The progressive agenda depends on Biden’s ability to reform the FDA and CDC

The party of government must show that it can govern. Over the first eight months of his presidency, Joe Biden has launched an expansive agenda that outlines a progressive vision of a more activist federal government. Recently, though, the Biden administration’s on-the-job performance has reinforced doubts about the government’s ability to deliver on such ambitious promises.

Biden and his team must focus on improving how the government actually functions if they hope to convince a skeptical public to place its trust in the progressive dream.

Following the messaging debacle of the Pfizer booster decision, the administration should start with the Food and Drug Administration (FDA) and the Centers for Disease Control and Prevention (CDC). 

Trust in government has undergone a steady decline since the 1960s. For the progressive agenda to have a chance at shaping the nation’s future in the coming decades, this trend must be reversed. 

Unfortunately, the record of the nation’s leading public health agencies during the pandemic has done little to inspire such confidence.

From the CDC’s initial hesitance to recommend widespread mask-wearing to the FDA’s reluctance to approve the kind of rapid, in-home tests that helped contain the Delta wave in Europe, the public health establishment’s inconsistent performance has hindered the federal response.

Over the past few weeks, the chaotic booster shot approval process created widespread confusion. This began with the White House’s premature announcement that all Pfizer vaccine recipients would get boosters. It continued with a series of clashing expert recommendations to the two agencies about whether booster recipients would include high-risk workers or be limited to people with medical vulnerabilities and those over age 65. CDC Director Rochelle Walensky capped it off with a late-night decision to override her own expert advisory panel’s recommendations and adopt instead those of the FDA. 

This followed the FDA’s excruciatingly slow — and still uncompleted — process of authorizing the Pfizer vaccine for children younger than 12. While the decision to collect additional safety data on the vaccine in that age group has some scientific justification, the regulators’ emphasis on process over urgency has complicated the return to in-person schooling.

Addressing such problems would help stem further disease and interruptions of normal life, and could represent a first step toward restoring trust in government.

The Biden administration should launch a review of the organizational structure, operating procedures, decision-making processes, inter-agency coordination and, perhaps above all, public messaging of the FDA and CDC. Such a review would be geared toward producing specific recommendations for either executive actions or legislation (or possibly both) aimed at increasing the effectiveness of the nation’s core public health structures.

This is vital for fighting the COVID-19 pandemic and future health crises. It also is crucial for convincing the public that the government could actually implement a broader progressive agenda in the coming decades. 

In taking such action, Biden can look for inspiration to his Democratic predecessors, many of whom used the reform of government as the basis for achieving progressive policy goals.

Woodrow Wilson, despite grievous failures regarding race and civil liberties, helped create basic government regulatory structures, including the Federal Reserve Bank, the Federal Trade Commission, and the Department of Labor. Wilson also helped to strengthen the federal government’s antitrust laws. Such structures formed the basic core of the administrative state upon which contemporary governance now rests.

Franklin Delano Roosevelt is primarily remembered for the many legislative accomplishments of the New Deal, but he also undertook an aggressive project of institutional reform during his second term. In particular, the Executive Reorganization Act of 1939 restructured the executive branch and centralized control in the White House. The resulting expansion of administrative capacity played a critical part in creating the modern presidency.

When Lyndon Johnson undertook the Great Society a quarter-century later, he similarly viewed the effective and efficient operation of government as a priority. Johnson organized a series of expert task forces to guide the development and implementation of government programs. When Johnson decided to undertake the War on Poverty, he created the Economic Opportunity Administration to run it. LBJ’s actions provided a means to sweep away layers of rigidity and racial discrimination at the federal, state and local levels.

This is the sort of bold action that President Biden needs to undertake as we approach the end of the pandemic’s second year. There is much work to do across the federal government, but the FDA and the CDC provide an opportunity to begin by making these agencies more responsive to the urgency of the crisis. The fate of the progressive agenda depends on doing so. 

Guian A. McKee is an associate professor of presidential studies at the University of Virginia’s Miller Center of Public Affairs. Follow him on Twitter @guian_mckee.