COVID-19, Geography, and Influence on Policy

Or why moving certain functions out of Wor-Shing-Tun is a bad idea. Every so often, some pundit comes up with the supposedly brilliant idea of moving government agencies out of Washington D.C., so the government can see what ‘life is really like’ and to provide economic growth in other communities. A few years ago, some asshole with a blog noted that policy makers–which includes agencies–need to have regular and easy access to elected officials (boldface added):

Consider the U.S. government’s anti-antimicrobial resistance and food borne disease efforts. These issues involve multiple federal organizations, such as NIH (and multiple divisions within NIH), the CDC, USDA, and the FDA (DoD at times is also involved). In my opinion, the CDC, being based in Atlanta, is at a disadvantage. The other agencies can and do meet in person to discuss various problems, issues, and collaborations. Yes, many of the exchanges use email, the internet, and the phone–the same as everywhere else. But there are times when only a face-to-face meeting will do. For the D.C. area-based agencies, that just means a car ride or Metro trip. But scientists at the CDC have to get on a plane, and depending on the type of meeting, stay overnight. That’s both time-consuming and expensive.

By the way, does anyone think that federal agency travel budgets are going to increase any time soon? (And if you host a scientific meeting, consider having it in D.C. every now and again, because that’s often the only way federal scientists can attend).

While I’ve picked two areas that I know (and in which I know people), I think this is a more general problem: it’s harder for CDC to get an equal seat at the table in those intangible ways: face-to-face meetings and after-hours socializiation. Obviously, it has representatives and personnel in the D.C. area, but high-level personnel are typically based in Atlanta, giving them less presence as well. Any reliance on expensive travel also makes it harder for less-senior people to be involved in meetings, which is bad for the junior people and for the effectiveness of a meeting. To be clear, I think the CDC personnel are very good and very dedicated, but there is an effect of not being near other agencies with whom they need to interact.

So if you want to move federal agencies out of the den of inequity and villany that is D.C., fine. Just be aware that there are real costs to the effectiveness of those organizations. Those costs might be worth paying, but that comes at a price of lower mission effectiveness.

I wrote that in 3 B.C. (Before COVID). And here we are today (boldface mine):

The CDC, far more than other agencies, struggles with a slew of structural and cultural issues that have left the agency ill-equipped to fend off political attacks, or even to build up the political capital that could have helped it navigate the stark spotlight it finds itself in now.

With nearly all of its staff — including its director — based in Atlanta, the agency relies on a tiny D.C. office, currently leaderless, to navigate interactions with the White House or Capitol Hill. Even when the rest of its staff are taken into account, the CDC has just a fraction of the connected political staffers that can help other health-focused agencies like the Food and Drug Administration and Centers for Medicare and Medicaid Services in their Washington liaisons…

The clearest and most obvious marker of the CDC’s distance from politics: its headquarters are in suburban Atlanta. Every other federal agency of its size is based in the D.C. metro area.

In a city that runs on handshakes, face time, favors, and gossip, the CDC’s absence puts it at a distinct disadvantage, former CDC and HHS officials acknowledged to STAT.

“The ability to do your job depends on how effectively you build working relationships and partnerships with people,” said Howard Koh, who served as assistant secretary for health during the Obama administration. “Logistically, it’s a lot easier to meet people and build relationships when you’re at the [HHS] building [rather] than in Atlanta.”

Nicole Lurie, who, as the assistant secretary for preparedness and response from 2009 to 2017, enjoyed an office on the sixth floor of the HHS building in downtown D.C., echoed that sentiment. The ASPR is perhaps the closest parallel position to the CDC’s director when it comes to pandemic policy.

“It’s not only being able to walk into the secretary’s office, it’s lots and lots of other people who surround the secretary’s office that are influencers in one way or another,” she said. Lurie added that it would be much harder to have done her job if her office was not based in the HHS building.

Frieden, too, said he realized quickly that the job would be easier if he spent time in D.C.

“I made between 250 and 300 trips to Washington,” Frieden said. “I could come up for two days, I might have 15 meetings, a breakfast, a lunch, a dinner, another breakfast, another lunch, and then I’d go back.”

The agency does have a small office in Washington on one floor of a nondescript office building a mile from the Capitol. They spend most of their time answering questions from members of Congress, and serving as a kind of surrogate at HHS leadership meetings…

The director’s tenuous relationship to D.C. politics — as well as the agency’s physical distance from D.C. — have trickled down to the staff, too, former staffers said. The agency’s roughly 20,000 employees ignore politics far more than other federal agency staff.

When you live in D.C., you read, you converse, you breathe the political atmosphere, it’s not something you have to stop and think about — it’s second nature. And that’s not true in Atlanta,” said the former CDC official, who added that most staffers in Atlanta had the false impression they were protected from politics.

“They would rather not pay any attention to the political back and forth,” remarked Lurie, the former assistant secretary.

Even Frieden, the former CDC director, alluded to the ways CDC officials had a false sense of protection from politics.

“CDC scientists used to say to me, ‘Isn’t it great we are in Atlanta? We don’t have to get bugged by the folks in Washington all the time. But wow, why is our budget so low?’” Frieden said.

Fortunately, it’s not like this is killing us or anything.

It also hurts oversight of the CDC–and the testing fiasco, which is a result of making the same exact mistake twice, is a failure of oversight.

But things are fine, so nothing to worry about.

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