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Walensky, Citing Botched Pandemic Response, Calls for C.D.C. Reorganization
Among other flaws, public guidance during the coronavirus pandemic was ďconfusing and overwhelming,Ē the agency said.

Wednesday, August 17, 2022
New York Times
by Sharon LaFraniere, Noah Weiland

WASHINGTON ‚€Ē Dr. Rochelle P. Walensky, the director of the Centers for Disease Control and Prevention, on Wednesday delivered a sweeping rebuke of her agency‚€™s handling of the coronavirus pandemic, saying it had failed to respond quickly enough and needed to be overhauled.

‚€úTo be frank, we are responsible for some pretty dramatic, pretty public mistakes, from testing to data to communications,‚€Ě she said in a video distributed to the agency‚€™s roughly 11,000 employees.

Dr. Walensky said the C.D.C.‚€™s future depended on whether it could absorb the lessons of the last few years, during which much of the public lost trust in the agency‚€™s ability to handle a pandemic that has killed¬ more than 1 million Americans. ‚€úThis is our watershed moment. We must pivot,‚€Ě she said.

Her admission of the agency‚€™s failings came after she received the findings of an¬ examination¬ she ordered in April amid scathing criticism of the C.D.C.‚€™s performance. The report itself was not released; an agency official said it was not yet finished but would be made public soon.

Dr. Walensky laid out her basic conclusion from the review in candid terms: The C.D.C. must refocus itself on public health needs, respond much faster to emergencies and outbreaks of disease, and provide information in a way that ordinary people and state and local health authorities can understand and put to use.

In an interview on Monday, Dr. Walensky stressed that hundreds of Americans were still dying each day from the coronavirus and that while the country has not yet seen deaths from the outbreak of a new disease ‚€Ē monkeypox ‚€Ē it has presented some of the same challenges for the agency.

The C.D.C. has been criticized for years as being too academic and insular. The coronavirus pandemic brought those failings into public view, with even some of the agency‚€™s staunchest defenders criticizing its response as inept.

It remains unclear whether Dr. Walensky, an infectious disease expert whom President Biden picked to lead the agency in December 2020, can bring about the changes many see as necessary.

‚€úCan 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,‚€Ě Dr. Jennifer Nuzzo, an epidemiologist and director of the Pandemic Center at Brown University School of Public Health.

Others said it was difficult to judge Dr. Walensky‚€™s moves without more information, including the report she commissioned. The review was led by James Macrae, who has held senior positions at the Department of Health and Human Services, which oversees the C.D.C. He interviewed about 120 people inside and outside the agency.

‚€úJust saying we‚€™re strengthening this and that ‚€Ē the devil is in the details here,‚€Ě said Dr. Howard Markel, a professor of the history of medicine at the University of Michigan who has advised the C.D.C.

The agency has been under fire since the outset of the coronavirus pandemic two and a half years ago.¬ It bent to political pressure¬ from the Trump White House to alter key public health guidance or withhold it from the public ‚€Ē decisions that cost it a measure of public trust that experts say it still has not recaptured. It also made its own serious errors, including¬ deploying a faulty Covid-19 test¬ that set back the nation‚€™s efforts to curtail spread of the virus.

While it has steadied itself since Dr. Walensky assumed control about 18 months ago, the C.D.C. has continued to fall short.

Its public guidance has often been confusing, even to public health experts. Leaders of its Covid team rotate so frequently that other senior federal health officials have at times been unsure about who is in charge. And important data was sometimes released¬ too late to inform federal decisions, including studies on breakthrough infections that could have influenced a federal recommendation on authorizing a round of booster shots.

Regardless of who led the agency, ‚€úan honest and unbiased read of our recent history will yield the same conclusion,‚€Ě Dr. Walensky told employees. ‚€úIt is time for C.D.C. to change.‚€Ě

She outlined in broad terms how she hopes to transform operations by emphasizing public health needs, especially with a quicker response to emergencies like infectious disease outbreaks. One of her top priorities is to deliver clear, concise messages about public health threats, in plain language that can be grasped without sifting through voluminous pages on a website.

