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Times Article Says
CDC Is Broken And Questions Whether It Can Be Fixed
Reader Exclaims
“Heal Thyself, CDC, And Hurry Up About It!”
It has often been
stated in print and other media that the COVID-19 pandemic and the US
response to it has been and continues to be a window onto American
society. Some of what we see such as the vaccine development
initiative reveals impressive accomplishments. Perhaps the most
glaring proof of existing problems is that Americans have accounted
for 20% of the world’s deaths while having only 4% of the world’s
population. And this outcome is all the more alarming because the US
is home to the Centers for Disease Control and Prevention, widely
considered both domestically and internationally as the gold standard
in disease control work.
No Surprise
Thus it is not
surprising that one of the first institutions to come under closer
scrutiny for lesson learning should be the CDC. In a lengthy NY Times
magazine article entitled “COVID Proved the CDC Is Broken. Can It Be
Fixed?”, multiple public health professionals inside and outside the
agency were interviewed to get their opinions about the problems at
the agency and what might be done to repair it.
Problems
Politicization of the
agency that has prided itself on strictly following the science
appears to account for many of the problems or failings reported,
particularly those around guidance documents and messages communicated
to the public. However influential a role political considerations may
have played in CDC’s performance, the Times article identifies more
fundamental problems existing at the agency. These are 1) a lack of
funding, 2) a lack of authority, and 3) a culture that has been warped
by both. “Some of these problems come down to politics, but most are a
result of flaws in the agency’s very foundation,” according to the
Times.
Funding
Among the funding
problems identified is the fact that the budget is too small for the
mission and the funds come with too many restrictions which limit the
agency’s flexibility. In addition, there are no funds for emergencies
or dealing with the unexpected.
Authority
In terms of authority,
the CDC has a broad mission but little authority to compel
jurisdictions or individuals to follow its advice. According to the
Times, “Aside from a few quarantine powers, the most the CDC can do is
issue guidance, which is unenforceable and, ---as the past year has
repeatedly shown---just as likely to be weaponized as meaningfully
employed.” This is a new phenomenon because prior to the pandemic CDC
guidance , especially about vaccines, was regularly followed even
though not mandatory.
Culture
In terms of culture,
some within the agency believe there is a delusion that the agency is
more capable than it really is because of some past successes. There
is a felt need, according to the article, for CDC staff to be able to
correctly identify and truly acknowledge what the problems are.
Insiders told the Times reporters “the biggest barrier to modernizing
the CDC was the agency’s own lack of imagination.”
Surveillance
One of the key
activities of the agency is disease surveillance, that is, identifying
and monitoring disease incidence to spot outbreaks and epidemics and
bring about control measures. The Times article makes a case that the
agency is not up to date and sufficiently modernized to fulfill this
basic role the country expects of it.
During the pandemic
many non-CDC sites such as one at Johns Hopkins and one at the NY
Times appeared to have more up to date and more user friendly
tracking information about the pandemic than did CDC. According to the
Times, “COVID is the biggest crisis the CDC has faced, by far, in all
its history. It is exactly the kind of threat for which the agency was
created in the first place. But when it finally arrived, by most
accounts, officials there had very little to meet it with.”
Guidance
Another key activity
is providing technical guidance for disease control and again in this
area the article documents multiple failings on the part of the
agency. Criticisms center on the fact that guidance was either too
slow in coming, too out of touch with reality on the ground to be
useful, or based on flawed science or flawed interpretation of
science. Political interference in the guidance development process
has been reported in the media and may account for some of these
failings.
Able to Learn?
Additional funding has
been made available to the agency and more may be on the way. However,
the Times questions whether or not the CDC is really undertaking an
honest effort to identify and learn from recent mistakes and
shortcomings. Also, some of the needed reforms such as changes in the
funding structure and a grant of more authority, are not really within
the power of the agency as much as they are in the power of the
Congress.
Finally, the article
acknowledges that more money, new laws, or a more imaginative or
innovative spirit can’t be the whole answer. Despite what many in
epidemiology and science might like to think, public health is
politics and the science cannot ever be purely apolitical. The science
often is uncertain and requires judgment calls and competing values
require tradeoffs which someone must decide and others have to accept.
In other words, there is no getting around the need for public trust
to do public health science. Unfortunately, the pandemic appeared in
an environment of unprecedented low trust in government.
System Challenge
Also, CDC is only one
agency and it is part of a national system that also needs to function
well and to cooperate for the whole system to work correctly. A
distressing observation made in the article is lack of real
understanding among all of the players in the system of what exactly
federal disease control is supposed to do and what the limits of the
current system actually are.
The Times article
concludes “In retrospect, it seems clear that only a strong CDC ---a
well-funded, well-run federal authority, grounded in science and
resistant to political pressure but also mindful of lived
reality---could have rescued American policymakers from the worst of
their COVID confusion. And only a stronger CDC stands a chance of
correcting these errors when the next pandemic comes along…”
A reader comment
following the Times article appears to miss the mark by only focusing
on the agency itself to bring about reform, but the sentiment
expressed may be widely shared by all Americans. The reader exclaimed
“Heal thyself, CDC, and hurry up about it!”
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