Why We Need More Medical Intelligence, Stat

It has slowly begun to dawn on the American public that, contrary to government assurances over the past year-and-a-half about “flattening the curve,” the COVID-19 pandemic isn’t going away anytime soon. It’s become our unpleasant New Normal. With enough vaccinations and smart public health measures, we should be able to gradually convert the coronavirus from a lethal global pandemic into something resembling another winter flu season: a challenge to be endured yet which doesn’t overburden hospitals or crush the economy.

More than anything else, the COVID-19 experience has revealed how poorly prepared American public health was for a major pandemic, despite decades of unheeded warnings from experts. When the next one comes – and there will be a next one, it’s just a question of when – it may be far worse, more lethal. We simply must do better as a country before the feared “big one” hits and a pandemic causes millions of deaths and true devastation to the economy.

Intelligence has a major role to play here, looking forward, even though the Intelligence Community hasn’t exactly covered itself in glory during our COVID-19 nightmare. If the IC provided important warnings of the early spread of the pandemic from Wuhan across China, then across the planet, those reports were not taken sufficiently seriously by the Trump administration in the critical winter of 2019-20. Moreover, the IC’s disappointing inability to come to any conclusion about the true origins of the coronavirus, as it was tasked to do this summer by the Biden administration, does not inspire high confidence for the future.

Nevertheless, the need for better medical intelligence is plain, given the enormous damage wrought on American society and our economy by COVID-19. Others have noticed this gap too. Scott Gottlieb, the former commissioner of the Food and Drug Administration, in conjunction with pushing his new book on how to do better with the next pandemic, is calling for better medical intelligence, and this is a welcome development. In a Washington Post op-ed last week, Gottlieb called for “something akin to a Joint Special Operations Command for generating actionable information, analysis and coordination. Instead, what we had, in the CDC, was an agency that operated like an academic department of public health.” He amplified this in a weekend interview with CBS in which Gottlieb advocated for “an organization that is in the business of serving surfacing actionable intelligence, has a different mindset around information, doesn't need to be the final definitive answer, but knows how to surface information to policymakers who are making active decisions.”

While Gottlieb’s interest in medical intelligence is commendable, and he should be applauded for taking up this worthy cause, he seems to possess limited understanding of the actually existing Intelligence Community. In the first place, the IC already has a medical intelligence center, which Gottlieb makes no mention of. While Gottlieb sensibly doesn’t want a new intelligence agency devoted to medical intelligence – if there’s something the IC does not need, it’s more bureaucracy – he believes that a significantly enhanced medical intelligence capability ought to reside inside the Centers for Disease Control, which is something that few IC mavens would seriously consider.

There’s a lot to unpack here, so let’s start with discussing the National Center for Medical Intelligence, which is the IC’s existing entity for analyzing and reporting classified medical intelligence. Located at Fort Detrick, Maryland, NCMI is a component of the Defense Intelligence Agency, not to mention one of the least-noticed outfits in American spookdom. NCMI traces its origins to medical intelligence efforts by the Army Surgeon General during World War Two, and by the late Cold War this had evolved into a joint service organization termed the Armed Forces Medical Intelligence Center, which was subordinated to DIA in 1992, then got rebranded with its current “national” title in 2008.

That title is something of a misnomer. While NCMI possesses fully cleared MDs and PhDs, including seasoned experts in virology and pandemics, in truth the center’s mission has historically been focused on protecting the U.S. military from exotic diseases. America’s armed forces deploy around the world, including to out-of-the-way places which contain infectious diseases seldom encountered in America. NCMI provides classified medical threat reporting whenever a pandemic appears, so that the Department of Defense can prepare. It’s important to note what NCMI is, and isn’t, as I did several years ago, when the center was engaged in the fight against Ebola in West Africa:

It’s NCMI’s job to provide senior military and civilian decision-makers the specialized intelligence they need to understand and mitigate these threats.

