Scott Gottlieb

Note the subtitle: Why COVID-19 Crushed Us and How We Can Defeat the Next Pandemic. I don’t want to be too hard on Gottlieb, Commissioner of the FDA during the Trump administration from 2017-2019. His constructive aim is to use what we learned during COVID-19 to outline steps that might prevent or mitigate the next pandemic. This is a noble goal, especially given that however much we may wish it were otherwise, that monstrosity is necessarily coming. Gottlieb dutifully relates his particular account of the failings of the system, all familiar and fair.

His account stands not fundamentally in the service of history. For Gottlieb, the disaster animates a series of practical proposals, ideas widely held within the mainstream virology and public health communities. These are important and necessary suggestions which deserve a broad and visible hearing: viewing health and emerging diseases as a national security issue (global, right Dr Gottlieb?); creating and funding permanent reserves in our capacity for the production of health supplies, including equipment and testing capability; improving surveillance including the use of cutting edge genomic tools to do so. Lastly, expecting that international cooperation in early reporting may be limited, given the disincentives involved.

But Uncontrolled Spread is unsurprisingly restrained and understated when it comes to the CDC and its shortcomings. The introduction explicitly states this is not a book about politics. Gottlieb argues that many of the same systems failures would have occurred no matter who was in charge. Possibly, though a partial truth at best. I will not recount Trump’s many actions and statements, public and private, that contest this interpretation. I can’t help but wonder whether Gottlieb is still so involved in the political world of US public health that he is unwilling to be too harsh on colleagues or former colleagues. The same might be said for his careful language regarding the handling of the pandemic by the Trump Administration. In contrast he fervently holds China’s feet to the fire for their delay in full early disclosure, even as US intelligence nonetheless warned the Administration of a worrisome outbreak in China as early as November 2019. And even as the protagonists of The Premonition were able to calculate with remarkable precision the coming events in January 2020 from public sources alone.

There will no doubt be a wave of attempts to reckon with what just happened to the US and the world as we emerge from the worst pandemic in a hundred years. The two books I have paired here crystalize an essential piece of what that reckoning requires. What good are policy recommendations without a direct and open assessment of the failures that such recommendations aim to correct? Without clearly confronting the failures and malfeasance in the national response, policy blandly lacks the requisite sense of urgency and incisiveness.

We ought to start by acknowledging the unmitigated disaster that might have been reduced. How many of the more than one million direct deaths, losses that will weigh forever on loved ones and on the nation, might have been avoided with a conscientious and vigilant response?

Uncontrolled Spread falls short in assessing responsibility. In fairness, it is a constructive book that tries hard not to offend. But offense should be the least concern in favor of honesty, and Gottlieb misses major parts of the failing. Generously, it’s a first attempt at transforming the global tragedy of COVID-19 into actionable measures for better protecting the country and the planet from the inevitable. In that sense, it’s a thoughtful and useful effort. Let us hope we remember our history and take action, rather than adopting the usual strategy of being destined to repeat it.… (mehr)