And the garbling was spawning conspiracy theories. And the commission actually reset the basic narrative, that is, in people have seen the movie United 93, that movie is basically drawn from the commission’s report and it spins off from that. And so on matters large and small, the commission work actually kind of reset what the main narrative was about. It spotlighted issues like the significance of terrorist travel, for example, rather than terrorist money – terrorist money, actually having been relatively trivial and not very interesting, but terrorist travel, having been extremely important and a point of vulnerability.

And so we now have all sorts of systems in place to try to, which people experience in ways they can kind of half-see, having to do with monitoring who gets on airplanes before they get to the United States and allowing us actually to run checks on people before their plane enters American airspace, and also much more security in our passports and our travel documents than used to be the case.

There are many examples, mostly not very well known. We created something called the National Center on Counterterrorism, NCTC, the National Counterterrorism Center, which actually has been a highly successful interagency organization of a kind that did not exist before 9/11. It’s not a very well-known organization. It’s situated inside the office of the Director of National Intelligence, but it’s actually by many people considered almost a model of interagency joint threat work and has proven out pretty well over the last 15 years or so since it was really set up. Other bureaucratic moves, like the creation of the office of Director of National Intelligence itself, used the momentum of the 9/11 commission report to get it done, but was actually a very old issue having to do with the organization of the intelligence community, which people had been debating actually since the end of the Eisenhower administration and the 9/11 commission report became an occasion to revisit that subject.

Brink Lindsey: So this time around the subject matter is very different. Arguably more complex, so many different national authorities and also the international angle. Also the political context is different. Of course there was partisan controversy back then, but partisanship was temporarily subdued in the aftermath of 9/11 — well, relative to now, nothing subdued about polarization these days. So, how did those differences affect how this commission would need to be different?

Phil Zelikow: Yeah, because I think what you have to do is do an investigation that puts the crisis in a broader perspective and allows people to see it in ways that get beyond the partisan argument – which is really a cultural argument about do you trust medical experts, or you don’t trust them, do you think people overstepped their authority. All that argument is interesting, but actually, as I was suggesting earlier, I think if people can step back and see the narrative more broadly, they’ll actually see a whole raft of interesting issues that are substantially unrelated to those arguments. And then they’ll have a chance, if they want to, to step past those arguments and actually engage things that could make the country stronger and healthier and prepare it better for the future. 

Let me just give you one illustration of that we’ve already see in our preliminary interviews. On the NPI issues, one of the things we found is that where these things worked or didn’t work or were managed well politically turns less on the substance of what you chose to do, the substance of whether you chose masking or school closures, less on the substance and more on the process of how those decisions were made. In general, the federal government more or less abdicated responsibility for the management of the crisis from about April 2020 on for the rest of the year. We can have an argument as to whether that was a good thing, but the federal government effectively abdicated most of the management of the crisis from about April 2020 on, leaving it to state and local authorities.

Brink Lindsey: Other than Operation Warp Speed, but the actual management of the pandemic….

Phil Zelikow: Correct. And then state and local authorities, the standing public health organizations in all these jurisdictions were immediately overwhelmed. So the pattern you see everywhere is the creation of all sorts of ad hoc decision-making structures that usually engage all sorts of people from local medical centers. And they really vary a lot. And there are all kinds of lessons here about how you prepare yourself to manage a large crisis, which, by the way, could extend to a hurricane, it could extend to many things. And some jurisdictions actually set this up pretty well. And by setting up pretty well, that means they really brought a lot of stakeholders into the process. 

So, businesses who were going to be affected by measures like lockdowns and so on either felt included or excluded from those decisions. They either understood them or didn’t understand them. And we found that in places that organized this pretty well, in which they included a lot of stakeholders and businesses felt that their concerns were understood and that the measures were tailored to at least consider sensible business interests or educational interests, where you actually had really good community outreach from pulpits and in communities, that actually in general these sorts of measures worked better. Whatever the content of the measures was, by the way, they tended to work a little bit better. They tended to be somewhat better designed. In other words, where you designed a good crisis management process, the crisis management tended to go better, regardless of the substance of what crisis management measures you adopted. That’s actually an interesting lesson. There’s a big lesson there about how to organize ourselves for crisis management at various levels of government.

