The stream of books about the government response to the pandemic that began with Michael Lewis’ “The Premonition” has just yielded its most important product to date. “Lessons From the Covid War” is public policy analysis at its near-best: lucid, sober, probing, at once analytical and engaging. But the book ultimately comes up a bit short, in ways that interestingly mirror the national response it chronicles and critiques.
The lead writer is Philip Zelikow of the University of Virginia, who served as executive director of the 9/11 Commission. But the credited author is the self-appointed, foundation-funded Covid Crisis Group, an assembly of some 34 distinguished figures from public health and public administration, including Zelikow, Ezekiel Emanuel, Peggy Hamburg, and Mark McClellan. Together, they seek to provide the report of which we were deprived when the Congress and White House chose not to name an investigative commission to look at the pandemic response. The result is both the product of some of the nation’s best minds (including many of Lewis’ “Premonition” protagonists — Charity Dean, Richard Hatchett, Carter Mecher) and a book that seems to have been edited by committee, sometimes to a fault.
“Lessons From the Covid War” has considerable strengths. It distills a complex welter of events into a clear account without excessive detail and at digestible length. It doesn’t shy from complexity or uncertainty — perhaps the biggest lesson from the pandemic about how to communicate. For instance, it lays out the options for the proximate cause of the outbreak, and then forthrightly acknowledges that it is simply too soon to choose with confidence between zoonotic spillover and lab leak. At the same time, it is appropriately critical of the opacity (and deceit) of the Chinese government from the very start of the pandemic.
The narrative takes a sophisticated approach to lead the reader through how our government, and our health care system, works and, often, doesn’t. The dysfunction of the myriad components of the federal Department of Health and Human Services (ASPR, BARDA, CDC, CMS, FDA, NIH!) — a collection of dueling fiefs, rather than an integrated agency — has never been more plainly laid out. The authors make clear the advantages that the involvement of the Department of Defense brought to Operation Warp Speed to develop vaccines. The Pentagon enjoys a rigorous hierarchy and command of logistics, both qualities notably absent from much of public health.
“Lessons From the Covid War” also smartly notes that money could have been tapped from FEMA in the early days of the crisis, and that none of the key players seemed to understand this at the time. It convincingly describes the degree to which differences between the choices made by most Republican and Democratic governors in 2020 have been exaggerated, echoing important observations in the overlooked memoir from Deborah Birx, who served as White House coronavirus response coordinator. Nationally, we have seen public health polarized along with everything else, but at the local level in many places, practicality held greater sway.
More broadly, the book elucidates the costs (inefficiency) and benefits (flexibility) of America’s federal system when it comes to inevitably national problems such as infectious disease. It is a story as old as Hamilton and Jefferson, but also as new as responding to the Delta and Omicron variants.
Most importantly, the book and its authors are unsparing about how poorly America performed in the pandemic, repeatedly coming back to shocking comparisons of death rates with those in Western Europe: 29% worse in spring and summer 2020, 51% by early 2021, 83% through the end of 2021.
As with our pandemic response itself, “Lessons From the Covid War” goes wrong mostly when it encounters the messiness of politics — or fails to do so.
The authors never quite know where to land on the matter of Donald Trump. Early on, he is referred to as a national “co-morbidity,” the equivalent of a cancer in the presidency at the time the virus emerged. But later passages make clear that Trump’s negligence and malevolence were a more active phenomenon than “co-morbidity” implies, damaging and delaying the national response, fatally undermining first masking and ultimately vaccine acceptance. Seemingly desperate to preserve some mirage of old-fashioned bipartisanship, however, the group pulls these later punches, or at least refuses to sum them up.
It does much better in assessing both the important good and significant harm done in 2020 by the meddling of Jared Kushner. It also, contrary to widespread claims from the left, criticizes the pandemic “playbook” Obama left for Trump as too much a set of questions: “The playbook did not actually diagram any plays. There was no ‘how.’ It did not explain what to do.”
Some of the book’s policy prescriptions are wise and well-considered, especially in outlining the sorts of “toolkits” state and local public health authorities need from Washington. It persuasively demonstrates the advantages multi-year appropriations would bring to future pandemic preparedness. But other proposals — such as the implication that we need to build new community health centers throughout the country, hire 80,000 additional people to staff them, and perhaps overhaul the entire hospital system — while laudable in the abstract, seem oblivious to the political, commercial, and budgetary realities of our time.
National politics is missing here, while small-group politics among the authors is perhaps all too present. The section on the critical problem of misinformation and disinformation is cursory, and press relations, and what seems to me the crucial role of the news media in the crisis, is entirely ignored. On communications in the crisis, it says, “Citizens can judge for themselves how well their leaders met [the] standard.” The same could be said of the entire crisis. But then why publish a book?
The political constraints facing elected officials exist offstage if at all. A proposed reorganization of HHS would shove around the much-weakened CDC, but there is no mention of the fate of the FDA and NIH, which are still championed (captured?) by industry. (Two former FDA commissioners are among the authors.) The scandal of shortcomings in our public health data systems is explained, but the authors never quite admit the urgent need to legally mandate local infectious disease data reporting into the federal government.
It feels like many of these choices may be the consequence of a book written by 34 opinionated people who opted for one common denominator. (It would have been far more illuminating to supplement the text with minority reports.) The resulting ambiguities are reminiscent — presumably unintentionally — of the sort of compromises that sometimes clouded pandemic communications, and policy, itself. That is a luxury academics can afford, but decision-makers in government, faced with a crisis, cannot.
The authors of these “Lessons” are a genuinely glittering group. But their work, while fascinating, does call to mind what House Speaker Sam Rayburn reportedly said to LBJ about the Kennedy New Frontier team: “They may be every bit as intelligent as you say, but I’d feel a whole lot better about them if just one of them had run for sheriff once.”
Richard J. Tofel, the former president of ProPublica, is a distinguished visiting fellow at the Harvard T.H. Chan School of Public Health.