The Centers for Disease Control and Prevention, an agency that has had its reputation battered by a series of missteps in the Covid-19 pandemic, and a slow response to the monkeypox outbreak, will undergo an “ambitious” overhaul, Director Rochelle Walensky announced Wednesday.
In an email to staff, Walensky said the renewal effort will focus on making the agency more nimble and responsive to needs that arise in health emergencies. The priority will be to gather data that can be used to rapidly dispense public health guidance, rather than craft scientific papers.
Walensky also said the agency needs to acknowledge the flaws of its response to Covid-19. Those mistakes date to the earliest days of the pandemic, when a test designed by CDC scientists to detect the new disease failed to work on the ground — leaving the country blind to how quickly the SARS-CoV-2 virus was transmitting at a critical juncture when aggressive measures could have slowed Covid’s spread.
That error happened on Walensky’s predecessor’s watch. But the agency has continued to struggle since her arrival at the beginning of the Biden administration, notably with confusing messaging about how long people who have been infected need to isolate to try to prevent onward transmission.
“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 the email, sent to the agency’s 11,000-person staff. “My goal is a new, public health action-oriented culture at CDC that emphasizes accountability, collaboration, communication, and timeliness.”
Outside experts expressed enthusiasm — though some of it tempered — for the changes Walensky is proposing.
Jay Varma, who spent 20 years at CDC before becoming director of the Cornell Center for Pandemic Prevention and Response at Weill Cornell Medicine, applauded many of the points Walensky stressed, particularly her promise to reform the culture of the agency and build up the capacity of its staff to respond to emergencies. Over the past two decades or so, Varma told STAT, public health agencies like the CDC have become increasingly bureaucratic.
“If your culture is not aligned entirely with what your mission is, it doesn’t matter how good the strategy is. It doesn’t matter what your org charts are. It is all about the workforce culture,” he said.
But Varma warned effecting change in the agency’s culture will be challenging.
“It’s an agency run by geeks. It’s run by doctors and Ph.D.s,” Varma said. “What are doctors and scientists notoriously bad at? Managing. They’re really good at hypothesis-driven research and analyzing information and making predictions about what might happen. What they’re really bad at is managing people in an effective way.”
Though Walensky’s statement focused on her intention to reform the culture of the CDC, she said there would be structural changes as well. To that end, she announced she has appointed Mary Wakefield, who served as an acting deputy secretary of Health and Human Services near the end of the second term of the Obama administration, to lead a team to help implement the reform. Wakefield’s first day at the agency was Monday.
The changes Walensky plans to make will help the agency focus on what she sees as its top priorities: preparedness and response, equity, global health, laboratory science and data modernization.
The announcement comes on the heels of a review of the agency’s response to Covid that Walensky commissioned in the spring. Jim Macrae, associate administrator for primary health care at the Health Resources and Services Administration — part of HHS — was tasked in early April with doing a swift assessment of the CDC’s performance during the pandemic. To date, Walensky has only received an oral briefing on Macrae’s findings, which have not been publicly disclosed.
Macrae and Wakefield previously worked together at HRSA, where she served as administrator from 2009 to 2015.
Macrae’s evaluation was reportedly based on interviews with 120 CDC staff members and key external figures and is said to reflect a consensus on how the CDC should communicate with the public going forward.
It is said to have focused on the need to share scientific data faster and to translate the science the agency generates into practical policies that are easy to comprehend. It also reportedly calls on CDC to strengthen its capacity to respond to public health emergencies — a key responsibility of the agency.
In response to Macrae’s findings, Walensky is creating a new executive council that will report to her, along with a new equity office.
Varma was also enthusiastic about Walensky’s goal to have the agency share scientific findings more quickly, suggesting the vetting process for publishing CDC science — typically through its online journal Morbidity and Mortality Weekly Review, or MMWR — has long been mired in excessive layers of review that keep the agency from sharing information public health agencies elsewhere need to know.
He pointed to an MMWR report issued Tuesday on a case of polio detected in June in New York state. “Why did it take so long to get that out there? If this is a real public health emergency, shouldn’t at least some of that information have been out earlier?”
The article, he suggested, would have gone through an extensive review process at various levels of the CDC, including by officials concerned that anything published by CDC authors might be interpreted as official government policy. “So that is the type of thing, a cultural thing, that needs to change. Where you say: ‘Getting information out, even if it’s preliminary and imperfect, is a priority,’” Varma said.
Some of the improvements Walensky signaled she would like to make will require new authorities from Congress — a fact she acknowledged in her statement. The agency’s capacity to rapidly craft data-based guidance in disease outbreaks, for example, is wholly reliant on jurisdictions around the country agreeing to share data with the CDC. She suggested she will ask Congress to mandate data sharing with the agency.
Michael Osterholm, director of the Center for Infectious Disease Research and Policy at the University of Minnesota, called Walensky’s reform objectives “an important first step.”
“You can’t begin to fix something until you begin to understand what the problems are,” he said.
But he noted that some of the data flow problems the CDC complains about are the result of their own limitations, saying the lack of interoperability between information systems is behind some of the issues. Osterholm pointed to the current monkeypox outbreak as an example.
“Right now the states have been prepared to provide the CDC with information on monkeypox cases through the notifiable disease system, but CDC can’t accept it,” he said. “They don’t have the software ability to do that yet.”
That points to another challenge Walensky will face in trying to bring about the changes that need to be made at the CDC. A number of the reforms she has identified will take money. Whether Congress will be open to increasing the budget of an agency seen to have fumbled the Covid and monkeypox responses remains to be seen.