To give you an illustration, some of this is nonpartisan. Forget what you think of Governor DeSantis in Florida. Below the level of the governor, Florida, in some respects, did relatively well because Florida agencies have a lot of crisis management experience, mainly from dealing with natural disasters. Now, Governor DeSantis … and without engaging whether the governor was an important player or not in that, that was an interesting thing to notice in vaccine distribution, vaccine outreach.

Or to take, for example, the city of Houston in Texas. That’s another area where the city of Houston … let’s put the state of Texas aside for a second. The city of Houston has an African American mayor, Sylvester Turner, lot of experience with disaster management, crisis management. Again, the city managed this pretty well under the circumstances. They had a really strong local medical center. They had very good community outreach, again, with church groups and all other kinds of community organizations. And that made a positive difference in a place like that, but we could contrast that to places where people felt alienated and excluded and no one cared about or listened to what happened to them, you didn’t engage local medical communities very sensibly, and a lot of things didn’t work as well, in fact right up to the point at which you have vaccines, but don’t know how to get them into people’s arms.

Brink Lindsey: Let me back up a little bit. The COVID Commission Planning Group, who is behind it? Who are the major funders?

Phil Zelikow: Four Foundations, Schmidt Futures, one of Eric Schmitz’s foundations, the Rockefeller Foundation, which is very well known in this space, the Skoll Foundation, which also does some nonprofit support, and a foundation called Stand Together, which is actually one of the Koch family foundations, which is associated with many conservative things. Stand Together actually is an effort to try to find areas for bipartisan cooperation. So you can see this is very diverse funding.

Brink Lindsey: Very heterogeneous funding.

Phil Zelikow: Right. So ideologically, these foundations are all over the map, but these four foundations came together to support this planning.

Brink Lindsey: So you may be facing some kind of a quandary about timing. On the one hand, having an act of Congress establishing a commission can empower your commission to do a whole lot of things more effectively than if you were just trying to do this as a purely independent private initiative. On the other hand, the iron isn’t getting any hotter. It’s actually starting to cool off. People have COVID fatigue. People want to move on. So the sooner this commission gets started, it seems to me the better. So how do you weigh those tradeoffs?

Phil Zelikow: It’s already late. I think this should have been organized, if necessary under private auspices with administration support last year, last summer, summer of 2021. Ever since then the window’s been closing and the momentum has been weak for positive action. This is partly because I think the administration didn’t want the disruption of a commission, what it regarded as disruption, and also the administration wasn’t planning a big bill to fix our public health system. So it didn’t need the commission to tee up that bill since the administration wasn’t planning to put a huge amount of effort into a bill that would arise out of this crisis. And that administration’s domestic agenda still does not prominently include any major legislation arising out of this crisis.

Brink Lindsey: In the fall of 2021, the administration did come out with a big pandemic preparedness plan initiative, like a $60 billion price tag over, I can’t remember, maybe seven years. And then when that was announced, the idea was that was going to go into the Build Back Better omnibus, but 90 something percent of it didn’t. And then of course Build Back Better died, but there was at least some contemplation by the administration of changes in the way we do things and a fairly aggressive plan for improving pandemic preparedness, really following in the footsteps of a big bipartisan commission that Joe Lieberman and Tom Ridge had co-chaired.

Phil Zelikow: Yeah, we know a little bit about that. One, that effort actually was focused relatively narrowly and too much in status quo institutions. It would mainly have pumped a lot more money into existing R&D efforts, which actually are in some ways flawed and need significant reform, but it was mainly a placeholder to try to reserve money to support more biomedical R&D in the Build Back Better bill. And then the dollar placeholder more or less fizzled, as you point out. And even so though, even that effort wasn’t really yet envisioning serious systemic reform, like for the public health system.

Brink Lindsey: It was upgrading on monitoring and doing a lot of anticipatory vaccine and treatment development, but not a lot of structural reform.

