Politics. Was it when Bill Clinton concluded that political relevance for him and his party rested on “running government like a business?” After all, George H.W. Bush, was ostensibly elected to continue the policies of his predecessor, Ronald Reagan.
And then he didn’t.
Bill Clinton had to weave his way through a political environment where the forces of Lyndon Johnson’s Great Society were nearly spent. Greed was good. The pearls of American youth headed to Wall Street where they would be well positioned to “unleash shareholder value.”
Into this mix fell the P3, a tool for government to act more like a business while business acted more government, substituting share buybacks for tax cuts, deploying creative accounting and issuing forth narrative-heavy PR.
Public-Private Partnerships are not all bad. Satellites are not going to be launched without the full support and cooperation of governments. They are just mostly bad. They tend to socialize losses while privatizing gains by forcing the risk onto the local, state of federal government.
Few American industries are expected to take risk like the pharmaceutical business. But, for the kids working to “unleash shareholder value” risk sounded old fashioned.
Behold the Foundation for the National Institutes of Health and the Centers for Disease Control Foundation, P3s that can pool donations, largely from the Bill and Melinda Gates Foundation, Bloomberg Philanthropies, and, most importantly, all the major drug companies, while pursuing projects away from the prying eyes of Congress.
(The CDC Foundation also has a program to leverage platforms like Benevity to access employee donations from companies like Uber, Facebook and Twitter.)
The FINIH collects about $100M in donations and grants, the CDC Foundation, about $250M. Relative to their respective agency budgets, rounding error, but enough money to give their donors influence over the projects, priorities and personnel.
Policy. If there was any doubt that Drs. Marion Gruber and Phil Krause, the country’s leading vaccine regulators, resigned from the CDC last summer due to political pressure, look no further than Judicial Watch’s cache of documents on that topic.
What is most intriguing about the notes traded amongst FDA’s leadership than the resignations, is a triangulation strategy deployed by the drug industry, particularly PFE.
First the company releases “interim” data, designed to get public health officials, political leadership and, perhaps, the public, excited about the next round of boosters/expanded eligibility. Then the White House declares boosters/vaccines will be available soon for just about everyone. Then everyone looks around and wonders why the FDA is so slow.
The bumbling bureaucrat is the trope on which Dr. Deborah Birx relies as she recounts her days on the White House Coronavirus Task Force in Silent Invasion. What she, perhaps unwittingly, communicates is that the rank and file at the CDC were just not down with her belief that 50% of COVID-19 infections were communicated by asymptomatic people.
(The consensus at the CDC was about 17% asymptomatic spread was likely, based on studies of the Diamond Princess.)
Today, Former FDA Commissioner, Scott Gottlieb, suggests that the CDC needs an overhaul so it can respond to health emergencies more rapidly and effectively. The subtext is that the CDC is filled with people who lack urgency and/or competence.
The failures of the federal bureaucracy in the early days of COVID are legion. However, especially after reading Birx’s book, there is the possibility that the bureaucrats are not the problem.
Gruber and Krause resigned because they felt the political/industry machinery had not taken the time to consider sufficient data before recommending boosters. Birx offers little justification for her claim of 50% asymptomatic spread on which rests a whole host of invasive public health policies. Gottlieb forgets that an outbreak of Monkeypox could and should be managed by the states and much of the failure to do so rests with them, not the CDC.
Perhaps, instead, the problem is political and agency leadership, standing a little too close to money and power.
Power. When faced with wayward leadership and political interference, bureaucracies have their own little ways of sending a message. My favorite, by far, is the CDC’s Weekly Provisional Mortality Data.
In April 2020, someone at the CDC thought it necessary to provide baseline mortality data for 2014-19 and for the Covid-19 era, 2020-present. These data are and always have been available through the clunky WONDER system but a more useable version was created and made available via API, OFeed and Excel.
Perhaps the original idea was to defy White House narratives. There have been, since the CARES Act passed, claims that death counts are misleading due to coding incentives. The CDC provided an authoritative source for mortality data that was easily accessible..
Whatever the origins, the data set has been updated for over two years, slowly revealing the agony of COVID policies that mandated vaccines for nearly everyone, regardless of other considerations, kept people away from healthy activities like exercise, social, and spiritual interactions, and limited access to health care.
Those inescapable conclusions must have reached the CDC’s C-suite in Atlanta. Knowing bureaucracies, someone somewhere asked, “is this right?” sending the data teams to review each record. The data set did not update for about a month in June for an unannounced "system upgrade." Most of July's updates were clunky with certain disease lagging new data relative to others.
As the most recent update suggests, yes, it is right. People continue to die in excess of the baseline, not just from COVID and despite the distribution of almost one billion vaccination doses. Someone, as we say in politics, is gonna have to do some 'splaining.
Have a great rest of the weekend.
Emily Evans
Managing Director – Health Policy
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