The Centers for Disease Control and Prevention has not exactly distinguished itself with its pandemic-era guidance and public utterances. Not surprisingly, its credibility has taken a hit in the wake of the communication and advisory blunders.
As it’s often said: the first step in fixing a problem is acknowledging that you have one. To that end, CDC Director Dr. Rochelle Walensky announced plans this week for a top-to-bottom review of how the agency goes about its business.
In an email sent to CDC staff, Walensky shared plans for an evaluation that would examine the agency’s “structure, systems and processes.” The effort will last a month, the email noted, and will commence April 11.
Jim Macrae, associate administrator for primary healthcare at the Health Resources and Services Administration, which is part of the Department of Health and Human Services, will lead the review. Three CDC officials will aid in the process, including acting principal deputy director Deb Houry, COO Robin Bailey and chief of staff Sherri Berger.
“Over the past year, I have heard from many of you that you would like to see CDC build on its rich history and modernize for the world around us,” Walensky wrote in the email, according to the Washington Post. “I am grateful for your efforts to lean into the hard work of transforming CDC for the better.”
There’s little question that public trust in the agency has eroded since the start of the pandemic. Last summer, it faced a flurry of criticism over its communications about breakthrough infections and masking guidance. Dr. Leana Wen, visiting professor of health policy and management at George Washington University, noted then that the CDC “keeps getting… the policy interpretation and communication totally wrong.”
A January NBC News survey found that 44% of Americans said they trusted the CDC on COVID-19, while 43% said they didn’t. A Pew Research survey from February echoed those results, revealing that 60% of Americans said they were feeling confused due to changing public health recommendations around COVID-19.
Getting to the bottom of exactly why the public doesn’t trust the CDC, however, is a trickier task, according to Terry Haines, founder of healthcare consultancy Pangaea Policy. He noted that the CDC has “twin problems” with which to contend.
“One is the lack of trust based on the CDC’s communication and the other one hits at the agency’s credibility. There’s a concern that what the agency has been up to during the pandemic has been politicized to some extent, and that they’ve been bending to political pressures,” Haines explained. “Both things need to be addressed fundamentally.”
Simply evaluating the agency and “restructuring” in some way, however, likely won’t be enough. Haines argued that an outside expert could more effectively — and impartially — conduct a review with the needed level of thoroughness.
“The thing they don’t know, and need to figure out fast, is why don’t people trust them,” Haines said. “When you have an outside consultant and facilitator, that’s part of what you investigate. You identify the problems and why they exist, then figure out when to restructure, as opposed to bringing someone in to recommend restructuring on a one-month basis.”
The CDC’s issues go beyond communication and rebuilding public trust, according to Georges Benjamin, executive director of the American Public Health Association. Many of them, he believes, are linked to funding.
Benjamin pointed to several areas of potential improvement, most of which were noted in Walensky’s email. They include modernizing the agency’s data infrastructure, boosting its workforce, strengthening lab capacity and overhauling rapid-response mechanisms for disease outbreaks.
“There are opportunities to streamline decision-making so they can operate more quickly,” Benjamin said. “Some of the reasons we complain that they’re slow in putting out information, for example, is because they don’t always have the information: The data systems are terrible, data comes in piecemeal, and they can’t validate it.”
The CDC has acknowledged its data issues and pushed a program, the Data Modernization Initiative, to address them. But as with most of the areas needing improvement, there are questions about whether the agency can afford it.
“It’s absolutely about inadequate funding,” Benjamin stressed. “The whole public health system has been inadequately funded for years — not just at the local and state level, but at the federal level. Once [the CDC does] this review, they’re going to find all kinds of things they’ll need funding for.”
So without this needed investment, the CDC review may yield meager results. Still, Benjamin remains optimistic.
“The CDC is not fundamentally broken, but they are certainly working with their hands tied behind their back,” he said. “If we’re serious about protecting public health, we need a really good investment in public health and the CDC.”
Haines agreed, adding, “If you’re going to improve the agency, you need to get outside the government echo chamber. It’s going to be difficult, but you’ll get a much better CDC if you create a higher level of trust and communicate better with the public. If you don’t, Walensky will leave the agency with the same kind of situation that she inherited going in.”