Uncontrolled Spread

July 26, 2021
Gottlieb, who served in the Trump administration as FDA commissioner from 2017 to 2019, delivers a well-informed if self-serving take on America’s botched response to Covid-19. Covering well-trod ground, Gottlieb recounts the first reports of a new respiratory disease emerging in China, the CDC’s mistakes in developing and distributing a diagnostic test for the virus, shortfalls in the national stockpile of medical equipment, the use of mRNA technology to develop the first vaccines, and the politicization of preventive measures such as mask wearing. He notes that the Obama administration’s pandemic response plan didn’t discuss masking, and describes President Trump during a March 2020 White House visit as “well-briefed” by his staff and accepting of the need for “strong action” to mitigate the spread of the disease. Gottlieb’s suggestions for how to better prepare for the next pandemic include using “the tools and tradecraft of our clandestine services” to gather information on foreign outbreaks, and manufacturing more “critical healthcare components and finished goods” in the U.S. Though he lucidly explains scientific and logistical matters, Gottlieb’s tendency to cite his own Wall Street Journal op-eds grates. This pandemic postmortem is more concerned with boosting the author’s reputation than breaking new ground.

August 1, 2021
The former commissioner of the Food and Drug Administration assesses the systemic failures underlying the world response to the Covid-19 pandemic. Numerous public entities within the federal government, writes Gottlieb, are charged with preparing for the outbreak of epidemic diseases. Most of their energies were directed toward fighting the flu. "The federal government started off in a weak position, with plans that were ill suited to countering a coronavirus," writes the author. "This mismatch between the scenarios we drilled for and the reality that we faced left us unprepared. Poor execution turned it into a public health tragedy." It took time, of course, to recognize fully that Covid-19 spread through a handful of "superspreaders" and mostly indoors in areas that were both crowded and poorly ventilated--the White House during Trump's frequent self-congratulatory public events, for one. Trump, Gottlieb makes clear, bears plenty of responsibility for the government's inadequate response, as do lieutenants who politicized the Centers for Disease Control and Prevention, suppressed information, and followed Trump's lead in rejecting mask-wearing and other safety measures. "The president could have found a middle ground on masks," Gottlieb writes. "His message could have been: We don't need mandates....However, we're going to act responsibly and wear masks." The author argues that even under different leadership, the response would likely have been little better, at least in part because there is not enough coordination among agencies. He urges that preparation for pandemics be considered a part of national security, with the Pentagon fully involved and with a system that works its way around informed consent "to address a public health emergency" so that data is quickly shared. Moreover, he argues that testing procedures be standardized, as they are not now, with a full inventory of equipment in both public and private hands. These and other measures are urgently needed: If Covid-19 was the worst pandemic in recent history, "it won't be the last." Of considerable interest to health policymakers and public-safety officials as well as students of epidemic disease.

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