This week Dr. Rochelle Walensky, head of the CDC, admitted what many of us have already observed: the agency’s actions and communications have been inadequate in managing either the COVID-19 or monkey pox outbreaks.
In what the NY Times called a “rebuke to the agency” she said (in a video to the agency’s employees) “To be frank, we are responsible for some pretty dramatic, pretty public mistakes, from testing to data to communications.” In further comments Dr. Walensky also suggested that the CDC would reorganize to make the agency more effective in the future.
Most Americans have been frustrated with the communications provided by the CDC. Many of their recommendations are confusing, seem to be at odds with current scientific knowledge, and provide little background for how decisions about recommendations are made. While it is encouraging that the director admitted these problems, more information needs to be available before the impact of these new directions can be estimated. The actual review recommending the restructuring was not made available.
The recommendation for restructuring came from a panel led by career bureaucrats at the agency. The review was led by Jim Macrae, former acting administrator of the Health Resources and Services Administration and a senior manager at the Department of Health and Human Services in the Obama administration. This suggests it was an organizational review, not one that evaluated the scientific work or medical decisions of the agency.
There also seems to have been little examination of the role of political influence on the CDC concerning communications and the process by which it makes decisions. Both the Biden and Trump administrations have been accused of meddling with the Agency and attempting to alter recommendations.
While most experts agree that fundamental changes are necessary, since the details of the report were not released, it was difficult to evaluate the proposed changes. Several public health leaders expressed skepticism. Dr. Jennifer Nuzzo, an epidemiologist and director of the Pandemic Center at Brown University School of Public Health, was quoted in the NYT as saying, “Can she do it? I don’t know. Does it absolutely need to be done? Yes. Is it just a reorganization that is required? I don’t think so.”
One thing is clear: morale in the agency is poor among the 11,000 employees and many are leaving for industry or other opportunities. Being rebuked by the director certainly will not help this problem and a simple organization change will not fix the scientific and medical issues that have complicated communications.
Drs. and CDC Directors Rochelle Walensky and Robert Redfield.
It is important to remember is that many of the communications problems have arisen from Dr. Walensky. There has been a palpable disconnect between the most recent CDC directors and agency staff and scientists. Both Drs. Redfield and Walensky are remarkably similar in their expertise being infectious disease physicians specializing in the care of HIV patients. However, neither has a public health background. This likely frustrates agency scientists and makes it difficult for the director to evaluate the public health issues being discussed.
Reflecting this, many of the communications from Drs. Walensky and Redfield seemed to have been given as press releases that they read verbatim. Question and answer sessions that followed these statements were disastrous. Now compare this with the thoughtful comments on similar matters by Ashish Jha, MD, former dean of Brown University’s School of Public Health and the White House COVID-19 response coordinator. The difference is remarkable in part because Dr. Jha innately understands public health topics.
Given this, the most valuable part of any CDC reorganization might be to have someone with an actual public health background run the agency!