Phil Zelikow: Yeah, but in the NIH world, not necessarily in the world where ideas are brought or turned into viable medical products. But any case, that’s mostly fizzled too. So then that pretty well fizzled by the end of 2021. So where we are now, to come back to your earlier question, is the window is narrowing, you’ve got a Senate bill that’s out of committee but has not yet been given floor time, but not a parallel bill in the House. The window in which to get this moving is narrowing. Some might even argue it’s already too late, because for the commission to do its work it needs at least a year and a half. Now we’re already into 2024. Even if the commission was created tomorrow, you see the problems.

Now maybe the idea is, “Well, we’ll create the commission next year. We’ll have the distance of time. We’ll be able to look at it more reflectively. We’ll get it with a report maybe in 2025 so it’s out of the presidential politics of 2024,” but by that time, the Congress, if the Republicans get one of the houses of Congress, they will be launching their own COVID investigations. They’re going to launch their own origins investigation, done their way. They’re going to launch their own investigation going after Tony Fauci, depending on who’s organizing this, I suspect and fear. And I think those efforts will actually somewhat muddy or poison the waters and actually then make a commission’s work even harder.

Brink Lindsey: So what are you going to do? How long are you going to wait for Congress? I mean, are you determined to establish a commission regardless of what happens in Congress, or is it now contingent on what Congress is doing? If it’s not contingent on what Congress is doing, how long do you give them before you just get going on your own?

Phil Zelikow: That’s a great question. And my advisors disagree on how to answer. I think a lot of our advisors are very frustrated with the situation. They see a whole raft of things that could be done fruitfully. And they’re very frustrated that we can’t just get this going and start putting these ideas in front of the American people. On the other hand, I think that the passage of the Senate bill has effectively frozen the situation for an outside effort, because if that bill goes forward anything we start doing on the outside will then immediately be overridden and problematic. I think that now that there is a viable Senate bill, the fate of the commission more or less now rests with whatever happens with that bill and outside efforts are effectively frozen. What I might do with the help of some of our advisors is write some sort of short-form piece that at least puts forward some ideas about things that we can already see that could be a more fruitful way of focusing work than where a lot of the arguments are that are going on.

Brink Lindsey: Is there a possible option, though, of starting up your committee on your own steam and if Congress doesn’t act, then you keep going? If Congress acts, you just turn over everything you’ve got to the commission and hand the baton off?

Phil Zelikow: Yeah. And what we’ll do is if the commission gets set up, we’ll make available to them the records of all the work we’ve already done and all the people that are already involved and see what they want, see if they can make some good use of that, but I think we’ve pretty much reached the point where we’ve taken that about as far as we could, and that if we try to launch a much larger scale investigation, I think the foundations too will want us to kind of step back and they’ll just shrug their shoulders. “Why should we pour millions of dollars into this if Congress might pass a commission next month?” So I think basically now the hope for a COVID commission, for better or worse, effectively rests now with the fate of this Senate bill. But there are some things that we will do already to make our work available to whatever comes out of that. And there are some things we can do to lay down some markers as to where we think this should go. If that bill fails, I think for me anyway personally by next year, I’m not sure it’s as interesting to try to create a private commission next year.

Brink Lindsey: Let me switch gears now and get your own personal assessment of lessons from the pandemic.

Phil Zelikow: Yeah.

Brink Lindsey: You’ve talked with hundreds of people. You’ve done an extremely deep dive. You also have a very deep background in public service and in scholarship about public service and about public administration. I’ve seen you describe the failures of our pandemic responses as a software problem, not a hardware problem. I’ve also seen your writings on the kind of decline in the quality of US public administration generally described as a software problem. So can you tell me what you mean by that and how you connect the specific failures you see in the pandemic response with the broader deterioration in American public administration that you’ve written about?

Phil Zelikow: Sure. So the hardware and software metaphors go like this, the hardware of government is the structures and tools available to do work. So it’s the basic institutions. The software is what you do. Given certain structures and tools, what is it that you do? My argument is that, in general, on a lot of these issues, the problems are less to do with the hardware of the basic structures and more to do with people don’t know what to do, or they’re not very good at doing it.

