Just about everyone in America has an opinion on how the Centers for Disease Control (CDC) handled the COVID pandemic response—and these opinions often follow political lines. However, trust in the agency is low among Americans of all political stripes, and even Director Rochelle Walensky has acknowledged that the CDC has failed to “reliably meet expectations.”
A lack of public confidence in the agency charged with controlling infectious diseases has myriad consequences. The CDC just announced a reorganization aimed at addressing at least some of its shortcomings during the COVID pandemic. The goal of CDC reforms should be to restore the agency’s credibility and public trust, and this would be accomplished most effectively with a robust external review.
COVID was a challenging time—our information about it was changing rapidly—and though some of the agency’s efforts had positive results, there were clear, avoidable failures at the CDC. A panel of experts that convened at the American Enterprise Institute offered a helpful framework for understanding these failures that can be grouped into four categories: protocol tunnel vision, position consistency, scientific and disease data dissemination, and assisting local health departments and healthcare workers.
The CDC’s tunnel vision on prioritizing low transmission rates over all other medical issues and the nation’s economic health was misguided and costly. Americans’ avoidance of going into healthcare spaces during the pandemic created a huge treatment gap for other illnesses, such as cancer and heart disease. Furthermore, the lengthy shutdowns turned many businesses, and whole industries, belly-up.
Inconsistent scientific analysis of viral spread and the flip-flopping on mask mandates further eroded the public’s confidence. It is one thing for policy changes to be based on updated scientific study, but many Americans came to suspect that politics—not science—was driving some CDC guidance. The communication, at least, around these inconsistencies was a failure.
Slowness plagued their data dissemination, sometimes taking days to weeks to publicly post case counts and death rates. This problem partially stemmed from the antiquated technology used between the CDC and localities—literally excel spreadsheets, faxes, and sometimes snail mail. The latest reorganization announcement seems primarily focused on improving data infrastructure, which is very much needed.
Finally, the lack of personnel assistance in the “trenches”—the frontline work against COVID done by local health departments and healthcare workers—was a failure. Dr. Theresa Cullen, a seasoned public health giant, pointed out that the CDC’s Epidemic Intelligence Service (EIS) officers, the boots-on-the-ground, were desperately needed around the country, but most of them were instead at the Atlanta headquarters.
To turn failures into forward movement, the CDC needs to improve the quality and volume of resources it provides to the public and healthcare communities and refocus its mission. Like Dr. Cullen said at AEI, more CDC personnel working in American localities are needed during a pandemic. CDC Director Walensky says the U.S. needs to add 80,000 more public health workers. Additionally, the strategic national stockpile of medical supplies also needs to be bigger; it ran out way too fast. Third, to provide better data, the CDC needs to upgrade its technology for gleaning, storing, and disseminating this data to and from state localities. One can hope that the planned organizational overhaul addresses this.
And then there’s the CDC’s mission: what exactly should it be putting its efforts and resources towards? Does the CDC really need to be trying to regulate the environment? It is not a regulator, at least not a good one. That’s the role of the EPA. The CDC should focus on what it was established for: infectious disease prevention and control.
The CDC reorganization will create a “new, centralized leadership team of multi-disciplinary experts.” This should include input from public health economists. The effects of pandemic regulations on the U.S. and world economies have been a grave lesson on the interrelationship between the public’s health and wealth.
Will the reorganization effort result in real reform? Let’s not kid ourselves: real, honest assessment for change needs an independent, external review to correctly diagnose the several failures of the CDC during the COVID pandemic. If the CDC really wants to restore public trust, they should ask to be externally reviewed. Then they can do the hard work of ensuring higher levels of competence, credibility, and accountability before the next pandemic hits, whenever that might be.