Science

The CDC Has Been on a Steady Decline. We’re Just Finally Noticing.

The once-world-class agency has been surprisingly absent during this pandemic. It’s part of a broader trend for American institutions.

CDC headquarters
Photo illustration by Slate. Photo by James Gathany, Centers for Disease Control and Prevention/Wikipedia.

The board game Pandemic probably isn’t the best choice for those looking for a bit of escapism while on lockdown, but if you want to try your hand at saving the world from an outbreak of a deadly disease, set up the map and put your character—scientist, research technician, quarantine expert—on the starting point: Atlanta, home of the Centers for Disease Control and Prevention. Where else could possibly be home base? Since shortly after the end of World War II, the CDC in Atlanta has been the axis mundi of the infectious disease world, head and shoulders above any other national public health agency. And yet, now that a pandemic has actually struck the United States full force, the CDC seems baffled—bumbling, cowed, and, above all, silent. Veteran science and health journalists are stunned by the CDC’s lack of leadership in the very sort of crisis it was born to combat. As one said to CDC head Robert Redfield early last month: “You’re invisible now, sir. Your agency is invisible.”

The problems at the CDC run much deeper than the bungled rollout of coronavirus test kits or sloppy procedures that led to contaminated labs. As serious as these mistakes (and their public health consequences) are, they are not the only reasons that CDC’s reputation has taken such a precipitous tumble. It’s sometimes hard to see the forest fire for the burning tree, but the fall of the CDC is part of a broader trend of exceptional, world-leading American agencies abdicating their preeminent positions. The CDC isn’t even the first example.

A bit more than a year ago, the Federal Aviation Administration was the agency in crisis. After two high-profile plane crashes, a mainstay Boeing airplane, the 737 Max, seemed unsafe to fly. However, the FAA, the most renowned agency on the planet for ensuring airline safety, was slow—and seemingly reluctant—to ground the planes. As Italy, Poland, Oman, and essentially every other country around the world suspended flights of the 737 Max, the FAA tried to reassure the public that the 737 plane was perfectly safe. The acting administrator of the FAA declared that the agency’s extensive review had found “no systematic performance issues and … no basis to order grounding the aircraft.” Unlike every other airline regulator around the world, the FAA was seemingly blind to an enormous safety issue. A scathing review by a House committee declared the agency had “failed in its duty” and that its oversight of Boeing was “grossly insufficient.” But that was nothing compared with what Boeing’s own employees were saying behind the regulator’s back: “This airplane is designed by clowns, who are in turn supervised by monkeys,” wrote one. The debacle was a clear sign that the agency could no longer be relied upon to make hard-nosed decisions founded on engineering evidence; politics, economics, industry ties, or some combination thereof had trumped the FAA’s scientific judgment.

Sometimes an agency doesn’t decline from the zenith like a falling star, but its reputation slouches, bit by bit, toward mediocrity. Since the early 1960s, the Food and Drug Administration has been approving drugs and medical devices based upon their safety and efficacy—an objective, scientific assessment that makes benefits and harms to patients the criterion for whether a pharmaceutical can come to market. But in the past two decades, the agency has shown signs of surrendering objectivity under political pressure. In the early 2000s, for example, FDA leadership overruled the decision of its rank-and-file scientists to put up roadblocks limiting the over-the-counter sale of the Plan B emergency contraceptive. Generally, though, external pressures have led the agency to approve questionable drugs rather than block them. It’s seldom as spectacular as when leadership overrules the scientists (as happened in 2016 with a drug for muscular dystrophy); more generally, it’s a loosening of standards, accepting lesser and lesser support for a drug’s safety and efficacy. “There has been a gradual erosion of the evidence that’s required for FDA approval,” the author of one study in the Journal of the American Medical Association said earlier this year.

These slipping standards are having a very real effect on our lives right now. Even given the need to relax certain standards in the face of the coronavirus crisis, the FDA has faced (warranted) criticism for letting ineffective COVID-19 antibody tests on the market without sufficient scrutiny and for authorizing the use of the president’s favorite COVID treatment, hydroxychloroquine, with scant evidence of efficacy. “I understand the desire to find hope, but we need more evidence than is currently available before we encourage widespread use,” warns former FDA commissioner Margaret Hamburg.

Not all American government agencies are internationally recognized for their excellence, but the ones that are have a lot in common. They attempt to base their decisions on scientific or engineering data or, at the very least, objective criteria that leave little wiggle room for political interference. They invite scrutiny; a high degree of transparency keeps them from departing from their standards on the fly. And above all, they maintain and nurture a pool of expert staff that is as good as or better than anything one can find in the commercial sector on a scale that no private company could ever hope to match. These are the attributes that make an institution healthy enough to resist the crushing political pressure that bears on all high-stakes regulatory agencies.

Yet transparency is under attack seemingly everywhere in government. The CDC has forbidden its scientists from speaking to journalists without clearance from headquarters. I’ve had to take the FDA to court to get it to release certain basic information about clinical trials—information that its European sister agency, the EMA, releases as a matter of course—deeming the records confidential. In-house experts are gainsaid by leadership or even made entirely irrelevant as their duties are passed off to the commercial sector. The FAA was dependent on Boeing employees to vouch for the 737 Max rather than independently verifying the plane’s safety itself. The FDA’s dependence on test manufacturers to vouch for the accuracy of its coronavirus tests is unlikely to have much better results.

The forces weighing on these great institutions aren’t new—the CDC, for example, got a taste of the politicization of science in the mid-1990s when Congress functionally forbade the agency from studying gun violence as a public health problem. In previous administrations, experts pointed to possible signs that the agency was losing its way; since the beginning of the Trump administration, the scorn for science and transparency has further taken its toll. But the public only noticed the agency’s malaise when a crisis came and exposed its weakness.

Unless we figure out how to reverse the course of this institutional disease, government agencies that once served as models for the rest of the world may soon cross into the nether realm of bureaucratic mediocrity. At that point, there won’t be much left to mourn if activists finally succeed in drowning what remains in that proverbial bathtub.