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Ebola and the Failure of the Administrative State


When news broke two weeks ago that a Liberian man, Thomas Eric Duncan, had been diagnosed with Ebola in Dallas, Dr. Tom Frieden, director of the Center for Disease Control and Prevention, declared: “We are stopping Ebola in its tracks in this country.”

Since then, Duncan has died, two of the nurses who treated him have contracted Ebola, and it has become clear that the situation is a lot less under control than the administration is willing to admit. We are assured by the president that “the dangers of a serious outbreak are extraordinarily low,” that our leaders are “taking this very seriously at the highest levels,” and will now put forth a more “aggressive” federal response.

That is cold comfort. The government’s response to the outbreak has exposed the weakness of the modern administrative state in general, and the incompetence of the White House in particular. Consider the latest developments in the outbreak. The second nurse to contract Ebola, Amber Vinson, traveled from Cleveland to Dallas on a commercial flight Monday and checked herself into the hospital Tuesday with Ebola symptoms. She called the CDC before she boarded the flight and reported she had a temperature of 99.5—yet CDC officials didn’t stop her from boarding the plane.

Vinson was one of 76 staffers at a Dallas hospital that could have been exposed to Duncan. According to Frieden, the CDC requires anyone who may have been exposed to travel by “controlled movement,” which means not traveling on commercial airlines or public transportation. Clearly, the CDC is unable to enforce this requirement, which invites the question of how they’ll be able to monitor all the people with whom the nurse might have had contact. During a telephone press briefing Wednesday, Frieden was asked about the 132 passengers that were on the flight and he said, implausibly, that the CDC is “contacting everyone who was on that flight,” as if it were a matter of picking up the phone.

Thus continues a pattern of crippling naiveté and ineptitude from the White House on everything from healthcare reform to foreign policy. Now we’re seeing it with the Ebola outbreak. On the press call, Frieden explained that you can’t get Ebola from sitting on a bus next to someone who’s infected, but if you have Ebola then don’t use public transportation because you might infect someone.

Got that? The infected could transmit the disease on a bus, but the non-infected shouldn’t fear catching the disease from sitting next to an infected person on a bus. It’s either one or the other; both cannot be true. Frieden was responding to a question about whether the CDC vetted President Obama’s recent video message to West African countries, assuring residents that they “cannot get [Ebola] through casual contact like sitting next to someone on a bus.” Frieden’s gem of bureaucratese is worth quoting at length:

“I think there are two different parts of that equation. The first is, if you’re a member of the traveling public and are healthy, should you be worried that you might have gotten it by sitting next to someone? And the answer is no.” “Second, if you are sick and you may have Ebola, should you get on a bus? And the answer to that is also no. You might become ill, you might have a problem that exposes someone around you.”

The Limits of Administration

Before he was president, Woodrow Wilson articulated a rapturous view of what a centralized, professional bureaucracy could achieve. Writing in 1886, his shining example of government efficiency was… the post office:

“Administration is everywhere putting its hands to new undertakings. The utility, cheapness, and success of the government’s postal service, for instance, point towards the early establishment of governmental control of the telegraph system. Or, even if our government is not to follow the lead of the governments of Europe in buying or building both telegraph and railroad lines, no one can doubt that in some way it must make itself master of masterful corporations.”

Ah yes, the post office—a smashing success. And why not a government monopoly of the telegraph system, too? What could be better? To be fair to Wilson, in the late 19th-century maybe the post office did seem like a paragon of competent and efficacious administration. At the time, government monopolies in certain industries were thought to be “natural”—hence the eventual creation during World War I of a telephone monopoly operated by AT&T but controlled by a government commission headed by the postmaster general.

History has shown this kind of confidence in centralized bureaucracy to be hopelessly naïve. Government, alas, simply isn’t as capable as Wilson hoped it would be. Does that mean we should disband the CDC and let hospitals dealing with Ebola cases fend for themselves? Of course not. But it should mean, at the very least, that we start talking about how to reform, say, the Food and Drug Administration, which has prevented the development of experimental drugs to treat Ebola through the exercise of a regulatory monopoly.

It also means we should think twice before defaulting to the assumption that government agencies like the CDC or the National Institutes of Health could have prevented the outbreak if only they’d had more funding, as the NIH’s Dr. Francis Collins averred recently to the Huffington Post. In a piece cataloguing the billions we’ve wasted over the last decade to respond to something like an Ebola outbreak, Mollie Hemingway properly labels Collins an adherent to “Progressive faith in the habitually unrealized magic of increased government funding.”

But whether it’s funding or regulation, it’s becoming clear that government “everywhere putting its hands to new undertakings” isn’t working out all that well. Perhaps it’s time for officials at the CDC and the White House to admit that we’re not entirely sure how easy it is to spread Ebola, stop blaming funding shortages, and unleash the power of private innovation to combat the virus.

In a hundred years, when Americans read about the U.S. Ebola outbreak of 2014 and antiquated government agencies like the FDA that hampered the development of a vaccine, they’ll laugh at us. Today, the idea of a government telephone monopoly overseen by the postmaster general is ridiculous. Likewise, future Americans will probably scoff at us for thinking our FDA, in its current form, was somehow necessary or helpful, or for how the Department of Health and Human Services could spend almost a trillion dollars a year and yet fail to prevent or adequately respond to the Ebola outbreak.

Or maybe a century from now America will still be a nation of Woodrow Wilsons. They’ll see “every day new things which the state ought to do,” their view “steadily widening to new conceptions of state duty.” If so, let’s hope they’ve got an Ebola vaccine.