As global health threats evolved, the CDC didn’t

Beating disease is in the DNA of the Centers for Disease Control and Prevention, the federal agency that oversaw the eradication of smallpox, the elimination of malaria, and the eradication of polio as a threat to American health in its first decade.

But as the 75-year-old agency’s director conceded this week, the CDC hasn’t evolved to keep up with the increased speed and higher proportion of germs in the modern world.

In the face of a historic threat — the emergence of a novel virus that has killed more than 1 million Americans — “our performance has not reliably lived up to expectations,” said Dr. Rochelle Walensky to CDC staff in an encouraging call for change.

The arrival of monkeypox has already drawn further criticism from the agency’s creaking machinery. Failure to improve could mean extinction for a public health organization that has long been a model for the world, experts said.

Many of these pundits have spent much of the COVID-19 pandemic barely containing their dismay at the agency’s faltering efforts to overcome its early missteps and regain Americans’ confidence.

Now they’ve stopped trying to defend the CDC’s performance.

“A botched response to the greatest crisis of our lives,” said Lawrence Gostin, a Georgetown public health authority.

A record of mistakes that resulted in “one of the biggest losses during this pandemic: trust in our public health agency,” it says dr Richard Besser, a former CDC director who is now President and CEO of the Robert Wood Johnson Foundation.

“A culture that was just arrogant and overestimated their ability to get it right,” said Kathleen Hall Jamieson, director of the University of Pennsylvania’s Annenberg Public Policy Center and an expert on science communication.

As the coronavirus swept across the globe, the agency’s renowned specialists ran an early test to detect it. They issued incorrect and confusing guidance on the value of face coverings. It took them months to acknowledge what outside scientists quickly found — that the virus that causes COVID-19 was primarily airborne. And they drew on epidemiological evidence from Israel, Europe and South Africa rather than US data, which was often difficult to pluck from a patchwork of overwhelmed public health departments responsible to state politicians.

CDC pronouncements on basic things — how long an infected person should be isolated, who needed vaccines and boosters most, how long immunity would last, and what should come next — were delayed, garbled and loaded with caveats common to ordinary Americans are incomprehensible. When new findings required updates to previous guidance, they trickled haphazardly and out of context into the news cycle.

“To be honest, we’re responsible for some pretty dramatic, pretty public errors,” Walensky said in a video distributed to the agency’s 11,000 employees. “We’re still suffering the consequences of these failures – from testing to data to communications.”

Neither the novelty of the virus nor political interference can absolve the CDC of mistakes made well into the second and third years of the pandemic, she added.

“An honest and unbiased reading of our recent history will lead to the same conclusion,” she said. “It’s time for CDC to change.”

A CDC building at its Atlanta headquarters.

A CDC building at its Atlanta headquarters.

(Ron Harris/Associated Press)

Walensky’s sobering admissions followed an extensive review based on interviews with some 120 public health experts inside and outside the agency.

In meetings with senior public health advisors and leaders, she heard about a culture of scientific self-absorption that was frustrating the agency’s core mission of getting public messages across. CDC epidemiologists, she was told, had acted with all the scientific conservatism and urgency of an academic medical journal.

“By the time they were done, the data might have been bulletproof,” said a senior CDC official who was not authorized to speak to the press. “But its real relevance was gone.”

The CDC’s risk communication mission is designed to embody three imperatives: Be first. To be right. Be believable. “Nonetheless, during COVID, we have seen that CDC did not come first and often lagged behind other sources of information — and misinformation — by a significant period of time,” Besser said.

Walensky’s top priority is to improve the CDC’s ability to communicate scientific knowledge about a health threat in an early, frequent and authoritative manner, particularly to Americans who need it to protect themselves and their communities.

“No one can say their messages were timely, understandable, timely and calm,” Gostin said. “They always seemed to lead from behind.”

To a deeply divided public, the CDC’s changing policies have often been interpreted as a lack of persuasion, or worse, dishonest manipulation. Many chose simpler and more frequently updated sources for their pandemic information.

But even scientists and public health experts — people who appreciated the scientific complexity of the CDC’s job — gave up running the agency, Gostin said.

Walensky will try to win her back with a series of proposals to modernize the agency.

The initiatives aim to strengthen the agency’s workforce and its partnerships with health organizations and state and local health authorities. They would streamline data collection and sharing of CDC science.

They would make the agency’s health messages quicker and easier to understand when time is of the essence. And to avoid the kind of government talks that often left CDC unsuspecting, a “no surprises attitude” became a key principle of the agency’s communications.

dr Rochelle Walensky stands with Dr. Anthony Fauci in the Eisenhower Executive Office Building on the White House campus.

dr Rochelle Walensky stands with Dr. Anthony Fauci prior to the White House COVID-19 Response Team’s regular call to the National Governors Assn.

(Carolyn Kaster/Associated Press)

Some changes, including flexibility to reallocate funds in an emergency, will require Congressional approval, a process that has already begun. Others, including the establishment of a new public communications office and an agency-wide focus on diversity, equity and inclusion, have just been rolled out.

And then there’s the task of cultivating a habit of mobility.

“Yes, we’re going to move some boxes in the org chart,” Walensky told CDC staff. “However, I cannot stress enough that moving boxes will not modernize this agency or better prepare us for the next pandemic. The culture will change.”

Of course, the legal, budgetary, and political constraints under which the CDC has operated will continue to present significant challenges, Gostin said.

For decades before COVID-19 emerged, steady declines in funding eroded the corps of public health workers at the county, state, tribal, and federal levels. Shrinking budgets dried up laboratory capacity needed during a sudden outbreak and hampered the introduction of new methods of public health surveillance, from genetic sequencing of virus samples to wastewater monitoring.

While the pandemic has underscored that these methods are here to stay, the CDC still needs money to build up its laboratory capacity and a workforce capable of practicing 21st-century epidemiology. After spending billions on the pandemic, this could be a tough sell for a wary Congress, Gostin said.

The CDC also needs to find more effective ways to obtain data on emerging health threats, Gostin said. State and local governments — not a federal agency like the CDC — are responsible for implementing and enforcing public health measures. A federal judge’s order this spring showed that the CDC does not even have the uncontested authority to require mask-wearing on planes, trains and other public transportation.

Also, under the Supreme Court’s interpretation of the 10th Amendment, the CDC cannot compel state or county health departments to collect and share public interest data if they do not want to.

That has hampered the CDC’s pandemic response. At various points, a multitude of states, including Florida and Texas, simply didn’t provide data on COVID-19 cases, immunizations, and deaths, leaving the federal agency to guess the missing numbers or do their calculations without them.

If the CDC is to avoid such blind spots in a future emergency, it must create surveillance systems by tying together health systems and willing states and counties, as is the case with flu surveillance. And action must be taken quickly.

Lorien Abroms, who teaches public health communications strategy at George Washington University, is optimistic the CDC can overcome its record of pandemic failures.

“Certainly they can reform,” she said. “They came from a place of greatness. We used to be world leaders in epidemiological intelligence. I definitely think we can come back to that.”

https://www.latimes.com/science/story/2022-08-20/as-global-health-threats-evolved-the-cdc-didnt As global health threats evolved, the CDC didn’t

Russell Falcon

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