Weekend Reads | Rebuilding the CDC

by Kevin Schofield

This weekend's read is a new report titled "Building the CDC the Country Needs." It's been a rough three years for the Centers for Disease Control and Prevention, better known as the CDC, and its reputation has suffered greatly as a result of the enormous demands and intense scrutiny it has worked under since the beginning of the pandemic.

In a country that seems deeply committed to a disjointed, largely privatized health care system, the CDC is the beating heart of the United States' scant investment in public health. That said, for decades, the CDC has been the envy of nations around the world for its stellar reputation and world-class work in understanding infectious diseases and other public health risks. That isn't to say the CDC has managed to stay above the political fray: Over the years, it has been pulled into the country's culture wars as politicians have waded into issues around sex and sexually transmitted diseases, drugs, HIV, gun control, and, most recently, the COVID-19 pandemic. Unfortunately, as political divisiveness has intensified and distrust in institutions has spread, the CDC has found itself unprepared to lead the nation through the most deadly global pandemic in a century. While its recommendations were sound based upon the science and information known at the time, the agency lacked the infrastructure, the partnerships, and the communications skills to explain to the American public why it was important to wear masks, close schools, stay home, and, ultimately, get vaccinated — not to mention why its recommendations would change over time as more became known about the virus causing COVID. This damaged the CDC's public perception, as did its missing, incomplete, and sometimes conflicting guidance for members of the disabled community and for those at high risk. But it also left openings for political actors and other opportunists to further undermine the CDC's credibility and turn a portion of the public against them, collectively setting back efforts to save lives by getting the virus under control.

Last fall, the Center for Strategic and International Studies (CSIS) created a working group to review the current state of the CDC, identify issues, and recommend changes that would help it regain its position as the leading public health authority in the country (if not the world) and position it to be ready to deliver better results during future public health crises. CSIS likens this exercise to the reinvention of NASA after the Challenger disaster and, similarly, the overhaul of FEMA after Hurricane Katrina. CSIS did not attempt a thorough and exhaustive review but instead a "rapid, targeted" one focused on pandemic response and identifying the "important near-term steps that will lead to a significant reset within CDC."

The report walks through the CDC's successes and failures over the past three years and identifies several key challenges, including:

• The CDC's specific responsibilities and the authority it wields (such as the ability to order the closure of schools) during an infectious disease outbreak are unclear.
• Its global mission is underpowered; while global work represents 25% of the CDC's budget and has led to the eradication of smallpox and other public health triumphs, that part of its mission is "poorly understood and undervalued by policymakers."
• The CDC has "lost a substantial share of its independent, trusted scientific authority in speaking to the nation."
• The CDC is based in Atlanta, and is under-represented in Washington, D.C. That leaves it at a disadvantage in situations where its work becomes embroiled in political fights.
• It has underinvested in building a network of partners in other federal agencies, state agencies, nongovernmental organizations (NGOs), and private industry that could serve both as champions for the CDC when its work comes under scrutiny and as critical public health infrastructure to respond rapidly and effectively in moments of crisis.
• The CDC has trouble attracting and retaining top talent, in part because of competition from private industry, but also in part because it has fallen behind in important new areas, such as genomics and data science.
• The CDC is neither quick nor nimble, in part because it doesn't have the authority and capability it needs to execute well on key tasks, such as data collection, flexible contracting, and reallocating budget dollars when new needs arise. It is also underfunded.

The report points out that CDC Director Rochelle Walensky has been open about mistakes made during the pandemic and has begun to lead an effort to address some of the issues the work group identified. Nevertheless, it lists some recommendations of its own for the CDC. First, CSIS believes the CDC's "core mission" needs to be clarified and reaffirmed, including strengthening and fully integrating the global part of its mission. Second, it recommends that the CDC enlarge its presence in the nation's capital, both to launch a new dialogue with Congress and the White House on the CDC's future and to "upgrade" the agency's engagement in the federal, interagency policymaking process. Third, the CDC should reform its process for issuing guidance quickly to protect the public from disease risks. Fourth, it recommends that the CDC should "strengthen partnerships that create greater coherence and predictability, quickly move CDC far closer to the front lines, and improve the agency's service to all Americans." It also urges the CDC to change its career incentives program, improve its data-collection processes, and ensure it has budget flexibility to allow it to respond nimbly.

The report concludes by pointing out that an existential threat to the CDC, such as the one it faces right now, "puts the health and safety of the nation at risk. America needs a strong national public health agency to promote biodefense and protect the population from health threats."

While CSIS calls this a "historic challenge that appeals to America's better angels," it is difficult to remain hopeful that our elected officials will rise to the moment given the heightened divisiveness in "the other Washington" and the raging culture wars pulling us apart as a nation. Practically speaking, it's hard to imagine our political leaders willing to re-elevate the CDC as an independent, trusted authority when many of the issues it addresses today are the same ones leaders campaign on — and are attempting to legislate. Nevertheless, the report makes a strong case that following its recommendations will start to put the agency back on the path to becoming "the CDC That America Needs."

Building the CDC the Country Needs

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