Of missiles, dinosaurs, and disease

Francis Collins, geneticist and former head of the National Institutes of Health, has taken some grief recently for stating that public health experts such as himself failed in their response to COVID. Collins `believes that public health figures took a “very narrow view” and failed to consider all the various negative ramifications of promoting aggressive COVID measures such as shutdowns and school closures.

The natural response, especially amongst those who were early skeptics of shutdowns, mask mandates and the like, is to say, “Oh, now they tell us!” It is not unreasonable for people to be frustrated by Collins’s admission, which strikes one as too little, too late. Collins comes off as naïve as to how public policy is actually made, astonished that a policy might have consequences beyond those immediately intended.

We now know that, for example, the closure of schools likely caused damage that far outweighs any immediate health benefits that may have accrued. Policy recommendations (which sometimes became policy mandates) such as social distancing and masking were oversold. Yes, it seems that blindly “following the science” in the guise of people such as Francis Collins and Anthony Fauci may have been a mistake.

One also wishes not to be too hard on COVID policy failures. Certainly in the early stages of COVID we were all flying blind. It was prudent to err on the side of caution. Also, to a certain degree, Collins is simply stating what students of public policy have known for some time–namely that in bureaucracy, where one stands depends upon where one sits.

What that phrase means is that the policy advice one gets from administrative staff will depend upon the particular bureaucracy from which that administrator comes. The classic example of this phenomenon derives from Graham Allison’s famous work on the Cuban Missile Crisis, The Essence of Decision Making. Allison used the Cuban Missile Crisis of 1962 as a case study for particular models of how policy is made, especially policy in crisis situations. One of the models Allison considers is that of bureaucratic politics. It is this model that leads to Allison’s conclusions that where you stand on a policy question depends upon where you sit, i.e., what bureaucracy you work for.

For example, in the Cuban crisis, Air Force Secretary Curtis LeMay is sometimes criticized for advocating the bombing of Cuba. But in Allison’s bureaucratic model, this is a completely conventional policy suggestion. You ask the Air Force what they can do, they’ll tell you. In this particular situation, bombing Cuba might have been the best policy suggestion the Air Force had to offer. If there are Russian missiles in Cuba and you ask the Air Force what they can do about it, what do you think the Air Force will say?

That doesn’t mean you have to accept that suggestion or even that LeMay himself thought it ultimately the best policy course. It was just the one his department could provide. The Cuban Missile Crisis is justly recognized as quality policy making because John Kennedy’s “Ex Comm” group took in all policy advice, held each up to scrutiny, and considered the ramifications of each measure, avoiding the errors of group think or overly hasty reaction.

A fictional example of bad decision making is in the novel (and to some extent the film) Jurassic Park. In the dinosaur theme park created in that story, various characters have knowledge of part of the park’s operation. No one is responsible for knowing the whole thing. When systems begin to fail (and when some folks fall prey to dinosaur snack time), decision making fails since each person only knows his or her own job. There is no mechanism for gathering expertise from various sources, taking the best of what each person has to offer, and then making an informed decision.

If anyone is to blame for bad policy making during COVID, it isn’t the public health officials; it is the elected officials whose job it is to consider all the alternatives and consider all consequences of various policy suggestions. Collins, to this extent, is right. You ask a public health official what to do in a pandemic, and they will advise maximizing public health measures. The problem is, though, that while health is an important good, is not the only good. Elected officials should have considered other goods such as economic production, maintaining education, and basic freedom to travel. It is up to the elected leaders to weigh policy advice from various quarters, hold it up to scrutiny, and compare the costs and benefits of each.

It was elected officials such as Donald Trump and later Joe Biden who help up Anthony Fauci as some kind of Delphic oracle regarding COVID, despite the fact that Fauci is a doctor in name only. Yes, he has a medical degree, but he hasn’t actually practiced medicine in over fifty years but has made a career out of being a government bureaucrat. Why does his opinion matter more than, say, Jay Bhattacharya, who also holds a medical degree along with a doctorate in economics and whose expertise is precisely public health? Fauci’s opinion mattered more only because elected officials allowed it. This is not to engage in the now common dumping on Anthony Fauci, but it is to say that Fauci should have been simply one voice in the room and a voice that deserved some skepticism. That he became the face of COVID policy is an example of what happens when you have weak leadership from your elected officials.

We need elected officials who are able to take in competing suggestions, assess them, consider various goods, and use practical wisdom to come to a decision. This is yet another argument for a liberal education. Only someone with broad knowledge of various subjects and with wisdom cultivated through deep engagement with an intellectual tradition is better positioned to fulfill the role of the prudent statesman than the political social climbers and entertainers we have in many elected roles today.

The statements of Francis Collins might be “too little, too late,” but from the point of view of educating the public, I’ll go with “better late than never.” Instead of complaining about the policy during the last pandemic, let’s plan for the next crisis. That crisis will demand that we have leaders who can intelligently assess proposals put forward, ask probing questions, and have the wisdom to act decisively but not rashly. Those with a broad experience in life and learning are more likely to fit the bill. It’s up to us as citizens to recognize such people, advocate for them, and then vote them into power.