Bureaucracy in a Time of Pandemic

When I was in New York City, I was talking to a colleague and happened to make a comment about how much of the work of public health is about establishing bureaucratic norms. My comment reflected how a core focus of our work is creating effective processes within institutions that support health—which is indeed the work of bureaucracy. My colleague responded by saying, “Wait till they call you a faceless bureaucrat.” This remark—which, perhaps, I should have seen coming—captures the disregard many have, intrinsically, for bureaucracy. The very word conjures blandness, redundancy, and red tape. This is reflected in representations of bureaucracy in film and literature, in the novels of V. S. Naipaul and Franz Kafka, and in movies like Office Space and the television show The Office.

Within public health, the COVID-19 moment has brought the features of bureaucracy into focus in different ways, as we have worked within bureaucracies to meet the challenge of the past year and a half. During this time, it would be fair, I think, to say that bureaucracy’s record has been mixed—that bureaucracy, for all the good it has done, has also made some stumbles. In particular, the following three challenges have complicated our efforts to be maximally effective during the pandemic.

First, the bureaucratic structures in charge of communicating with the public at the national level have struggled to do so effectively. While much criticism has rightly been directed towards the Trump administration for the incoherence of its messaging around COVID, it is also true that the public health bureaucracy has, at times, presented the public with mixed messages around what to do during this crisis. This is the case now, for example, as messaging changes around masking and it is difficult to get a sense of public health speaking with a clear voice on the subject. It is also the case that bureaucratic messaging around the pandemic could sound, at times, moralizing and pedantic, undercutting its effectiveness.

Second, the messy rollout of vaccine access has revealed bureaucracy’s limits in implementing solutions at scale in the midst of crisis. An organization like the CDC can study vaccines, make recommendations about their use, even assist in their delivery. But there is only so much it can do when it comes to persuading populations to actually get the shot. It is here, particularly, where the “faceless” character of bureaucracy can be problematic. The organizations making public health recommendations are staffed by people who were not selected by the public—this is true even when it comes to the White House, where just a handful of the decision-makers inside were directly elected to their posts. This can inform mistrust, a feeling, in the case of vaccines, of “ust who are these people who are telling me to put something in my body?” This difficulty is perhaps less a failing of those working within the public health bureaucracy and more a limitation of the structure of bureaucracy itself, one which has been on display during the pandemic.

Third, during COVID, bureaucracy has, to some extent, lived up to its reputation of creating, at times, chaos of rules and regulations. The pandemic has been characterized by an ever-shifting fabric of laws and guidelines, shaped by the evolving nature of the virus and a changing social and political context. This context has posed a challenge for all of us, of course, not just for bureaucracies. However, bureaucracy’s structural predisposition towards complicated regulation and red tape has made it seem, rightly or wrongly, less surefooted than, say, the efforts of private industry which did so much to quickly produce a COVID-19 vaccine.

I do not raise these points to argue against bureaucracy. On the contrary, a well-functioning bureaucracy is essential for supporting the public’s health. It is also core to supporting our embrace of the public institutions which are a hallmark of a society founded on the principles of small-l liberalism. For these principles to flourish, the institutions that are their outward face must function in a manner that inspires trust. For them to do so takes an effective internal bureaucracy.

How can we ensure bureaucracy maintains a high level of effective functioning? Organizations function best within an incentive structure which rewards effectiveness and discourages the lack of it. While bureaucracies may not be accountable to the voting public or the dynamics of the marketplace, there are a range of incentive structures that can be leveraged to support greater accountability. Then there are the demands of reality itself. Throughout COVID, for example, the demands of the moment have helped keep bureaucracy accountable, by creating steep human costs for failure. It is when bureaucracy is most insulated from these costs that it is least accountable. In public health, then, the very stakes of our mission can help support a higher level of bureaucratic performance. In this way, we can perhaps avoid the charge of being “faceless,” instead remaining outward-facing, responsive to the needs of the communities we serve.

Finally, bureaucracies work best when they are non-pedantic, embracing rules and regulations not for their own sake, but for their use as tools to support health and improve lives. This means resisting the self-perpetuating cycles of red tape which can sometimes characterize bureaucracies, in favor of a flexible approach, based on the needs of the moment. Core to this will be grounding our actions in the external data, rather than in internal bureaucratic priorities. This can help undercut the charge of arbitrariness so often applied to bureaucratic initiatives.

Fundamentally, bureaucracy should always be rooted in the work of making people’s lives better. Because the bureaucrat really does play a key role in the creation of a healthier world. We need bureaucratic systems to work well, and, for all the ease with which they can sometimes be lampooned, few of us would want to be without the services they provide.