All we know right now
- The CDC director announced that the agency would undergo a major overhaul.
- The reason for the overhaul was the agency’s belated response to COVID-19.
- The CDC will also work to improve its communication with the public and restore public trust in the agency.
Dr. Rochelle P. Walensky, director of the Centers for Disease Control and Prevention, announced on August 17 that the nation’s top public health agency would undergo a major overhaul, saying it had responded too slowly to the COVID-19 pandemic. .
In a meeting with CDC senior management, Walensky outlined his plans, reported CNN. This includes reorganizing the agency’s structure to focus on public health needs and responding to outbreaks such as those caused by the coronavirus and monkeypox virus.
With this in mind, there will be less emphasis on publishing scientific papers, with Walensky calling on staff members to produce “data for action” as opposed to “data for publication,” according to a briefing paper, as reported by the New York Times.
The CDC will also work to improve its communication with the public and restore public trust in the agency.
At times during the pandemic, his public messages — such as those on face masks, social distancing and reminders — were “confusing and overwhelming,” according to the briefing document.
“My goal is a new culture of public health action at CDC that emphasizes accountability, collaboration, communication, and timeliness. I look forward to working with the incredible people at CDC and our partners to realize the full potential of the agency to benefit the health and well-being of all Americans,” Walensky said in a statement.
The CDC’s overhaul plan follows a month-long review of the agency’s response to the COVID-19 pandemic by Jim Macrae, an administrator at the Department of Health and Human Services. The report of this review has not yet been released.
Walensky also sought feedback from his own staff on the agency’s operations and performance.
The CDC’s missteps with the pandemic began in early 2020, with the agency releasing a faulty COVID-19 test to public health labs, which left public health officials oblivious to the true spread of the coronavirus in the world. country.
Some say the agency has also struggled to issue clear public health guidance on COVID-19 mitigations or respond quickly enough to a rapidly evolving and spreading coronavirus.
Susan Hassig, DrPH, MPH, a professor in the department of epidemiology at Tulane University School of Public Health in New Orleans, said one of her issues with the CDC during the pandemic was when the The agency said people who had received a COVID-19 vaccine no longer needed to wear face masks in indoor public spaces.
“It was a very bad decision, in terms of real prevention [of coronavirus spread]”, she said, “because mRNA vaccines have never been officially tested in the [clinical] trials for their ability to prevent infection. Masks, however, work to prevent infection.
Walensky acknowledged the agency’s pandemic shortcomings in his statement.
“For 75 years, the CDC and public health have been preparing for COVID-19, and in our big moment, our performance has not reliably met expectations,” she said.
Walensky has assigned HHS Assistant Secretary Mary Wakefield to oversee the agency’s reorganization, which will include:
- The Office of Science and the Division of Laboratory Sciences will report directly to the Director of CDC.
- A new Office of Intergovernmental Affairs will interact with state health departments and other federal agencies.
- An agency executive board will set CDC priorities, influence budget decisions, and monitor progress on agency priorities.
- A new Office of Equity will help increase the diversity of the CDC’s workforce and ensure that agency operations reflect the role of diversity in public health.
- A new mechanism will be developed to share CDC data earlier, before publication in a peer-reviewed journal.
- The agency will revamp its website to simplify and streamline advice for the public and healthcare providers.
Many of these can be accomplished through the CDC’s existing authority, but Walensky also plans to ask Congress to require state and local jurisdictions to share their public health data with the agency. Currently, this is done on a voluntary basis.
Walensky will also ask Congress for greater flexibility in how the agency can use its funding, to allow it to more quickly adapt to a public health crisis when it emerges.
The CDC has already begun implementing some of its proposed changes, including hiring Kevin Griffis, a former public affairs expert with the Department of Health and Human Services and Planned Parenthood, to lead the communications efforts of the agency.
Many public health experts point out that the CDC has been underfunded for years, so if the reorganization is successful, the agency will need the resources to make it happen.
“The pandemic has definitely made it clear that we need an overhaul [of the CDC]. So I hope Congress will provide the necessary funds to make this possible,” said Lorien Abroms, ScD, MA, professor at the Milken Institute School of Public Health at George Washington University in Washington, DC.
Abroms, a health communications expert, said the CDC also needs to change the way it communicates with the public, to better fit the way people currently consume information — 24/7 and largely through social media.
“In some ways, it feels [the agency is] still using communication strategies that were developed 40 years ago,” she said.
In addition to communicating clearly and consistently, Abroms said the agency will need to streamline its review process so it can release its findings more quickly.
Otherwise, it “creates a vacuum” that could be filled by other groups, some of whom may not be sharing accurate information.
“A major challenge is understanding how to communicate in an environment where there is competing information – and often that information is misinformation,” she said.
Additionally, “the source of the message, i.e. the government agency, may not be trustworthy,” she said. “So there are more challenges [today] that there never was.
Dr. Bruce Y. Lee, a professor at the CUNY Graduate School of Public Health & Health Policy, said the agency’s problems are not limited to the pandemic.
“We have seen many issues over the past few years with the response to COVID-19, as well as the monkeypox outbreak,” he said. “So there’s a need to really reconsider how the CDC is organized.”
Lee said the agency has come under fire during the pandemic for a lack of communication about the scientific rationale for some of its decisions, including easing COVID-19 precautions such as face masks and social distancing.
“There have been a number of people in the public health community who have questioned why certain precautions were relaxed at certain times,” he said.
While much of the attention in recent months has been on how the CDC has handled the COVID-19 pandemic and monkeypox outbreak, Hassig said the agency has a lot more to do.
“They have a huge field of work. It’s not just infectious diseases, it’s osteoporosis, cardiovascular disease, maternal health, injuries, etc. “, she said. “That’s all that affects the health of the American public.”
Over time, the CDC’s ability to address all of these areas has been hampered by shrinking budgets, she added.
Beyond funding, Hassig said there are certain aspects of the agency’s mission over which she has complete control. However, there are also things that are not entirely within the purview of the agency.
This includes the decentralized US healthcare system, which makes it difficult for some groups to access medical care and testing – this can make it difficult to monitor the spread of pathogens such as coronavirus and monkeypox virus.
“With monkeypox, most cases are in men who have sex with men,” Hassig said.
But “I can guarantee you that there are many more people in different subgroups of this community – and possibly in other communities – who just aren’t tested, because they don’t have access to the testing process,” she said.
Another challenge for the CDC, Hassig said, is that much of the public health work is done at the state level, where public health agencies are also underfunded — and sometimes politically influenced.
But even there, the CDC has options.
“These local agencies are really the foot soldiers for the implementation of public health activities in the United States,” she said. “One way for the CDC to get state and local agencies to cooperate is to use the funding ‘carrot’.”