The CDC is broken and apologies can’t fix it

Dr. Rochelle Walensky, director of the Centers for Disease Control and Prevention, is getting credit for a mea culpa for saying what seems obvious: “For 75 years, the CDC and public health have been preparing for COVID-19, and in our big moment, our performance did not reliably meet expectations,” 

This is a classic act of contrition theater, in which Walensky avoids taking any responsibility for the agency’s failure to understand the threat the nation faced or the CDC’s unfounded “guidance” regarding how to slow the spread of COVID, measures that the agency now acknowledges are flawed.

It is not a small issue that CDC personnel undermined respected scientists outside of government who quarreled with mask mandates, social distancing, shutting schools, closing businesses, and promoting universal vaccination with serums whose known risks to some were downplayed. All this while dismissing Americans who doubted that the CDC had a monopoly on “the science.”

In truth, the CDC did a great deal of damage to public faith in science and enormous damage to public trust in government writ large. The more consequential cost, of course, is what epidemiologists know as excess death — those whose lives were lost following government guidance on how to save their lives.

Walensky’s apology came as a prelude to the release of an internal review of the CDC’s management that she ordered in April in response to growing criticism including the threat of a congressionally mandated investigating commission.

For the review, she turned to someone she characterized as an “outside” senior federal official, James Macrae, a 30-year veteran of the Department of Health and Human Services bureaucracy. Incredibly, the other members of the four-person review were Walensky’s three deputy administrators. Their remit was a comprehensive evaluation of the agency’s “structure, systems and processes,” all to be done in four weeks.

With no private sector input, the report appears very much a product of Washington — interesting findings that will hold off critics but are unlikely to regenerate trust in the agency. For instance, the report finds that CDC scientists are too focused on producing papers for peer-reviewed journals rather than practical research. In the future, Dr. Walensky says, CDC researchers will be evaluated on whether they “produce data for action,” not “data for publication.”

Not surprisingly, Walensky’s review finds the CDC underfunded, the excuse for its remarkable inability to ever provide a real-time statistical profile of the pandemic. (The agency cannot yet tell with certainty current COVID-related rates of infection, hospitalization or death.) Yet, Congress has appropriated huge sums for “data modernization” since 2012. In the last three budgets alone, the CDC has received $1.4 billion to improve its information systems and create a forecasting competency.

Oddly, Walensky has insisted that the idea for the review was her own and not the White House’s. Perhaps she realizes that some of the erosion in public trust involves her readiness to do dirty work for the president. It took the Supreme Court to tell the CDC it could not suspend evictions to enforce quarantines. And it was Walensky who took suggestions from the head of a national teachers’ union when developing guidance on school closings. Shutting schools increased the incidence of childhood mental illness and unnecessarily disrupted family life throughout the country.

Acknowledging failure and offering apologies won’t work to recapture public trust. The CDC’s inability to detect COVID’s presence early on and its failures to deliver a workable containment strategy are not new problems. The agency failed similarly in the HIV-AIDS epidemic and the CDC is already behind in controlling monkeypox. 

The real problem at the CDC is that it long ago forgot its principal job is preventing epidemics of communicable disease. Today’s CDC has programs, studies or other resources to prevent diabetes, heart disease, colorectal cancer, drug abuse, gun violence, obesity, loneliness among the elderly, the consumption of junk food by truckers, and dozens of other social problems that politicians and public health experts refer to as “epidemics” and for which the tools of managing real epidemics won’t work.

To hold the public’s trust again, Walensky should ask Congress to cut the CDC down to size, restoring its focus on preventing communicable diseases. Many of the agency’s other efforts can be sent to other government agencies, many within the National Institutes of Health, for primary responsibility. Without such a drastic move, no apology, however sincere, will save the agency.     

Carl Schramm is a university professor in the School of Information Studies at Syracuse University and a member of the COVID Commission Planning Group, a national COVID coalition founded by Schmidt Futures, the Skoll Foundation, Stand Together and the Rockefeller Foundation.