Opinion: The CDC needs to reorient itself to better respond to future crises

As the Centers for Disease Control and Prevention (CDC) continues to release the results of its long-awaited internal review, its glaring COVID-19 missteps merit closer scrutiny and reform. Founded in 1946 as the successor to the United States’ effort to fight malaria, the CDC’s journey has been marked by well-recognized successes like helping eradicate polio and smallpox and fighting the Ebola outbreak abroad. The CDC has long been trusted worldwide for its up-to-date, evidence-based epidemiology and public health guidelines. But Americans’ trust in public health experts is rapidly eroding. A poll by Pew Research Center notes that (as of May 2022), only 52% of Americans rated public health officials as doing an excellent job responding to COVID-19, down from 79% at the outset of the pandemic.

Why such a sharp drop? Public health officials’ apparent dogmatism from the early stages of the pandemic could be a major contributor to this rapid breakdown in trust. Let’s take masks, for example. From the very beginning of the pandemic, guidance has ranged from unclear to simply contradictory.

In March 2020, the CDC advised against the general public buying and using masks, requesting them to be saved for healthcare workers. In early April, the CDC flip-flopped, recommending masks for everyone over age 2, citing a growing corpus of evidence pointing to effectiveness in reducing disease transmission. After a few months of public health experts advocating for increased mask-wearing, the CDC issued an order requiring passengers on airplanes and public transportation to wear masks. Two months later, the CDC updated its guidelines to remove the mask requirement in small indoor gatherings. And all of this was before the Delta variant emerged as a major public health threat. Flip flops continued — and are still continuing — with politicians, practitioners, the general public alike raising concerns about the CDC and communicating the desire for clear and transparent information. 

A Gallup poll from September 2021 revealed that a mere 32% of Americans agreed that the CDC had communicated a clear action plan to combat COVID-19. Amidst widespread outcry about the CDC’s role in the COVID-19 response, Director Rochelle Walensky ordered an internal review of the agency. In an August statement, she conceded that the CDC’s response did not reflect 75 years of preparation for a large-scale pandemic like Covid, acknowledging that “in [the CDC’s] big moment, [the CDC’s] performance did not reliably meet expectations.”  

Just days before Walensky’s public mea culpa, the CDC, in its weekly Morbidity and Mortality Weekly Report (MMWR), significantly scaled down its suggested prophylactic measures, downscaling quarantine duration and recommending masks only around people with active cases. But what fundamentally changed from late July that merited such a drastic move from the CDC? Conflicting messaging makes getting clear answers more challenging.  

That’s not the only problem. In his seminal work on public health law, Lawrence Gostin observes that “if public health strays too far into political advocacy, it may lose the appearance of objectivity.” But the lines between public health and politics continue to blur. On one side of the aisle, we see the highly politicized appointment of Dr. Joseph Ladapo as Florida’s surgeon general amid outcry from state Democrats who saw him as a ‘yes’ man for Gov. DeSantis. President Biden’s recent declaration on “60 Minutes” that the pandemic “was over” (which members of his own Administration soon contradicted) doesn’t seem too different, with the statement being made less than two months before the midterms.

Late this September,  Director Walensky sidestepped questions on whether the pandemic was truly over and declined to address President Biden’s surprise declaration on 60 Minutes. Meanwhile, the Department of Health and Human Services (HHS) is on track to extend the public health emergency instituted by former HSS Secretary Azar in early 2020. The World Health Organization (WHO) recently commented that “we’re not there yet” when asked about the end of the pandemic — again, seemingly at loggerheads with President Biden’s claim.

Attempts to promote health and potentially reduce the spread of COVID-19 by spreading misleading information — about the purported efficiency of cloth masks early on in the pandemic, for example — might be well-intentioned. However, these claims, fundamentally, are still falsehoods that peck at the institution’s credibility. Instead, the CDC should focus on what it was initially supposed to do — identifying barriers to health equity, researching new pathogenic strains, and developing tools for local governments and organizations to better respond to outbreaks. The CDC’s mission is more important today than ever. If the CDC reorients itself and learns from its COVID-19 missteps, it will be prepared to deal with future pandemic-scale crises. 


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