Barack Obama and his administration are getting slapped around pretty hard on swine flu. Last night, ABC's "World News" featured a story alleging that the US Government was relying on obsolete vaccine-making technology, while this morning, front-page stories in The Washington Post and The New York Times highlight administration vulnerabilities. As the Times puts it in its lede: "A vaccine shortage is threatening to undermine public confidence in government, creating a very public test of Mr. Obama’s competence."
Ouch! And those doubtful feelings will be reinforced as the public processes the admission of HHS Secretary Kathleen Sebelius, who told the Times that she had been "naive" in thinking that the vaccine would arrive in necessary quantities.
Conservative critics will ask, of course, what else the administration is "naive" about--including naivete about the ability of the government to make a complicated healthcare reform bill work. And conservative critics might further ask, "What if the same level of flu-SNAFU had occurred under George W. Bush, or any Republican president? Wouldn't the chorus of criticism be much louder?" Perhaps, but the blame-game is not the point of Serious Medicine Strategy.
What we are all looking for is better solutions. As argued here in the past, fatalism or nihilism toward public health is not an acceptable answer. As with any other kind of medicine, if the swine flu vaccine is not as good as it could be--not as available, not as effective, not as safe--the answer is to keep trying until it is as good and plentiful as it needs to be. We must be prepared to make changes, shift intellectual models, fire people--anything but give up the effort. Persistence. That's the only way anything gets done in this world.
And for inspiration on how to proceed--and for practical advice--we might recall how great national efforts of the past were carried through to a successful conclusion. One huge lesson is the need for a strong sense of prioritization, from the top down. And it is not at all clear that the Obama administration has done that. It's pretty clear that swine flu has been a lower priority than a half-dozen other issues, including "health insurance reform." Yet if there ever was a reminder that the delivery of health is more important than the delivery of health insurance, this is it. People are dying right now, and yet the Administration and much of Congress, locked into a particular politico-bureaucratic model of healthcare, is more focused on healthcare "reforms" that will come, if they come at all, in two or three or more years.
That's a serious lack of command focus. As Marc Rotterman, a veteran political observer, remarked to me recently about the long lines for the vaccine, "This wouldn't have happened with Eisenhower as President." Indeed. Dwight Eisenhower knew how to get things done, in the US Army, at NATO, and as Commander-in-Chief. Ike was neither a rigid ideologue nor a hand-wringer; he was an effective executive, committed to center-right goals, on both foreign and domestic policy. And he got most of them done, during two terms as president, by riding everyone involved until he or she produced.
And it's also clear that neither the Obama administration, nor the Congress, has set up an efficient decision-making/decision-implementing mechanism for dealing with swine flu. Once again, we can look to US history for successful models. One such model was the Joint Committee on the Conduct of the War, established on December 9, 1861, as the US government was reeling from early military failures in the Civil War. The Joint Committee had a grand total of eight--that's right, eight--members, four from the Senate, and four from the House. But in large part because it was manageably compact, the Committee helped organize and mobilize support for the war effort. And so it was a key to victory in that great conflict--a vital bit of streamlining, assuring competent, as well as constitutional, oversight from Congress.
There are, of course, other successful models. But all those models have a few things in common, including command focus and coordinated implementation. The Obama administration could profit from a little less hubris, and a little more humility.
(That's a screen grab of a committee report, above, from the University of Michigan archive.)