CDC, battered by pandemic, will undergo major rethink of its work

A public health agency once held up as the world’s gold standard will put itself under the microscope and try to diagnose swift, appropriate remedies for the relentless criticism it has received for months of faulty performance in dealing with one of the most lethal infectious disease outbreaks in a century.

The federal Centers for Disease Control and Prevention (CDC) must improve its work in its core functions, including “beefing up the nation’s public health workforce, data modernization, laboratory capacity, health equity, rapid response to disease outbreaks, and preparedness within the United States and around the world,” the agency’s chief, Dr. Rochelle Walensky, has written to her 13,000 expert colleagues. She is insisting, no matter the political risks and practical difficulties, that significant changes must occur, the Washington Post reported, noting of the agency’s much-derided work on the coronavirus pandemic:

“Since the pandemic began more than two years ago, the once-storied agency has been under fire for its pandemic response, from initial delays developing a coronavirus test, to the severe eligibility limits to get the test, to missteps often attributed to Trump Administration meddling. But even under the Biden Administration, the agency’s guidance on masking, isolation and quarantine, and booster doses has been repeatedly faulted for being confusing. A consistent criticism has been the agency’s failure to be agile, especially with analysis and release of real-time data.

“Walensky seemed to acknowledge those criticisms in brief public remarks about the reasons for the reorganization. ‘Never in its 75-year history has CDC had to make decisions so quickly, based on often limited, real-time, and evolving science,’ she said in the statement. ‘… As we’ve challenged our state and local partners, we know that now is the time for CDC to integrate the lessons learned into a strategy for the future.’”

Walensky has asked an outsider — Jim Macrae, who served as acting administrator of the Health Resources and Services Administration for two years and has held other senior positions at the federal Department of Health and Human Services — to lead the internal, top-to-bottom review of CDC. He will work on this initiative with three senior CDC officials: Dr. Deb Houry, acting principal deputy director; Robin Bailey, the chief operating officer; and Sherri Berger, the chief of staff.

The White House said it supports Walensky’s plans but did not request them.

The CDC review will result in changes that may include altering the way the agency director is chosen, making the post longer in term and possibly requiring U.S. Senate confirmation. The internal reviews likely will target the agency’s funding, particularly the roller-coaster of Congress providing big sums after crises occur, then slashing budgets. The CDC also, more than ever, will wrangle with the bitter question of whether it can be rooted in evidence, science, and objectivity, or if problematic politicization of its work is inevitable.

Sticking with science, avoiding politics?

That question has erupted, separately, as Dr. Robert Redfield — the roundly criticized head of the CDC during the Trump presidency and the agency chief at the start of the pandemic — has groused publicly about the lack of resources he found at the CDC, a point on which his peers agreed. He also complained about what he asserts were unfair attacks from his predecessors and other medical and scientific experts who wanted him to better protect the CDC from meddling and attacks by the president and White House staff. He told an audience of news organization panel on the CDC this:

“The one thing I’ve gained from three years in the Trump Administration is every time that I go through an airport now, I trigger the metal detector because of all the shrapnel that’s in my back. It was disappointing that some of my CDC director colleagues felt the necessity to publicly criticize me in the news.”

The former CDC chiefs could not agree whether it would be a good step to change the director’s term to a decade, rather than its current five years. They disagreed whether Senate confirmation for the post would make it more or less political. They agreed that the agency deserves robust, sustained funding, especially since the pandemic has made clear that public health is as crucial a component of national security as military might, on which the Congress spends hundreds of billions of dollars without a blink.

Still, critics have lit into the CDC, arguing that, despite the sizable resources allocated to it, the agency has become too bureaucratic, ponderous, and unresponsive, failing, in particular, to modernize its creaky infrastructure. This has proven to be a nightmare with a basic for a public health agency: data collection. The CDC, until recently, found the public relying on crucial metrics for the pandemic — case numbers, hospitalizations, and deaths — on experts with Johns Hopkins or major news organizations.

The agency’s reputational decline — in the eyes of the public and among global peers — has been painful within the CDC, the New York Times reported:

“The CDC has long been revered for its methodical, scientific approach to improving public health around the world. Scientists outside the United States were trained by agency experts, and its standards have been embraced and emulated globally.”

Not good. In my practice, I see not only the harms that patients suffer while seeking medical services, but also their struggles to access and afford safe, efficient, and excellent health care. This has become an ordeal due to the skyrocketing cost, complexity, and uncertainty of treatment and prescription medications, too many of which turn out to be dangerous drugs.

Patients, doctors, hospitals, insurers — indeed, all of us — need outstanding public servants with health, medical, and scientific expertise to be our trusted guardians and advocates, providing evidence-based recommendations on the best policies possible for our individual and collective well-being. The world has become so complex, uncertain, and interconnected that we cannot huddle in the dark or in tiny health havens while diseases and other threats to our wellness explode all around us.

We also can’t let loud-mouth celebrities, ignorant and duplicitous politicians, and destructive opiners reverse hundreds of years of medical and scientific progress with anti-science, counter-factual attacks. Those espousing utter hokum can’t be allowed to rip down the U.S. health care system. We have much work to do to make major fixes and to build on our battered public health and medical-scientific agencies and institutions.