A New Director for the CDC: Will the agency regain its reputation?

The U.S. Centers for Disease Control and Prevention (CDC) will has a new director, Dr. Mandy Cohen. There are high hopes that this change in leadership will begin the process of restoring the CDC to its once vaunted position as the world’s top public health agency.

Although lack of funding and political interference has for many years challenged CDC to carry out its mission to protect the public’s health, the Covid-19 pandemic highlighted deficiencies in the CDC, leading to widespread criticism of both health experts and politicians. At the end of last month Dr. Rochelle Walensky left her position as CDC director and Cohen will soon take her place. Walensky’s resignation sparked discussion about what has gone wrong with CDC and how to fix it.

Multiple Problems at CDC

To be sure, CDC remains the bulwark of the U.S. public health efforts and has retained its outstanding ability to detect pathogens that threaten health, to characterize them, and to set the course to limit their threat. No one knowledgeable about the CDC doubts that it is still the agency most capable of rapidly identifying new infectious organisms. Nevertheless, in multiple areas the CDC proved during the pandemic to be fraught with systemic problems. Dr. Tom Inglesby, director of the Johns Hopkins Center for Health Security, and Dr. J. Stephen Morrison, senior vice president at the Center for Strategic and International Studies, recently conducted an extensive investigation of the CDC’s performance during the pandemic and wrote in the  New York Times that the agency had lost prestige and trust due to “errant leadership decisions, operational mistakes, chronic structural weakness and attacks from a hostile White House during the first year of the pandemic.”

The problems at CDC are many. For example, even though we rely on CDC to use the most cutting-edge scientific tools, its data collection and analysis technologies are outdated and need serious upgrading. Too often during the pandemic the CDC appeared challenged to report accurate, updated mortality and morbidity statistics about Covid.

The CDC is also mired in bureaucratic entanglements that threaten its ability to respond rapidly to new public health challenges. A tangled reporting structure—about 160 budget lines–made the agency unwieldy and unable to quickly put in motion a coherent plan to deal with the pandemic as it unfolded.

But it is in communication to the scientific community and especially to the public that CDC fell most short during the Covid-19 pandemic. In our view, the agency often seemed unable to get a clear message across in time to influence people’s understanding of the pandemic. Communication from the CDC often seemed scattershot, overly technical, and sometimes conflicting. Exactly who should get Covid-19 vaccine boosters and when was never clearly communicated in ways people could easily grasp. The changing recommendations about the value of face masks to decrease viral transmission and acquisition risks seemed to befuddle CDC’s communication abilities. In the face of its confusing messages, the agency was helpless to deal with misinformation and disinformation that quickly spread. Scientists and health professionals know that Covid-19 vaccines are both safe and effective and that face masks do in fact help reduce (but not completely prevent) viral spread, yet anti-science voices easily overwhelmed those facts and CDC played little role in preventing their dangerous messages or fighting back against them. Walensky is said to have  “struggled with the communications side of the job” and publicly acknowledged her “limitations as a communicator.”

Walensky Blamed for CDC Shortcomings

Depending on the specific CDC critic, Walensky either tried to right the agency ship or was responsible for worsening its deficiencies. In her brief two-year tenure, the former head of infectious diseases at Harvard Medical School’s Massachusetts General Hospital did initiate  numerous attempts at reform. Yet, little that she did satisfied the most negative naysayers, harshest among them perhaps was Dr. Vinay Prasad, a frequent critic of U.S. policy during the pandemic. In a blistering critique of Walensky’s tenure at CDC, Prasad outlined four areas of deficiency and concluded that she had failed in all of them. He wrote that “History will remember her as the worst CDC director of all times.”

 While we find Prasad’s pronouncement excessively harsh and have disagreed with his stand on some of CDC’s policies and recommendations, we understand his frustration with CDC’s pandemic performance. We do believe Walensky made a reasonable, good faith attempt to get CDC back on course but seemed overwhelmed by the task. Now, there is  widespread praise for President Joe Biden’s choice to name Mandy Cohen as Walensky’s successor. Cohen is a Yale-trained physician with a public health degree from Harvard who formerly directed North Carolina’s public health agency. She had been an advisor on public health issues during the Obama administration and thus has national and state public health policy experience, something Walensky lacked. She will face significant challenges, especially in view of the  severe criticism CDC has been getting from Republican members of Congress. Furthermore, the recent compromise on the federal debt ceiling could mean restrictions in new funding for CDC at a time when if anything the agency clearly needs more money.

Some Things Needed to Repair CDC

It remains to be seen if Cohen can indeed continue the process of fixing the CDC. Several things are needed, including:

1. Increase CDC funding. For years, the agency has been underfunded, but it is clear that reforming CDC will require a greater outlay of public funds. We spend billions of dollars protecting us from the threat of military action by other countries, but must remember that the deadliest thing to affect the U.S. in this century has been a viral infection. It makes sense that we should spend more to protect us from ongoing and emerging public health threats and that means improving funding for the CDC. 
2. Get Congress to pass legislation to mandate that states comply with CDC data reporting requirements. Right now, it is optional whether states report data on things like mortality and morbidity statistics for infectious diseases like Covid-19 to the CDC database, making it very difficult for the agency to collect accurate, nation-wide data. A mandate for states to comply with reporting requirements will require Congressional action.
3. Upgrade CDC technology. It was somewhat shocking to learn that CDC data collection and analysis technology is outdated. That obviously needs to be urgently remedied, possibly again requiring Congressional action to approve necessary funds.
4. Revise the CDC bureaucracy. Walensky already put in motion a plan to streamline the CDC’s reporting and budget structure so that the agency can be nimbler in the face of anticipated and realized health crises. Cohen needs to pursue that plan.
5. Overhaul CDC communications. Of particular importance to us at Critica are the shortcomings that became especially apparent during the pandemic in the ways that CDC communicates vital health information to scientists, health professionals, and the public. As we often argue, public health communication in the age of the internet is no longer a top-down affair in which experts tell the public what to do and people follow this guidance with little reservation. Today, public health messages are subject to endless back and forth across social media and public health agencies must adapt to the new reality of how people get health information. We advocate that CDC develop a new office of communication with input from scientists in the health communication field to craft entirely new approaches to public health messaging. These approaches must include anticipating what the public will be hearing about various public health topics and getting ahead of issues before misinformers can weigh in. It also involves honing messaging strategies to use the best available, evidence-based methods of communicating information to the public. And it means being transparent about areas of uncertainty and the ongoing need for more research to clarify what is presently unclear.

Like many others, we wish Mandy Cohen all the best and hope that she will be successful. The world desperately needs a cutting-edge, nimble, and responsive CDC. The agency has fallen from its most illustrious perch, but we believe it can regain its reputation and the public’s trust if sufficient reform is pursued.