Dreams About Rebuilding Trust
Assuming a perfect world and a spherical cow, what would it look like to rebuild trust in an institution like the CDC?
I want to say right off the bat that this is not a blueprint for reforming the CDC. For the sake of an intellectual exercise, I’m assuming here that there is the political ability and institutional willingness to reform the CDC. I’m assuming that the existing powers at the CDC recognize that they have squandered their charter as a reliable public health institution and wish to rebuild that legacy. This also presupposes that there would be no legal challenges, no outcry or sabotage in the effort to reform.
(For those unfamiliar with the spherical cow joke, it’s a physics joke about transforming the problem into a more simplistic form in order to solve it without all the messiness of the real world.)
In short, this is a vision of what people would need to see from the CDC in order to restore their faith in it as an important and reliable public health institution.
Stage One: Oops, We Did It Again
The first step in reconciliation needs to be the acknowledgment of the wrongs done. There needs to be recognition either from within the CDC or from someone who has direct control over the CDC (like the President) that there has been damage done due to poor information or poor guidance in the past.
This can’t be some sort of “I’m sorry you were offended” apology, it needs to be a real admission of wrongs performed by someone who believes that these wrongs need to be addressed.
I don’t think this can plausibly be someone who held a major position of power during the pandemic. Anthony Fauci, Deborah Birx, Francis Collins, or any current or former CDC directors are all out as possible torch-bearers for this because they simply do not believe it. They believe that the CDC did a good job and that it does more harm to criticize the CDC than to defend it.
This will have to be a generational change. There are many younger doctors and researchers who are willing to admit the mistakes made in their profession and industry.
Perhaps their willingness to admit this is due to the fact that they were not at the helm while these mistakes were made or maybe they are simply not as obstinate as the ruling elders of public health. But this message will need to come from new voices who have a plausible distance from the current CDC administration and are earnest in their desire to change the direction of the CDC.
Stage Two: Cha Cha Chaaaaanges!
This brings us to the second component of restoring trust: there must be a changing of the guard. Even with a public admission of wrongs, people will not be willing to place trust back in an organization where such a massive wrong can be committed without consequence. The CDC will need to publicly dismiss the most visible figures of the COVID crisis.
They don’t need to make this a humiliation ritual, but they will need to make it clear that certain people will be stripped of decision-making power. This will need to include those who promoted lockdowns and mandates, those who encouraged the censorship of opposing views, and those who participated in the most egregious scientific errors of this pandemic. They will need to be publicly shown the door. The CDC needs to assure the public that these experts and researchers will no longer influence policy.
Similarly, the CDC is going to need to make at least a few appointments of high-profile doctors, researchers, or data analysts who provided a counterpoint to the formal COVID policy. It needs to be seen as a changing of the guard with notable inclusions of the people who were conspicuously excluded from the conversation during the pandemic.
My own recommendations would be a grab-bag of the well-known COVID counter-experts: Martin Kulldorff, Monica Ghandi, Jay Bhattacharya, Scott Atlas, Francois Balloux, Paul Offit, Tracy Beth Høeg, Vinay Prasad, just about anyone on the Urgency of Normal team. Every one of these figures has shown both a commitment to scientific rigor, a devotion to sustainable public health policy, and (possibly most important) a willingness to risk their professional position and reputation when they think that the “official” recommendations are off the mark.
This sort of substantive change to the face of expertise at the CDC would provide a plausible story that we are entering a new era with a functionally reformed CDC.
Stage Three: Put Up or Shut Up
You can make all the apologies you want and shuffle the staff around as a starting point, but eventually people are going to need to see changes in tone and policy to be convinced that the CDC is reliable again. Demonstrating that commitment to change will be the hardest and the most controversial part of an effort to reform the CDC.
There are a few good ways of doing this, none of them without consequence.
One very important but easily implemented demonstration of reform is to allow space within the CDC for competing experts. The public health strategy during the pandemic was for them to hash out what they wanted people to do and then provide a united front along every avenue of communication.
