Ebola, CDC and bureaucracy

By now we all know about the Ebola virus and about the Americans who have contracted it.  What has until recently not been well-known is the behind-the-scenes role of the Centers for Disease Control (CDC).  And the bigger story of the CDC is its representative role of large bureaucratic agencies in general and their pathologies.

First, the CDC has downplayed the Ebola situation from the start, arguing that it does not pose a significant threat, that it cannot be transmitted through the air, that there is a plan for dealing with it (even though it was not deemed significant, that no travel ban is needed (even implying that it might be racist).  The latest, contradictory statement, by the director of the CDC is that Ebola will be a health threat for some time to come.  We found apparently no protocol for how to deal with those who might be exposed in treating Ebola in others.  The list goes on.  One feels like he is riding a really fast carousel, or one of those new wild roller coasters.  Now whether Ebola poses a major threat remains to be seen.  But that is the point; we simply don’t have enough information.  And so we place a central planner (CDC) in charge of a problem about which knowledge is lacking.  And we see the results—uncertainty, action followed by inaction, inconsistent and even contradictory statements and actions, failure to take action in any meaningfully rapid way, except after severe criticism.  Unfortunately, I suspect we even see some political maneuvering going on, as President Obama, the ultimate head of the CDC, remains indecisive or deliberately unresponsive.

This should not surprise anyone.  I have written about the problem of large bureaucratic agencies before and the literature is ample.  In this case, the main problem seems to be the knowledge problem, about which Friedrich Hayek wrote quite a bit—most of it correct.  The central planner (bureaucracy) cannot possible possess or obtain the quality and quantity of information necessary to make decisions or to act decisively.  No agency can do so because it is simply impossible, Hayek argues.  There is too much.  (see Hayek, “The Use of Knowledge in Society,” American Economic Review (1945))   Moreover in some (many?) cases, we just don’t have anything certain, nor do we know the future.  Yet the CDC still has to “do something.”  It could of course have been doing something as long ago as 2008, we have come to discover.  But it chose instead, not surprisingly, to engage in other projects that might be more appealing or politically correct, like research on the most arcane subjects.

Here is the classic example.  The latest health care worker to contract Ebola, Amber Vinson, worked with the Mr. Duncan, who died of the virus in Dallas.  She was apparently wearing the CDC-approved protective gear—whatever that was, the CDC later asserted—but was exposed to the patient for several days and worked in the hospital around others who were exposed.  Later, as she was preparing to fly to Cleveland to plan her wedding, she contacted the CDC several times to tell them she had a fever of 99.5 degrees and to ask whether she should fly.  She was told by the CDC that her fever did not reach the level of 100.4, the “trigger” level, and that she could fly (on a plane with 133 other people, after having been exposed to the virus).  She flew, did contract Ebola and exposed the other passengers.  This happened because of the typical wrong-headed approach of all large bureaucracies to make rules (and more rules) that are enforced without any actual reasoning process.  What happened to a simple and quick hesitation at least to contact others to get advice, and hopefully to tell Ms. Vinson she shouldn’t fly—just in case.  Simple “common sense” (logic) trumped by bureaucratic rules.  And with a resultant potential much more disastrous result.  We are tempted to call it stupid but there is a sort of inexorable logic about it, perverse, but predicated on its own bad starting assumptions, coupled with lack of information and leading to really bad incentives.

Some have called for the resignation of Dr. Thomas Frieden from his position as Director of the CDC.  But I submit that this would not change much at all, if anything.  The problem is with the bureaucracy itself and what it is supposed to be doing.  Like any large, centralized agency with an expansive scope of authority, the CDC cannot function well.  It doesn’t matter who the head is.  The “body” does what it wants, more or less, regardless of the particular head “on it.”  Information is distorted or lacking, communication as to mission is therefore distorted, and overall the agency doesn’t do what it was established to do—if even that is clear in its enabling legislation.

If we want to attack the Ebola problem, the CDC is not currently the best way—far from it—but the alternatives are few.  Perhaps we ought to listen more to the medical establishment, not perfect by any means, but which at least seems to err on the side of caution and therefore more reasonable action.  It may also be less politically encumbered, though that too is sometimes suspect.  In the long run the CDC needs either to be significantly restructured or, better yet, get out of much of what it wastes taxpayer money to do, and focus on genuine health crises.  Better yet, give its authority to some private organizations who are not so tied to the state and have better incentives to “get it right” or at least not get it so wrong—or who will not be totally incompetent or irrational.  There is of course a place for government, to enact and enforce quarantines and travel bans.  But let’s eliminate the perverse incentives by changing the entire structure of the CDC or taking it out of the picture altogether.