When the boring tasks of governance are not performed, infrastructures don’t get built. Then, when epidemics strike, people die.

Goodbye, Organization Man

International New York Times | 15 September 2014

David Brooks

Imagine two cities. In City A, town leaders notice that every few weeks a house catches on fire. So they create a fire department — a group of professionals with prepositioned firefighting equipment and special expertise. In City B, town leaders don’t create a fire department. When there’s a fire, they hurriedly cobble together some people and equipment to fight it.
  

We are City B. We are particularly slow to build institutions to combat long-running problems.

The most obvious example is the fight against jihadism. We’ve been facing Islamist terror for several decades, now, but every time it erupts — in Lebanon, Nigeria, Sudan, Syria and beyond — leaders start from scratch and build some new ad hoc coalition to fight it.
   

The most egregious example is global health emergencies. Every few years, some significant epidemic strikes, and somebody suggests that we form a Medical Expeditionary Corps, a specialized organization that would help coordinate and execute the global response. Several years ago, then-Senator Bill Frist went so far as to prepare a bill proposing such a force. But, as always, nothing came of it.
   

The result, right now, is unnecessary deaths from the Ebola virus in Africa. Ebola is a recurring problem, yet the world seems unprepared. The response has been slow and uncoordinated.
   

The virus’s spread, once linear, is now exponential. As Michael Gerson pointed out in The Washington Post, the normal countermeasures — isolation, contact tracing — are rendered increasingly irrelevant by the rate of increase. Treatment centers open and are immediately filled to twice capacity as people die on the streets outside. An Oxford University forecast warns as many as 15 more countries are vulnerable to outbreaks. The president of Liberia, Ellen Johnson Sirleaf, warned: “At this rate, we will never break the transmission chain, and the virus will overwhelm us.”

The catastrophe extends beyond the disease. Economies are rocked as flights are canceled and outsiders flee. Ray Chambers, a philanthropist and U.N. special envoy focused on global health, points out the impact on health more broadly.  For example, people in the early stages of malaria show similar symptoms to Ebola and other diseases. Many hesitate to seek treatment fearing they’ll get sent to an Ebola isolation center. So death rates from malaria, pneumonia and other common diseases could rise, as further Ebola cases fail to be diagnosed.
  

The World Health Organization has recently come out with an action plan but lacks logistical capabilities. President Obama asked for a strategy, but that was two months ago and the government is only now coming up with a strong comprehensive plan. Up until now, aid has been scattershot. The Pentagon opened a 25-bed field hospital in Liberia. The U.S. donated five ambulances to Sierra Leone. Coordination has just not been there.
  

At root, this is a governance failure. The disease spreads fastest in places where the health care infrastructure is lacking or nonexistent. Liberia, for example, is being overrun while Ivory Coast has put in a series of policies to prevent an outbreak. The few doctors and nurses in the affected places have trouble acquiring the safety basics: gloves and body bags. More than 100, so far, have died fighting the outbreak.
  

But it’s not just a failure of governance in Africa. It’s a failure of governance around the world. I wonder if we are looking at the results of a cultural shift.
  

A few generations ago, people grew up in and were comfortable with big organizations — the army, corporations and agencies. They organized huge construction projects in the 1930s, gigantic industrial mobilization during World War II, highway construction and corporate growth during the 1950s. Institutional stewardship, the care and reform of big organizations, was more prestigious.
   

Now nobody wants to be an Organization Man. We like start-ups, disrupters and rebels. Creativity is honored more than the administrative execution. Post-Internet, many people assume that big problems can be solved by swarms of small, loosely networked nonprofits and social entrepreneurs. Big hierarchical organizations are dinosaurs.
 

The Ebola crisis is another example that shows that this is misguided. The big, stolid agencies — the health ministries, the infrastructure builders, the procurement agencies — are the bulwarks of the civil and global order. Public and nonprofit management, the stuff that gets derided as “overhead,” really matters. It’s as important to attract talent to health ministries as it is to spend money on specific medicines.

As recent books by Francis Fukuyama and Philip Howard have detailed, this is an era of general institutional decay. New, mobile institutions languish on the drawing broad, while old ones are not reformed and tended. Executives at public agencies are robbed of discretionary power. Their hands are bound by court judgments and regulations.

When the boring tasks of governance are not performed, infrastructures don’t get built. Then, when epidemics strike, people die.