The Centers for Disease Control and Prevention is launching an overhaul of its structure and operations in an attempt to modernize the agency and rehabilitate its reputation following intense criticism of its handling of the coronavirus pandemic and, more recently, the growing monkeypox outbreak.
On Wednesday, CDC Director Rochelle Walensky shared a series of changes with CDC leadership and staff designed to “transform” the organization and its work culture by improving how the agency shares information, develops public health guidance and communicates with the American public.
“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,” Walensky said in a statement. “As a long-time admirer of this agency and a champion for public health, I want us all to do better.”
The CDC restructuring follows two reviews conducted in recent months, one by Health Resources and Services Administration official Jim Macrae into the CDC’s pandemic response and another by CDC Chief of Staff Sherri Berger into agency operations.
The reviews concluded that the “traditional scientific and communication processes were not adequate to effectively respond to a crisis the size and scope of the COVID-19 pandemic,” according to an agency statement.
Specifically, Macrae’s review, which included 120 interviews with CDC staffers and people outside the agency, recommended a series of improvements, including releasing scientific findings and data more quickly to improve transparency, translating science into practical and easy-to-understand policy, improving communication with the public, working better with other agencies and public health partners, and training and incentivizing the agency’s workforce to respond better to public health emergencies.
There is consensus within the CDC that it “needs to make some changes for how it communicates and how it operates — to be faster, to be nimbler, to use more plain spoken language,” said a CDC official, who was granted anonymity to discuss the changes before they were announced.
“People work incredibly, incredibly hard and care deeply about trying to make sure that the American people have the right information,” the official said. “Maybe the way that a lot of the [Covid-19] response was structured, and some of the incentives that people have here, are just not aligned properly to really put the focus toward getting information to people quickly and how that information can benefit Americans’ health.”
An embattled agency
The CDC has come under intense pressure from Americans of all political stripes since the earliest days of the pandemic.
It has fended off a battery of allegations over the course of the crisis, from putting politics over its vow to “follow the science” to bungling messaging to putting Americans’ lives at risk as pandemic restrictions have eased.
As public health officials came under attack across the country, so has the agency’s authority to implement Covid-19 mitigation measures, with critics on one side accusing the agency of federal overreach and critics on the other accusing the agency of not doing enough.
The CDC’s authority has been challenged in multiple court cases. Last year, the Supreme Court struck down its moratorium on evictions during the pandemic. The government has appealed a Florida federal district court judge’s April decision to strike the CDC’s directive that people wear masks on airplanes, trains and other public conveyances.
This year, the agency has struggled to strike a balance between the competing interests of a virus that continues to find ways to evade vaccines and natural immunity, and a public that is weary of taking the sort of precautions that federal and state governments have mandated.
As the Omicron variant swept the nation, the agency came under fire for shortening its recommended quarantine guidelines. This spring, its shift to assessing community-level risk by weighing hospitalizations and the burden on the health care system over the level of transmission was both confusing and put Americans at unnecessary risk, many public health experts say.
Last week, the CDC’s decision to lift quarantine recommendations for unvaccinated individuals exposed to the virus, including in schools, also drew criticism from doctors and public health experts who say the agency is embracing individual responsibility over public health when it is responsible for the latter.
Several school districts, including those in New York City and Philadelphia, are taking more precautions than the CDC now recommends as students return.
Walensky has repeatedly pointed out that the agency was underfunded before the pandemic started, noting that the public health workforce was seriously depleted and the agency has been hamstrung by structural issues, including limited access to data from states.
In an interview with POLITICO earlier this year, she said the CDC alone would not be able to bring Covid-19 under control, and called for broader investment in public health at the state and local levels.
“I actually really think many people have thought this is CDC’s responsibility, to fix public health [and] the pandemic,” Walensky said. “The CDC alone can’t fix this. Businesses have to help, the government has to help, school systems have to help. This is too big for the CDC alone.”
Nevertheless, Americans’ approval of the agency’s job steering the nation through a pandemic that has killed more than a million Americans has plummeted.
In March 2020, 79 percent of Americans said public health officials, including those at the CDC, were doing a good job responding to the pandemic, according to a survey by Pew Research Center. By May 2022, only 52 percent of Americans thought so, Pew found.
The agency’s more recent handling of the monkeypox outbreak, which many epidemiologists worry is now past the point of containment in the country, has again sparked widespread criticism that the CDC is unable to rise to the demands of a complicated public health crisis as it unfolds in real time.
A new roadmap
Among the structural changes to come out of the reviews are the appointment of former HHS Deputy Secretary Mary Wakefield to lead a team overseeing the overhaul, as well as the creation of a new executive council, built by Wakefield and reporting to Walensky, that will “determine agency priorities, track progress and align budget decisions, with a bias toward public health impact.”
The agency did not offer a specific timeline for when the council would be established, but noted broadly in a statement that “the work ahead will take time and engagement at all levels of the organization.”
The overhaul of the CDC’s approach to communicating with the public has already begun, and will include revamping and streamlining the agency’s web site and creating simplified public health guidance. The agency will also create a new equity office, working across all functions of the organization from hiring to policy to improve the agency’s diversity.
The overhaul seeks to change “the CDC’s culture” by moving away from a “misaligned” approach of incentivizing staff to publish their research in scientific publications and instead encouraging personnel to produce research and data aimed at public health policy and action, the CDC official said.
The agency is also considering measures that will speed up the publication of data and scientific findings, training more staff to be ready to respond in a public health emergency and setting up emergency staffing to ensure there are no personnel gaps during a crisis.
Walensky will also seek more authority for the CDC, through Congress and the Biden administration, to mandate data collection from states, to move money to external partners faster during an emergency and to offer more competitive salaries for recruiting, among other things.
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