A plan for CDC reform is long overdue

The last two years have demonstrated the harms of politicizing public health and of the Centers for Disease Control and Prevention (CDC), which has drifted away from its mission and core function as the nation’s public health fire department. 

Over 1,000,000 Americans have died from COVID-19, and at the height of the pandemic, a $26 trillion economy contracted at an annualized rate of 3.5 percent mostly because of overreaching CDC-recommended infection control policies.

With roots stretching as far back as 1946 and expanded through the creation of the Epidemic Intelligence Center in 1951, the Communicable Disease Center, as it was then called, functioned to predict and protect America from infectious disease threats, most notably to fight malaria in war zones. Yet, over time, the agency’s core mission became diluted as bureaucracy expanded to encompass such concerns as environmental justice, health equity, and the social determinants of health.

Today, like a conglomerate of unrelated businesses lacking a clear strategic direction, the CDC tries to be all things to all people. Worryingly, this lack of strategic focus has produced a series of long-term operational failures, including the fact that despite investing over $1.1 billion in chronic disease prevention, the prevalence of diabetes and obesity in America has risen over the past decade. Other actions demonstrate a failure to understand basic strategy and operations, such as the creation of a disease forecasting center nearly two years into the worst global pandemic in a century.

And in the past two years, the COVID-19 pandemic has served as a prism, magnifying the CDC’s weaknesses in what were prior core functions — forecasting, detecting and managing disease outbreaks. Operationally hamstrung by an unwieldy organizational configuration with 15 offices and centers reporting to the agency director, the CDC needs to return to a more focused and nimble structure. During the pandemic, the CDC struggled with crisis communications, early diagnostic test development, and transparent, timely, and sensible public health guidance on non-pharmaceutical interventions.

Simultaneously, the CDC failed to both anticipate and estimate basic tradeoffs in public health policy, such as the harms of school closures on childhood mental health, or lockdowns resulting in worsening of substance abuse and increased overdoses, or the CDC’s eviction moratorium, which expired July 31, 2021, while eventually struck down by the Supreme Court, still cost hundreds of thousands of landlords billions. Unlike nearly every other federal agency, the CDC exercised regulatory power without an opportunity for public input or evaluation of the economic effects of its policy decisions. The CDC failed at its core mission while contributing to the pandemic’s economic hardship.

Public mistrust also deepened as a consequence of constantly changing risk mitigation guidance founded on an unclear evidence base. The involvement of teachers’ unions — and not parental groups — politicized the CDC’s recommendations regarding the masking of students, and worsened public perceptions of what was once the country’s premier public health agency. This was subsequently compounded by opaque decision-making and even bureaucratic inaccessibility when the Department of Health and Human Services removed all departmental staff emails from the agency directory. The CDC today lacks accessible channels for feedback from the very public whose behavior it strives to change.

Americans have suffered at the hand of the CDC over the past two years. While the agency did commission a month-long “external” review by a small team of federal civil servants to demonstrate contrition, other public agency failures have prompted more thorough and incisive external reviews featuring a wide variety of stakeholders, including those economically affected by the agency’s decisions.

The CDC’s behavior during the pandemic calls for a congressionally-chartered commission to transparently review its performance, mission, and programs and help set the agency on a path back toward accountability for its original public health mission.

Recent congressional actions also highlight the frustration of politicians with the performance of the CDC. The proposed bipartisan legislation, the Prepare for and Respond to Existing Viruses, Emerging New Threats (PREVENT) and Pandemics Act requires the CDC to write a strategic plan every four years.

The failure of the very agency that is supposed to protect the nation from infectious disease and other public health threats, specifically, the CDC’s lack of preparedness when facing the COVID-19 pandemic, and its ignorance of the economic tradeoffs in public health policy, must never be repeated. The CDC must change, and this change won’t happen without an external motivating force.

Brian J. Miller is an assistant professor of Medicine and Business (Courtesy) at the Johns Hopkins University and a nonresident fellow at the American Enterprise Institute. Phillip Phan is Alonzo and Virginia Decker Professor of Strategy and Entrepreneurship at the Carey Business School and professor of Medicine (Courtesy) at the Johns Hopkins University.