From the comments, on CDC reform

Furious crowd of people protesting for human rights on the streets. Focus is on Caucasian woman with raised arm.
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These are the word of commentator Sure:

The reasons you cannot change the CDC have little to do with remote work the major issues are:

1. The people who staff the place could either make a lot more money doing something else or they believe they could. This means that they selected into working here and did so precisely because they like some combination of the present culture and the mission as presently understood. Asking them to change is going to be treated as something tantamount to taking a major pay cut at best.

2. It is overrun with academics. The director of NIOSH has 5 advanced degrees. And something like half the upper leadership has at least two runs through the academic gauntlet (granted the MPH is vastly easier than the MD or PhD) and pretty much all of them have reasonable output of academic papers. Many look at the CDC as complementary to an academic career and even the lifers have CVs at least compatible with going academic. This means a lot of the work product and setup is geared more toward publication, conference presentation, and deliberative work rather than rapid response.

3. The place has gone monocultural. Talking about the Obama era largely means talking about the old dinosaurs who retired out as the times changed. Since 2015, their political donations have been 99.94% to Democrats. This means that they get bogged down in the latest vanguard concerns of the Democratic base and that they are increasingly ignorant about and isolated from the bulk of the populace. Things that make some sense in dense urban corridors where few people get dirty at work make little sense in sparsely populated areas with significant morbidity burdens from work.

4. The hiring is completely incestuous. A huge number of low-level folks have parents who worked there or at related institutions (e.g. NIH) and even larger proportions involve folks who share educational pedigrees (universities, med schools, advisers). And even if a president wants to change this, there are civil service protections, congressional limitations (being a specifically delegated remit of authority), and of course that would require either Democrats to eat a lot of flak from their base among the educated or the Republicans signing up for a mass whipping for being “anti-science” and attribution of any cataclysm to this sort of personnel purge regardless of the real merits.

5. The activists are running rampant. Culturally competent pandemic management, as taught by the CDC, suggests that in a pandemic public health officials should not criticize cultural or ethnic leaders unnecessarily. They also suggest that you cannot shame or browbeat people into compliance with public health efforts, and that attempts to do so often backfire by having identity groups (religious, ethnic, national, etc.) respond to your nociceptive stimuli by rejecting previously accepted public health interventions. The worst messaging coming out of the CDC, particularly anonymously, violates all the guidelines I have seen the CDC issue when working overseas with MSF.

6. Doing your job well is boring. Most of the time you should be just making certain that resources (e.g. antibiotic stockpiles) are in place and that the same things that worked last time are ready to be implemented again (e.g. surge vaccination). And your ability to innovate and come up with something useful is pretty unlikely as there have been 50,000 people before you who give it their best stab. This leads to people “innovating” for the sake of “innovating”. This leads to people amplifying secondary concerns like “representation”, “equity”, “sustainability”, or the like. And a couple iterations of promoting the “innovators” over the maintainers will rapidly lead to atrophy of core capabilities. Zika or H1N1 represent less than 2% of the total work burden of the CDC, most of being agile is about maintaining capabilities when they are never used. And that is boring and at least currently not great for career advancement.

Remote work, in my best guess, would likely be a boon for the long-term flexibility of the CDC. Getting folks out of Atlanta and DC, having more capability for folks to work from the breadth of the country, and potentially even letting late career clinical folks have more access to the institution without having to disrupt their lives with a cross-country move are all to the good.

But until a bunch of people get fired, the CDC is unlikely to effectively change. On my more pessimistic days, I figure the real solution would involve burning the place to the ground.

Here is the original post.

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