English: The CDC didn't evolve to meet the global threats

 English:  The CDC didn't evolve to meet the global threats

Vanquishing disease is in the DNA of the Centers for Disease Control and Prevention, the federal agency that in its first decade of existence oversaw the eradication of smallpox, of malaria and polio as threats to Americans’ health. But as the director of the 75-year-old agency acknowledged this week, the CDC hasn’t evolved to keep up with the faster speed and higher stakes of germs in the modern world.

With the emergence of a virus that has killed over than 1 million people  - “our performance did not reliably meet expectations,” Dr. Rochelle Walensky told CDC employees in a bracing call for change.

“A culture that was simply arrogant and overestimated their ability to get it right,” said Kathleen Hall Jamieson, director of the University of Pennsylvania’s Annenberg Public Policy Center and an expert on science communication.

“To be frank, we are responsible for some pretty dramatic public mistakes,”  And, we still suffer the consequences of these mistakes - from testing to data to communications. An honest and unbiased read of our recent history will yield the same conclusion, it is time for CDC to change.”  Walensky’s admissions followed a comprehensive review based on interviews with roughly 120 public health experts. 

In meetings with senior advisors and public health leaders she got an earful about a culture of scientific self-absorption that hobbled the agency’s central mission of public messaging. The CDC’s epidemiologists, she was told, have acted with all the scientific conservatism and urgency of an academic medical journal. “By the time they finished, the data might have been bulletproof,” said one senior CDC official who was not authorized to speak to the press. “But its actual relevance and usefulness of that information had passed.”

The CDC Primary Mission, has failed. The CDC’s risk communication mission is supposed to embody three basic commands:  Be the first,  to be right. and have credibility.  “Yet we saw during COVID that CDC was not first, and often lagged by a significant period of time behind other sources of information  and of misinformation,” Besser said. Walensky’s first priority is to improve the CDC’s ability to convey scientific knowledge about a health threat early, often and authoritatively, especially to Americans who need it to protect themselves and their communities. 

Proposed initiatives aim to strengthen the agency’s workforce and its partnerships with healthcare organizations and state and county public health agencies and would streamline data collection and the sharing of CDC science. They would make the agency’s public health messaging faster and easier to understand when time is of the essence. And to avoid the kinds of governmental cross-talk that often made CDC look clueless, a “no-surprises posture” would become a key operating principle of the agency’s communications.”

For decades before COVID-19 appeared, steady funding declines hollowed out the corps of public health workers at the county, state, tribal and federal levels. Dwindling budgets dried up the kind of lab capacity needed in a sudden outbreak and stunted the introduction of new ways to monitor the public’s health.

While the pandemic has underscored that those methods are here to stay, the CDC still needs money to build up its lab capacity and a workforce capable of practicing 21st-century epidemiology. After the billions spent on the pandemic, that could be a hard sell to a wary Congress, Gostin said. The CDC also needs to find more effective ways to command data on new health threats, State and local governments are responsible for carrying out and enforcing measures to protect the public’s health. A federal judge’s order this spring demonstrated that the CDC doesn’t even have the unquestioned power to require that masks be worn on planes, trains and other forms of public transportation.

Nor, under the Supreme Court’s reading of the 10th Amendment, can the CDC compel state or county health departments to collect and share data of public health interest if they don’t wish to.

That has handicapped the CDC’s pandemic response. At various points, a wide range of states, including Florida and Texas, simply did not provide data on COVID-19 cases, vaccinations and deaths, leaving the federal agency to guess at the missing numbers or make their calculations without them.

If the CDC is to avoid such blind spots in a future emergency, it will have to create surveillance systems by lashing together healthcare systems and willing states and counties, as it’s done to keep tabs on influenza. And it will need to act fast.

as always, stay safe!

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