It has always been an iffy question how independent the CDC and FDA (and other federal science and public health agencies) are. It’s even an iffy question how independent they’re supposed to be.
As a rule, the agencies have been and are supposed to be somewhere in the middle between fiercely independent and reliably obedient. On most issues, the presidential administration they work for is legally entitled to overrule them when it wants to. It doesn’t usually want to. It doesn’t usually have much reason to want to, since the agencies don’t make a habit of surprising the White House with decisions it won’t like. Routine technical decisions proceed without much supervision. Potentially controversial ones get negotiated before they’re promulgated.
This was a pretty stable arrangement until the COVID-19 pandemic destabilized it.
Under Trump there was a widespread sense – somewhat justified – that he was forcing the CDC and FDA to do his bidding. Under Biden there is a widespread sense – also somewhat justified – that he doesn’t have to force them; they want to do his bidding.
It is indisputably true that President Biden listens to his agency heads and other expert advisors more than President Trump did. But it also seems to be true that the agencies are marching to the presidential drumbeat voluntarily under Biden at least as much as they marched to Trump’s drumbeat because they had no choice.
And like Trump, Biden prefers making pandemic-related announcements from the White House, with his agency heads and pandemic advisors in supporting roles (whether mute or voluble).
So the agencies’ reputation for independence, which plummeted under Trump (especially on the left), continues to sink under Biden (especially on the right).
To begin rebuilding that reputation, it would help for the agencies to resume holding their own news conferences and media briefings. When the CDC has something new to say in the way of pandemic-related scientific information or science-based advice, it should say it in Atlanta. When the FDA has something new to say about vaccines or medicines to fight the pandemic, it should say it in Silver Springs.
And when the administration has something new to say about administration policy, it should say it at the White House or HHS headquarters. Once in a while, CDC and FDA experts belong at those administration pressers as support personnel to explain the underlying technical details. But only once in a while. And as a rule, this support role should be played by the most expert agency officials on the subject at hand, not the agency heads.
Ideally, too, once in a while some daylight should show between what the administration is saying and what the agencies are saying. Not outright disagreement – that’s too much to expect – but something along these lines: “We recommended X based on the science. The administration considered our scientific advice, but it had other input as well, based on other considerations: values, equity, politics, cost, public support, etc. Based on this broader range of factors, the administration decided to do Y. We will of course do everything we can to make the Y policy a success.”
Why is establishing some degree of agency independence important? Because trust in the policies of a Republican or Democratic administration is necessarily and appropriately partisan – but ideally trust in the CDC and FDA would be nonpartisan.
Overall, I think, the pandemic has exacerbated public mistrust in government officials, in government scientific and public health agencies, and even in nongovernment experts. The effects have played out differently in different publics, though.
Mistrust in government was astronomical on the left during the Trump administration, and is now astronomical on the right.
People on the left mistrusted President Trump the most, of course, but also mistrusted the CDC and FDA to some extent because they believed (with some justice) that the Trump administration was forcing the agencies to say whatever Trump wanted them to say. People on the right now mistrust President Biden the most, along with NIAID head Tony Fauci, but they also mistrust the CDC and FDA to some extent because they believe (with some justice) that the agencies willingly say whatever the Biden administration wants them to say.
Meanwhile, mistrust in nongovernment experts increased modestly across the political spectrum early in the pandemic. But once vaccinations started to go into people’s arms, the mistrust diminished on the left and kept right on increasing on the right. It’s as if progressive-leaning people were thinking “The experts who created these miracle vaccines have got to be trustworthy!” while conservative-leaning people were thinking “The vaccines created by those people who keep misleading me have got to be dangerous!”
I am ambivalent about the increase in public mistrust the pandemic has engendered. Too much mistrust is obviously dangerous. But too much trust is dangerous too. I think the ideal public attitude toward both government officials and experts – and toward the CDC and FDA – is respectful skepticism.
So the way I’d most like to see the CDC and FDA try to rebuild trust isn’t by convincing the public that the agencies are always right. It is by convincing the public that the agencies know they’re not always right. Toward that end, I would like to see the CDC and FDA publicly embrace as legitimate a wider range of expert opinion.
Currently (and traditionally), the agencies are determinedly focused on message consistency. “Speak with one voice” is their mantra. On some issues, presumably, they entertain robust internal debate. On other issues, there is considerable disagreement within the expert community, but not so much inside the agency. And on still other issues, virtually all experts are genuinely on the same page.
The public doesn’t get to tell which is which. Whatever the extent of internal debate in the agency and in the expert community, agency messaging almost invariably gives the impression of confident consensus.
That manufactured façade of consensus is supposed to build public confidence in the agency’s conclusion. I guess sometimes it does. But often – more and more often in these polarized pandemic days – I think the opposite happens. People who have heard from a different expert with a different viewpoint get the impression that “their” expert’s opinion wasn’t just rejected, it was disappeared. It wasn’t even in the room when the decision was being made.
If an issue is genuinely controversial within the agency or within the expert community, agencies should demonstrate that they have considered the full range of respectable opinions other than the one they ended up supporting. Among the many benefits of this visible tolerance of opinion diversity:
- It teaches the public that science is often uncertain, that scientists aren’t always confident and aren’t always right … and are willing to say so.
- It is less alienating to people who support alternative opinions the agency rejected; at least those opinions got a hearing.
- It makes it easier for the agency to change its mind later in response to new evidence, since alternative opinions were on the table from the outset.
- It underlines the distinction between opinions that experts consider respectable minority views and those they consider profoundly unlikely and potentially dangerous.
- It nurtures sustainable trust in the agency.
Copyright © 2021 by Peter M. Sandman