This strategy was a disaster. During much of the pandemic, it seemed as if the CDC’s goal of providing a unified front was so important that it did not matter what the collateral damage was. In this endeavor, they knowingly labeled truth to be a lie, they called honest information disinformation and used every lever of power available to them to silence dissenting voices.
People are not stupid, they know scientists can disagree. Acting as if people are stupid and we cannot possibly risk exposing them to a second opinion made the experts at the CDC look petty, tyrannical, petulant, and (quite frankly) stupid. Smart people don’t need to shelter their listeners from alternate voices. That is a strategy for the insecure and intellectually weak. The irony is that I don’t think the people at the CDC are intellectually weak. But they acted like it, which is why they lost so much trust and why I’m writing about them right now.
The CDC needs to abandon its previous strategy of presenting itself as the only possible monolith of public health information and become a forum in which those experts can make their case. Instead of labeling these alternate opinions as misinformation, they need to bring them into the agency and allow their voices to be heard under the umbrella of CDC authority.
Providing a forum for competing experts shows that the CDC is a place where we can get all expert information. Imagine if, from the beginning, the debate over masks had included Bob Wachter, William Schaffner, and Monica Ghandi. This would have turned down the temperature of the debate and given people permission to disagree. It would no longer be the “pro-science CDC followers” vs “Team Reality science skeptics.” It could have been an understanding of risks and priorities aiming toward balance.
Warning: Here Be Monsters
There is no easy way to say this: Restoring trust in the CDC would mean that things will get worse before they get better. The act of removing the old guard and bringing in outsiders will convince some who still trust the CDC that the organization is being hollowed out by the barbarians and can no longer be trusted.
Indeed, the very mild act of the CDC reluctantly and at long last loosening their formal COVID recommendations has inspired the creation of People’s CDC. This might seem surprising, but this is actually exactly what I expected. A group that is deeply concerned about supporting ongoing COVID restrictions sees this as a failure of the CDC and has spawned an institutional alternative.
Just as I point people to the experts at Urgency of Normal, the People’s CDC points to their array of experts, pleading with their communities and local institutions to take guidance from their preferred source.
If there is real movement toward reform at the CDC, it’s going to run headfirst into this brick wall. Trust will decline. Breathless exposés will be written by disingenuous journalists hoping to hamstring genuine reform. Most people have forgotten, but ProPublica did a hit piece on Deborah Birx (absurdly titled “The Fall of the CDC”) for her crime of working with Donald Trump to improve the CDC in the mildest ways. Birx was merely attempting to bring some form of data-driven order to the chaotic agency and, for this meager attempt, she was crucified by the press. Any attempt at genuine reform will be treated with far more hyperbolic hysteria.
That is the cost of doing business. Any reform-minded leader needs to know this is going to happen and be prepared to deal with it.
This may be a folly of my youth but I think the best way to combat this would be by making it all public. These stories only exist because of insiders leaking to the press. Record every meeting. Make all conversations public. Reform the CDC right in front of the entire world.
As I said at the beginning, this could never happen. It’s too risky, too outrageous. It would infuriate some of the most powerful people in public health. And it would be too much fun.
Looney Tunes: The Fifth-Column Mouse (1943)
I know I've seen this seen this cartoon before, but it was so long ago that I didn't realize that it was a metaphor for the appeasement of Nazi Germany prior to World War II. A cat sneaks into a house and talks a terrified mouse into becoming his emissary to the other mice. The stooge mouse talks his fellow mice into appeasing the cat in order to avoid a fight. This appeasement causes the mice to spend all their time appeasing the cat until he betrays. They then organize, industrialize, and build a secret weapon to get rid of the cat.
This cartoon was released in March 1943, almost smack in the middle between Pearl Harbor and D-Day. There is a whole genre of cartoons from both Disney and Warner Brothers promoting the war effort and valorizing the ingenuity of American industry as all shoulders were put to the wheel to prepare for the war. This short is a great example of that genre. It’s fun and engaging while acting as a cheerleader for the American war effort.
Dream on.