Chief launches CDC shakeup, citing ponderous agency’s pandemic flubs

cdcwalensky-150x150The federal Centers for Disease Control and Prevention, one of the world’s premier public health agencies, will try to revamp itself after taking months of a political, scientific, and reputational battering for too often performing in shambolic fashion in response to the coronavirus pandemic.

Rochelle Walensky (shown, right) appointed the agency’s chief in December 2020, announced in April of this year that she had asked outside experts to conduct a top-to-bottom review of the CDC and to recommend reforms.

She now has told her 11,000 agency colleagues that the much-needed scrutiny showed that the CDC, with its $12 billion budget, had become too ponderous, bureaucratic, and academic in its work, communicating too slowly, badly, and in confusing ways with its most important constituents: the American people. As the New York Times reported of Walensky’s blunt assessment of the suboptimal response to the pandemic that has killed more than 1 million and infected 93 million-plus of us:

 “To be frank, we are responsible for some pretty dramatic, pretty public mistakes, from testing to data to communications.”

The CDC chief now hopes the agency will become, as many giant corporations aspire to being, more “nimble,” agile, responsive, and focused on the public, not internal concerns. More changes will occur in the CDC, but the Associated Press cited these steps as occurring first for the agency, which will:

  • Increase use of preprint scientific reports to get out actionable data, instead of waiting for research to go through peer review and publication by the CDC journal Morbidity and Mortality Weekly Report.
  • Restructure its communications office and further revamp CDC websites to make the agency’s guidance for the public clearer and easier to find.
  • Shorten the time agency leaders devote to outbreak responses to a minimum of six months — an effort to address a turnover problem that at times caused knowledge gaps and affected the agency’s communications.
  • Create a new executive council to help Walensky set strategy and priorities and appoint Mary Wakefield as senior counselor to implement the changes. Wakefield headed the Health Resources and Services Administration during the Obama Administration and served as the No. 2 administrator at HHS. Wakefield, 68, has started already. Undo changes in the agency’s organization chart made during the former administration.
  • Establish an office of intergovernmental affairs to smooth partnerships with other agencies, as well as a higher-level office on health equity.

The Washington Post quoted Walensky as saying this about her action plans in the days ahead:

“My goal is a new, public health action-oriented culture at CDC that emphasizes accountability, collaboration, communication, and timeliness.”

Big changes were demanded at the agency due to its recent shaky performance, often ripped not only by partisan politicians but befuddled members of the public, doctors, nurses, and hospitals, the newspaper reported:

“Since the coronavirus pandemic began 2½ years ago, the once-storied agency has been under intense fire for its response, from initial delays developing a coronavirus test, to the severe eligibility limits to get tested, to missteps often attributed to Trump administration meddling. Even under the Biden administration, which appointed Walensky to lead the agency, its guidance and decision-making on masking, isolation and quarantine, and booster doses have been repeatedly faulted as slow, opaque and confusing.  A consistent criticism has been the agency’s failure to be agile, especially with the analysis and release of real-time data. White House officials have also grown frustrated with CDC and other health agencies over their response to monkeypox, with patients, physicians and even some administration officials asking why it was so hard to expedite testing and treatment.”

Experts quoted by media — critics, supporters, and former agency officials — supported Walensky’s attempts to diagnose the CDC’s problems and to treat them, though they differed on whether she will be aggressive and effective enough.

Scott Gottlieb, the Food and Drug Administration chief in the last administration and who slammed the CDC bureaucracy in his “Uncontrolled Spread,” his book on the U.S. coronavirus response, told the Washington Post this:

“[The] CDC is a very academic organization — and I think Dr. Walensky recognized that when she says that they need to change the reward structure, so people aren’t rewarded for publications but for operational execution.”

The New York Times reported this about the challenges in revamping agency operations:

“Many of the CDC’s experts are accustomed to conducting narrowly focused research that undergoes lengthy reviews, and they are uneasy with the kind of urgent action needed to address public health threats. That type of research is still critical, many experts say. ‘Having expertise in those rare diseases is very valuable. And it becomes valuable at times you just don’t really know,’ said Dr. Mitchell Wolfe, who left the CDC in June after serving as its chief medical officer. ‘I think monkeypox is a great example. A year ago, people would have asked why you have a monkeypox expert,’ he said. And some of the CDC’s problems are beyond its control: Much of its funding is tied to work on specific diseases and cannot be shifted to address public health threats. The agency also lacks legal authority to compel state and local health departments to deliver public health data. The pandemic itself is another impediment. The agency’s massive complex outside Atlanta sits mostly empty, while employees, including Dr. Walensky, work remotely.”

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. We need their best knowledge, derived from experience, research, and study, to be clear, comprehensible, and convenient to find.

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. The peril posed by infections, even after the terrible toll of the pandemic, has shown this, as we all worry about outbreaks of monkeypox, the fresh detection of once-contained polio, and a worrisome influenza season. We also have seen bad outcomes with measles, whooping cough, meningitis, and more.

We 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.

Patrick Malone & Associates, P.C. listed in Best Lawyers Rated by Super Lawyers Patrick A. Malone
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