This isn’t a bunch of 007s in lab coats. NCMI is made up of analysts, not collectors, and most of them are medical professionals who learn the intelligence trade, not the other way around. As NCMI’s director explained in 2012, “We take these very smart people and turn them into intelligence officers.” This center, while tiny by the standards of America’s vast seventeen-agency Intelligence Community, punches well above its weight, partnering closely with many IC agencies — there are liaison officers from the whole range of IC alphabet-soup agencies at NCMI, while they send experts out to work at those agencies in return — as well as a wide range of U.S. Government entities, including the Department of Agriculture and especially the Centers for Disease Control, who have fully cleared people embedded at Fort Detrick to facilitate collaboration and information-sharing.

As an all-source intelligence analysis organization, NCMI is dependent on raw intelligence provided by other agencies — signals intelligence and satellite imagery, especially — as well as open-source reporting from many places. 

All that remains true today, and NCMI is an impressive but small-time player in the vast IC; at last unclassified count, its staffing was in the 150 personnel range. Just what classified reporting NCMI supplied about the initial outbreaks of COVID-19 in the Wuhan area in late 2019 remains controversial. Unfortunately, this important debate was left touched in the unclassified summary of the IC’s analysis of the pandemic’s origins that was disappointingly released last month. However, we should assume that NCMI provided some classified reporting about the growing pandemic in the last months of 2019 – that’s their job, after all – and we can also assume that it never got the top-level attention it merited. For the simple reason that NCMI isn’t a major player in the IC. It’s a small subset of DIA, which isn’t a top-tier intelligence agency to start with (plus one with a mediocre reputation inside the Beltway). Simply put, warnings from DIA sub-agencies don’t carry the weight among spooks and policymakers that similar reporting from bigger agencies might. That’s Washington reality.

Fortunately, there is a way ahead on the medical intelligence front. Gottlieb is right, we don’t need another agency here. After 9/11, in an understandable effort to make the IC better, based largely on a misread of what the spies got wrong in the lead-up to the terror attacks on New York and the Pentagon, Congress added new layers of espionage bureaucracy, which hardly helped efficiency or cost-effectiveness. However, Gottlieb’s wrong about hosting a new medical intelligence entity inside the CDC. In the first place, the CDC has covered itself in even less glory over the course of this pandemic than the spooks have; public confidence in the CDC is currently low, not without cause. More seriously, housing any intelligence outfit inside a nonintelligence organization like the CDC ensures security lapses, not to mention culture clashes. The primary consumer of medical intelligence is Washington’s political and military leadership: what they choose to share with the public, usually via the CDC, is another matter.

Therefore, what we need urgently is a bigger, better, more lavishly resourced, and more bureaucratically potent medical intelligence outfit housed inside the IC. The solution is to create a new center under the Director of National Intelligence. The DNI already possesses three national intelligence centers as direct-reports, devoted to nuclear counterproliferation, counterterrorism, and counterintelligence; it’s time to add a fourth, dedicated to the analysis of all-source medical intelligence, what might be termed, at least unofficially, the national counter-pandemic center.

Directly reporting to the DNI, this new center would draw personnel from across the Intelligence Community’s many agencies, bolstered by properly cleared employees of the Pentagon, the CDC, Health and Human Services, the Office of the Surgeon General, and other federal entities with skin in the pandemic game. This will require the IC to hire more MDs and PhDs and getting them properly cleared Top Secret, but that can be done without great delay if the bureaucratic will exists to do so. Placing the new center under the DNI ensures a couple important benefits for the medical intelligence portfolio inside the IC. First, when they ask for enhanced intelligence collection by other agencies (e.g., HUMINT, IMINT, SIGINT) on the possible stirrings of the next pandemic pronto, it’s more likely to be answered quickly. Second, threat reports issued by a DNI center (rather than by an obscure subset of a second-tier IC agency) are likely to get the attention of policymakers without much foot-dragging.

Whenever the next pandemic hits, as it surely will one day, Washington needs to react faster and more decisively than it did with COVID-19. Here the Intelligence Community has a major role to play, to do better than it did in late 2019 and early 2020. Here, we lack informed analysis, plus bureaucratic juice, more than we lack collection capabilities. Getting medical intelligence right matters enormously for our national security, doing so is only a matter of will, including getting the bureaucracy right. We know how.

Ball to you, Congress…