Because a lot of the efforts to reform things are, “Oh, this thing didn’t work very well. We need to create a new agency, or we need to rewire the bureaucratic diagram.” And sometimes that’s valuable and sometimes that’s necessary. But I think the main problem is less about the hardware of government, the structures and tools, and more actually about the software of government, the lack of training and the inability to actually know how to get stuff done and know what to do. And I think that’s also true for this crisis.

There are some structural issues having to do with our public health system, but then even beyond the structural issues, there are some deep problems here. People don’t have really a good concept of what needed to be done. See, in a way, once you have a concept of what we should do, then you can go back and say, “Oh, we don’t have this or that tool to do this.” But first, you have to articulate the task really well, and then you’ll do a better job of organizing to perform that task. But a lot of people often get that backwards and they want to focus on the organization and processes without working on it. And I think in life it actually works better the other way. Focus on the task first and then figure out how to organize to get it done.

Now, let me give you an illustration of what I mean in this crisis. We had a complete failure to have basic intelligence about the enemy. So the country’s invaded by an alien invader, which is a microorganism. So I think it’s a useful construct. Think about it as an enemy invader from overseas that comes into and invades our country. So ordinarily, you’d want intelligence about this invader starting actually overseas. But at every point, where is it? What’s it like? What do we know? What is its character? And once it’s entered the country, where is it? Where is it moving? Our biomedical intelligence about this virus has been terrible from start to finish, even to this day, even where you do things like genomic surveillance in real time.

All right, so how come we never had good biomedical intelligence about this organism and we’re always behind? And we have to rely for our biomedical intelligence by asking the Israelis or the Danes, “What are you learning? Because we don’t know as much as you do.” Or, “How are vaccines working?” Because the Israelis actually have intelligence and we don’t. Well, so then you define a task, “Oh, well here’s this task. We need to actually systematically set up monitoring and surveillance in a biomedical sense so that we can see what’s going on.” And then, “Oh, well we don’t have the ability to perform those tasks.” And then there are some issues having to do with privacy laws and the fact that almost all the relevant information’s being gathered by various private organizations.

And the CDC itself is not in a very good position to solve this problem. Incidentally, the CDC’s whole role in this crisis has been misunderstood. The CDC was originally created as a research institution to aid the efforts of state and local governance. The CDC was not set up to be this policy mastermind of the country. The CDC has very poor policymaking capabilities. It was never set up as a policy agency. And it’s not very good at doing policymaking. It’s not very good at knowing how to engage stakeholders, at having the process to reconcile differences. It just isn’t doing any of that.

Brink Lindsey: And yet everybody had the expectation that it was the premier disease fighting agency in the world. There was an international report on pandemic preparedness that happened to come out right before COVID and we were number one, basically, on the strength of the reputation of the CDC. And yet it has become very clear that it’s very good at getting information and analyzing information in kind of retrospective academic fashion. It’s not very good with sharing information, and it’s certainly not very good with managing a crisis on the fly, or managing a humongous federal, state, local inter-agency effort.

Phil Zelikow: Well, a lot of our interviewees would tell us that it’s useful to think of CDC as if it were a kind of university with various academic departments. Now, it’s actually useful to have a university that has departments that are interested in infectious disease. But no one would usually go to the university and these academic departments and ask them to manage an urgent national crisis, at least not if you’ve spent a lot of time in universities as I have. So, see, in a way, the whole system of public health in America we have, which was created, is the one that we created in the Cleveland administration….

Brink Lindsey: And what was the communicable disease?

Phil Zelikow: Cholera…

Brink Lindsey: Cholera, yellow fever, those kind of things. Yep.