‚€úI think for a long time, C.D.C. has undervalued the importance of direct communication to the public with information the public can use,‚€Ě said Dr. Richard E. Besser, who served as acting director of the agency during the Obama administration.

Dr. David Dowdy, an epidemiologist at Johns Hopkins Bloomberg School of Public Health, said messages to the general public need to be ‚€úvery clear, very simple, very straightforward,‚€Ě not framed for scientists. ‚€úI do think that culture is changing, but we need it to change faster,‚€Ě he said.

Other planned changes are more bureaucratic but could have a big impact. A new executive team will be created to set priorities and make decisions about how to spend the agency‚€™s annual $12 billion budget ‚€úwith a bias toward public health impact,‚€Ě according to a media briefing document. Two scientific divisions will now report directly to Dr. Walensky‚€™s office, a move that appears aimed at speeding up delivery of data. Mary Wakefield, a former deputy health secretary in the Obama administration, was appointed to lead the reforms.

Dr. Walensky hopes to cut down the review time for urgently needed studies, emphasizing production of ‚€údata for action‚€Ě as opposed to ‚€údata for publication,‚€Ě the briefing document said.

In an interview, Dr. Walensky said that while ‚€úsome of the data are messy, and some of the data take time, I‚€™ve really tried hard to push data out when we had it.‚€Ě

The agency aims to alter its promotion system so that it rewards employees‚€™ efforts to make an impact on public health and focuses less on the number of scientific papers published.

‚€úThat‚€™s not going to change anything overnight. But in the long run it will have a huge impact,‚€Ě said Kyle McGowan, who served as chief of staff for the agency during the Trump administration and¬ fiercely criticized¬ the administration‚€™s interference in C.D.C. decision-making after he left the agency.

Dr. Walensky also plans to create a stronger cadre of officials who respond to public health crises by training more staff and requiring that those officials remain in their positions for at least six months. Previously, officials in charge of the pandemic response often left after only a few months ‚€Ē a system that helped mitigate burnout but also sowed confusion.

Dr. Walensky stressed that she would not let the burden of responding to a public health threat fall on just a few people. ‚€úThis is an agencywide top priority to respond when we are called upon,‚€Ě she said.

‚€úWe‚€™ve had the same people who deploy over and over again,‚€Ě said Mr. McGowan. ‚€úWhat they need is for more people to deploy longer.‚€Ě

Many of the C.D.C.‚€™s experts are accustomed to conducting narrowly focused research that undergoes lengthy reviews, and they are uneasy with the kind of urgent action needed to address public health threats.

Image
A coronavirus testing site in Houston in July 2020. Dr. Walensky ordered an external review this year, after months of scathing criticism of the C.D.C.‚€™s response to the pandemic.
Credit...Callaghan O'Hare for The New York Times
 
 That type of research is still critical, many experts say. ďHaving expertise in those rare diseases is very valuable. And it becomes valuable at times you just donít really know,Ē said Dr. Mitchell Wolfe, who left the C.D.C. in June after serving as its chief medical officer.

ďI think monkeypox is a great example. A year ago people would have asked why you have a monkeypox expert,Ē he said.

And some of the C.D.C.ís problems are beyond its control: Much of its funding is tied to work on specific diseases and cannot be shifted to address public health threats. The agency also lacks legal authority to compel state and local health departments to deliver public health data.

The pandemic itself is another impediment. The agencyís massive complex outside Atlanta sits mostly empty, while employees, including Dr. Walensky, work remotely.

ďThe actions that are being taken all strike me as actions that make sense and would make C.D.C. a more effective public health agency,Ē said Dr. Besser, the former C.D.C. acting director.

But he said it was hard to see how Dr. Walensky could execute wholesale changes when she only sees most of her staff at a distance. ďI donít know how you motivate and inspire culture change when people arenít together,Ē he said.
 
A coronavirus testing site in Houston in July 2020. Dr. Walensky ordered an external review this year, after months of scathing criticism of the C.D.C.‚€™s response to the pandemic.


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