THE head of the US Centres for Disease Control and Prevention (CDC) announced an overhaul of the agency meant to revamp everything from its operations to its culture, saying it had failed to meet expectations during the Covid-19 pandemic.
Director Rochelle Walensky began telling CDC’s staff Wednesday that the changes are aimed at replacing the agency’s insular, academic culture with one that’s quicker to respond to emergencies. That will mean more rapidly turning research into health recommendations, working better with other parts of government and improving how the CDC communicates with the public.
“For 75 years, CDC and public health have been preparing for Covid-19, and in our big moment, our performance did not reliably meet expectations,” Walensky said in a statement. “I want us all to do better and it starts with CDC leading the way. My goal is a new, public health action-oriented culture at CDC that emphasizes accountability, collaboration, communication and timeliness.”
Missteps by the agency, and criticism from within and without, began almost as soon as SARS-CoV-2 was first detected in the US early in 2020. The agency has been faulted for an inadequate testing and surveillance program, for not collecting important data on how the virus was spreading and how vaccines were performing, for being too under the influence of the White House during the Trump administration and for repeated challenges communicating to a politically divided and sometimes skeptical public.
In a video message sent to CDC staff Wednesday morning, Walensky said that the US had significant work to do to improve the country’s public health defenses. “Prior to this pandemic, our infrastructure within the agency and around the country was too frail to tackle what we confronted with Covid-19,” she said, according to a person who viewed the video, and spoke on condition of anonymity. “To be frank, we are responsible for some pretty dramatic, pretty public mistakes — from testing, to data, to communications.”
An infectious disease expert, Walensky took over the agency at the beginning of President Joe Biden’s term with promises of a reinvigorated US response to the Covid-19 pandemic. In April of this year, she launched a multi-pronged review to evaluate the Atlanta-based agency’s structure, systems and processes – though many of the agency’s challenges have continued on her watch.
At any government body, cultural change can be a challenge – especially so at agencies like the CDC where career officials can have tenures that are decades longer than their politically appointed leaders or elected officials. In May, Bloomberg reported on some of the feedback that agency staff had raised as part of conversations with those leading the review, in particular focused on cultural issues at the agency and challenges adapting to a new threat.
“The CDC, frankly, hasn’t been transparent or accountable,” said Daniel Pollock, an epidemiologist who worked at the agency for 37 years before retiring in November in part due to frustrations with its pandemic response.
Pollock, who was responsible for the CDC’s surveillance of health care-associated infections, wasn’t consulted as part of the review, but said that he was “not expecting that it’s going to change things.”
Walensky informed CDC senior leadership of her overhaul plan on Wednesday morning, after which an email went out to the broader agency with the video of the director describing the review and its results. The Biden administration was made aware of her plans ahead of Wednesday’s announcement, according to a senior CDC official with knowledge of the reorganization who asked not to be named as the details weren’t public at the time.
Over the last few months, Walensky worked closely with a small group of internal and external advisers to evaluate the review’s findings and plan the overhaul, which the group called “CDC Moving Forward,” according to the senior official. The team had planned to announce its plan earlier this summer, but had been delayed by an outbreak in monkeypox cases which has renewed some criticism of the CDC’s emergency response.
As a part of the overhaul, Walensky has appointed former Health and Human Services Department Deputy Secretary Mary Wakefield to lead a team tasked with making changes. The effort will include creating a new executive council reporting directly to the CDC director that will determine priorities, track progress and make budget decisions. It will not include layoffs, according to the senior official.
Walensky is also focused on revamping the CDC’s data systems, training the workforce and improving its laboratory infrastructure. She will also create new offices focused on health equity – long described as one of her top priorities – and intergovernmental affairs to improve relationships with other health agencies and partners.
The changes will help the CDC meet its “fullest potential,” Walensky said in a statement. The CDC does not have funding to deploy to the project given its budget for the year has already been allocated, according to the senior CDC official. The agency will discuss seeking funds for the reorganization in its next budget request, the official said.
A portion of the review was led by longtime HHS official James Macrae, who over the course of a month interviewed 120 current and former CDC staff and leaders as well as a wide variety of state, local and federal officials.
Macrae found that the CDC took too long to publish scientific findings and data that were used to make policy decisions. Part of his recommendations include finding ways to de-emphasize academic publication of research, such as by making it less important for employee performance reviews. – BLOOMBERG