Phil Zelikow: Right. So cholera, and mainly what you need to do in an outbreak is state and local authorities will need to do slum clearance, they’ll need to do sanitation hygiene. So they’ll need all kinds of state and local powers. They’ll need to shut up bad apartment buildings. They may need to burn stuff. They may need to create quarantine zones. So you’re thinking this total emphasis on the state and local authorities who can carry out your measures to contain cholera and yellow fever, and then they’re backed by some research entity that is looking at scopes and slides. And that, by the way, is not created until the 1940s, and that’s the CDC. But the basic structure of the American public health system is sort of this 1890 structure. Now, of course, now transport to the present day where you’ve got this enemy that’s coming from China, where you’ve got this national health system, you’ve grafted on this really quite an anachronistic public health system, which incidentally is pretty well completely divorced from our medical care system. Our public health system has very little to do with our medical care system. These are like in two different worlds. And now the public health system mostly just works on preventive care and….

Brink Lindsey: Chronic disease, right? Smoking, obesity.

Phil Zelikow: Right. Because it now rarely has to deal with outbreaks. There is a little bit of that sort of thing, tuberculosis, things like that. There is a little bit of that, but in general. So now the funny thing is that the CDC has been telling other countries how to organize themselves properly, say take South Korea, for example, which is a great beneficiary of CDC advice. Now, South Korea actually has a far better public health system than the United States of America has. So they’ve actually created a modern public health system that can do all kinds of things that we actually can’t do in the United States. So in a way, the students have learned so well from the teacher that they now have capabilities that far outstrip the capabilities that you’ll find in the teacher’s country.

Brink Lindsey: Yeah. Thailand’s another example. It’s a beneficiary of CDC’s international outreach. And they managed the crisis much, much more effectively than we did, which was utterly shocking. So at one level, well, there’s a whole bunch of software failures in our pandemic response. The most obvious one is the absence of federal leadership after April of 2020. It’s just impossible to run an effective pandemic response in the United States without active federal supervision and coordination. So an effective pandemic response was just hopeless after that. But the failures started even earlier. I’m sorry. I interrupted you.

Phil Zelikow: On that point, our advisors tell me, and I agree, that Debbie Birx’s recent memoir is actually good. And so if people want a portrait of that breakdown from someone who was right there, Debbie Birx, who you can criticize her in different ways, but she was trying. And she and her memoir, people believe is a pretty darn good window into the breakdown of the federal response.

Brink Lindsey: So another provision in this PREVENT Pandemics Act is the establishment of a permanent office in the White House on pandemic preparedness and response. So we would have for the first time, a permanent body whose explicit mission is to be the coordinator of the war fighting during the next pandemic. That seems like a good idea. Right now, somebody’s got to be in charge. Do you have thoughts about who it ought to be? It seems pretty clear, the CDC, it’s not in its DNA to do this stuff. So to be able to do it would have to be restructured fairly radically. Where ought primary responsibility be housed?

Phil Zelikow: Actually, a lot of people want to solve problems by centering them in the White House. And currently the executive office of the president is itself….

Brink Lindsey: Getting bigger and bigger, yeah.

Phil Zelikow: Right. I would actually, I’d look very hard at HHS, and trying to see if you can make that… It would be better if you could get that department to work properly. But this is, again, I would not focus too much on whether the entity that’s in charge is in the White House or in HHS. Probably what you’ll need is some kind of interdepartmental body anyway, and some ability to mobilize that. We actually have such interdepartmental bodies that exist now that are supposed to be activated in a crisis, but they didn’t work as well as they could have. But here again, the problem is more about the software of what to do than about what should we organize an inter-agency committee and where should it sit. If we understand better what tasks need to be done, it’ll become more naturally obvious where to put it. We have, on the books, existing institutions that could be adapted to purpose, and existing inter-agency bodies that could be adapted. The problem is in giving very clear such understandings as to what it is they should do, and then being sure that they have the authorities to do those things.

Brink Lindsey: So that’s structuring things at the federal level, but our public health system is primary located at the state and local level, and it’s extremely fractured. And as you’ve mentioned, it’s sort of antiquated in its conception. So that’s ultimately where a lot of the response is going to happen. Those are the people who are going to be doing stuff. Those are the people with the powers. Do you have preliminary thoughts about how to restructure this very uncoordinated system to make it to where it can function smoothly on a national level in the face of a national threat?

