- The CDC director announced the agency will undergo a major overhaul.
- The reason for the overhaul was the agency’s delayed response to COVID-19.
- The CDC will also work on improving its communication with the public and restoring public trust in the agency.
Dr. Rochelle P. Walensky, the director of the Centers for Disease Control and Prevention, announced August 17 that the nation’s lead public health agency will undergo a major overhaul, saying it responded too slowly to the COVID-19 pandemic.
In a meeting with senior CDC leadership, Walensky laid out her plans, reported CNN. This includes reorganizing the structure of the agency to focus on public health needs and responding to outbreaks such as those caused by the coronavirus and monkeypox virus.
In line with this, there will be less emphasis on publishing scientific papers, with Walensky calling for staff members to produce “data for action” as opposed to “data for publication,” according to a briefing document, as reported by the New York Times.
The CDC will also work on improving its communication with the public and restoring public trust in the agency.
At times during the pandemic, its public messages — such as those on face masks, social distancing, and boosters — were “confusing and overwhelming,” according to the briefing document.
“My goal is a new, public health action-oriented culture at CDC that emphasizes accountability, collaboration, communication and timeliness. I look forward to working with the incredible people at CDC and our partners to realize the agency’s fullest potential to benefit the health and well-being of all Americans,” Walensky said in a statement.
Some changes are already underway
The plan to overhaul the CDC follows a one-month review of the agency’s response to the COVID-19 pandemic by Jim Macrae, an administrator at the Department of Health and Human Services. The report from this review has not yet been released.
Walensky also sought feedback from her own staff on the agency’s operations and performance.
The CDC’s missteps with the pandemic began early in 2020, with the agency releasing a faulty COVID-19 test to public health laboratories, which left public health officials unaware of the true spread of the coronavirus in the country.
Some say the agency also struggled to issue clear public health guidance about COVID-19 mitigation measures or to respond quickly enough to a rapidly changing and spreading coronavirus.
Susan Hassig, DrPH, MPH, a professor within the epidemiology department at Tulane University’s School of Public Health in New Orleans, said one of her issues with the CDC during the pandemic was when the agency said people who had received a COVID-19 vaccine no longer needed to wear face masks in indoor public spaces.
“That was a very poorly made decision, in terms of actual prevention [of coronavirus spread],” she said, “because the mRNA vaccines were never officially tested in the [clinical] trials for their ability to prevent infection. Masks, though, work to prevent infection.”
Walensky acknowledged the agency’s pandemic shortcomings in her statement.
“For 75 years, CDC and public health have been preparing for COVID-19, and in our big moment, our performance did not reliably meet expectations,” she said.
Walensky has tasked HHS Deputy Secretary Mary Wakefield with overseeing the agency’s reorganization, which will include:
- The Office of Sciences and the Division of Laboratory Science will report directly to the CDC director.
- A new office of intergovernmental affairs will interact with state health departments and other federal agencies.
- An agency executive council will set priorities for the CDC, weigh in on budget decisions, and track progress on agency priorities.
- A new equity office will help increase the diversity of the CDC’s workforce and ensure that the agency’s activities take into account the role of diversity in public health.
- A new mechanism will be developed for sharing CDC data earlier, before publication in a peer-reviewed journal.
- The agency will redesign its website to simplify and streamline guidance for the public and health care providers.
Many of these can be accomplished through the CDC’s existing authority, but Walensky also plans to ask Congress to mandate that state and local jurisdictions share their public health data with the agency. Currently, this is done on a voluntary basis.
Walensky will also ask Congress for greater flexibility in how the agency can use its funding, to allow it to adapt more quickly to a public health crisis when it emerges.
The CDC has already started to implement some of its proposed changes, including hiring Kevin Griffis, a former public affairs expert at the Department of Health and Human Services and Planned Parenthood, to head the agency’s communications efforts.
Improved communication needed
Many public health experts point out that the CDC has been underfunded for years, so if the reorganization is going to be successful, the agency will need the resources to make it happen.
“The pandemic has definitely made it crystal clear that we are in need of an overhaul [of the CDC]. So hopefully Congress will provide the funds to make that possible,” said Lorien Abroms, ScD, MA, a professor at the Milken Institute School of Public Health at The George Washington University in Washington, D.C.
Abroms, a health communications expert, said the CDC also needs to change how it communicates with the public, to better fit the way people currently consume information — 24/7 and much of it through social media.
“In some respects, it feels like [the agency is] still using communication strategies that were developed 40 years ago,” she said.
In addition to communicating in a clear and consistent way, Abroms said the agency will need to streamline its review process so it can publish findings more quickly.
Otherwise, this “creates a vacuum” that could be filled by other groups, some of whom may not be sharing accurate information.
“A key challenge is to figure out how to communicate in an environment where there is competing information — and often that information is misinformation,” she said.
Also, “the source of the message, meaning the government agency, may not be trusted,” she said. “So there are more challenges [today] than there have ever been.”
Dr. Bruce Y. Lee, a professor at the CUNY Graduate School of Public Health & Health Policy, said the agency’s problems are not limited to the pandemic.
“We’ve seen over the past several years a lot of issues with both the response to COVID-19, as well as to the monkeypox outbreak,” he said. “So there is a need to really reconsider how the CDC is organized.”
Lee said the agency drew criticism during the pandemic for a lack of communication about the scientific justification for some of its decisions, including the relaxation of COVID-19 precautions such as face masks and social distancing.
“There have been a number of people in the public health community who have wondered why certain precautions were relaxed at certain times,” he said.
Challenges lie outside the CDC’s reach
While much of the focus in recent months has been on how the CDC has handled the COVID-19 pandemic and the monkeypox outbreak, Hassig said there’s much more to the agency.
“They have a huge scope of work. It’s not just infectious diseases — it’s osteoporosis, cardiovascular diseases, maternal health, injuries, etcetera,” she said. “It’s everything that affects the health of the American public.”
Over time, the CDC’s ability to address all of these areas has been hindered by shrinking budgets, she added.
Beyond funding, Hassig said there are some aspects of the agency’s mission that it has full control over. However, there are also things that are not entirely of the agency’s own making.
This includes the decentralized U.S. healthcare system, which makes it challenging for certain groups to access medical care and testing — this can make it difficult to monitor the spread of pathogens such as the coronavirus and the monkeypox virus.
“With monkeypox, most of the cases are found in men who have sex with men,” said Hassig.
But “I can guarantee you there are a lot more people in different subgroups of that community — and perhaps in other communities — that just aren’t being tested, because they don’t have access to the testing process,” she said.
Another challenge for the CDC, said Hassig, is that much of the work of public health is done at the state level, where public health agencies are also underfunded — and sometimes politically influenced.
But even there, the CDC has options.
“Those local agencies are really the foot soldiers for implementing public health activities in the United States,” she said. “One way for the CDC to get state and local agencies to cooperate is to use the ‘carrot’ of funding.”