Phil Zelikow: I do, and I should say our advisors do as well. Let’s suppose that you organized both crisis or disaster response, crisis management, at both the national state and local levels. And that at all levels, you had a crisis management structure that could work for a variety of kinds of extreme crises. But that it also exists at the national level, and then you can exercise things and activate them. And what goes with that is a capability of how do you gather the relevant intelligence about what’s going on and then communicate it to other levels of government. So, for instance, what happened in this crisis is as time went on, you very quickly began to develop sort of weekly telephone conferences that would get convened in which people at CDC would have these large telephone conferences with the people who were leading systems. So in other words, ad hoc they began building a national crisis management network. 

So suppose you actually set up a network of networks in peacetime that you exercise and practice, and that are not only used for a pandemic, but that have capabilities that could provide surveillance and intelligence about a pandemic or about other kinds of disasters, like say a cyber disaster or a nuclear explosion, different scenarios, or a catastrophic terrorist attack. And then you exercise those capabilities.

You could also imagine some sort of entity too, that’s connected at the federal level to building up our medical countermeasures. This will be mainly national. The medical countermeasures job will be mainly national. But if you develop vaccines on a very large scale, the distribution of vaccines would then have to go right down to the localities, and so you’ll want to use your crisis management for that.

Let’s suppose in the health case too, that we began to think about bringing a whole new idea into the system: community health workers. The system of community health workers in this country is embryonic. We have community health centers in very, very narrow prescribed settings. I won’t go into the bureaucratic detail of it. But if you compare the role of community health workers in the United States with the role of community health workers in many other countries, you’ll see how far behind we are. And you’ll also understand why so many people in urban, and rural communities, feel so alienated and distanced from the healthcare system, which they view as faraway elites whom they don’t consult, can’t afford or trust.

And community health workers are what bridge those gaps, that actually do outreach literally to people’s homes, that link the healthcare system to people’s lives in many other countries. And we could profit a lot by looking at that. So what I’ve just described here, if you think about it again, to use that phrase, is a network of networks. I’ve got a crisis management and health management system that is nationally organized, but that is nationally prepared to deal with similar networks that manage crises that are set up in peacetime at the state and local level, too.

Brink Lindsey: That’s all very interesting. You’ve used the metaphor of an invasion several times in this conversation, and I’ve heard you elsewhere talk about the need to align the public health mindset with the national security mindset, to think of pandemics as a national security problem. How do we do that?

One sort of grim conclusion I’ve come to over the years is there’s no such thing as a moral equivalent of war. Only war has the mobilizing and unifying powers of war. And one might have thought that a pandemic would’ve pulled the country together and had it unified against a common threat, but instead it just tore us apart even more. So how do we get to thinking about public health matters as a national security problem?

Phil Zelikow: Right. So first of all, here’s the good news. The good news is, especially in the early months of this crisis, we were galvanized on the scale of a war. The government used coercive authorities that I think has no precedent in the history of the United States since the Civil War. We used coercive authorities in some ways beyond what we used in civil defense during the second World War. And people everywhere, in every community in America, were frightened, worried, and activated. And then with, again, this use of authority at all levels. So at that level, it was very warlike.

Brink Lindsey: That’s right. That’s true.

Phil Zelikow: You’re right that partly because of failure of national leadership, and President Trump personally, I can’t pass over that, did then choose quite deliberately to polarize this issue instead of trying to knit people together around it. So you can contrast what happened here with what happened in a very individualistic country like Australia, where people are also fiercely individualistic and very Americanized in many ways in their social attitudes. But you know, the national leadership on this issue really pulled people together, and by the way, got them to accept even more coercive use of government authority there than anything we used here.

I’m not saying that we should have followed that and we should have done everything that they did. I’m just saying that in that sense, you had a warlike scale of effort and activation of the country and that the opportunity was there for national leadership to harness that in more positive ways.

Now it’s true that you were then soon going to start using up people’s tolerance. Especially in a country like ours, even if the national leadership had come together, people would’ve started running out of patience. And okay, and maybe they should have, because I think in some ways we overused a lot of our social control measures because we were doing such a crappy job at everything else and we didn’t know what to do.

Brink Lindsey: Yeah. I mean, it’s a great point that at the beginning of the pandemic, we really did have a wartime mobilization. We mobilized the citizenry to stay at home, but that was a stop gap until we figured out what to do. But then we never figured out what to do, and the federal government actually just walked away from the table and everyone else is there’s scrambling and improvising. And then meanwhile, the the public spiritedness capital accounts had been drawn down severely by this mobilization, and then what followed was disunion and disunity.

Phil Zelikow: I mean, and here’s a good example, too, of the way the intelligence issue relates to a question like that. So we locked down large parts of America at a time we didn’t actually need to lock them down.

Brink Lindsey: Right.

Phil Zelikow: See, we had no intelligence. We did it because we didn’t know any better and didn’t know what to do. It wasn’t that people were stupid or mean. It’s they did the best they could fumbling around in the dark and not knowing what to do. So we locked down a lot of places we didn’t need to lock down because we had no intelligence in where the enemy was. And therefore, by the time the enemy gets there, like in the fall of 2020, people had already run out patience, and they were already angry and alienated.

And so it’s sad in a way that by the time you get into the really dangerous period of the crisis, which turned out to be the fall and winter of 2020 and 2021, that’s where the majority of people died in this country, you’ve actually already run through your social capital in a lot of parts of America that you didn’t actually need to have locked down at all. There’s a whole issue then of how to have handled schools, which is another subject.

Brink Lindsey: Right.

Phil Zelikow: But I think there’s already a pretty strong emerging consensus, even among public health experts, that we did a very poor job of handling the schools. We did a poor job mainly, again, because we didn’t know what else to do. And to this day in many school districts, we’re still doing it because we don’t know what else to do. It’s sad. Lacking other tools, and lacking other scripts, people desperately try to protect themselves in whatever ways they can. I just came recently from the Philippines where until this day, and this is in June of 2022, everyone is still masking even outside. Why?

Brink Lindsey: And Thailand’s still doing it.

Phil Zelikow: Right. Why are they doing that? Because A, the people are scared. They’re scared of getting sick and that’s why they comply. And they’re scared that their medical care system will collapse and that they won’t be able to get care. So when people are really scared, then they’ll accept these measures. Even now they’re masking in ways that are inconceivable in the United States because they’re scared for themselves personally. They can’t afford medical care. They can’t afford to get sick. And they’re scared that their medical system can’t handle it.

We were a country that had the best medical care system in the world and in many respects, we screwed up our response because we didn’t know what to do. And the incoherence showed in a lot of the public guidance and it also began to undermine trust in the elites.

Brink Lindsey: Let me wrap up with the final question. We’ve had this crisis, a million Americans are dead, 10 million plus dead worldwide. So you can think of a crisis as like a heart attack. And heart attacks can in retrospect be seen two different ways. One, they’re the shock to the system that tells you I got to start living right, eating healthy. I got to start thinking about what’s really important in life. Or the heart attack can be in retrospect just an important landmark in a process of irreversible decline. Where do you think we are?

Phil Zelikow: Well, that’s well put, and the answer is, you know as well as, or better than I do. I think actually we have not yet made the choice as to whether we’re fatalistically going to live with our sickness and just wait for the next heart attack, or whether we’re going to try to do better.

I will say that our leadership, our political leaders in both parties have not done a very good job of looking to the future. They’ve done a very good job, the Biden administration has done a good job in particular and the Trump people on some of the vaccines, on trying basically to get us out of the hospital from our heart attack. But you know, that’s very different from now making the decision to live right. And our leaders aren’t really talking about what we need to do to prevent the next heart attack. A commission would’ve helped to move that conversation.

Brink Lindsey: So yeah, one thing, one good step.

Phil Zelikow: And maybe they still will.

Brink Lindsey: Yeah, one good step in the right direction would be to start a commission. We can keep our fingers crossed that that will occur. Thank you so much for your efforts in trying to get one off the ground. And thank you so much for speaking with me today. Really appreciate it.

Phil Zelikow: My pleasure.

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