‘The CDC alone can’t fix this’: Walensky calls for overhaul of U.S. public health system

Covid-19 a catalyst

Health officials have long tried to draw more attention and funding from Congress to prop up the public health sector, which Walensky said has lost nearly 80,00 workers in the last 10 years. Former CDC officials, including Tom Frieden, the agency’s director under President Barack Obama, prioritized funding to improve how state public health offices received and analyzed laboratory reports. Still, data-collection problems persisted as public health officials continued to leave their jobs.

Walensky said she thinks Covid-19 might be the catalyst for change.

“Ebola didn’t touch everyone. Zika didn’t touch everyone. Even during those what I would call public health crises, people didn’t always know what the CDC stood for. People were not talking about science on the nightly news,” Walensky said. “And I think this pandemic has by far touched everyone every day for the last two years. And I think people have realized that we can’t be in this place again.”

Congress has allocated hundreds of millions of dollars to the CDC over the past two years — much of which the agency distributed to states to help improve their data systems and analytics, and to hire more staff to handle the workload. But the CDC needs more funding to do what Walensky is envisioning. According to interviews with dozens of state public health officials, tens of billions of dollars are necessary to rebuild just the nation’s data systems and reporting processes.

“One could say you could dump money into a system and try and get it to work better. But you can’t. You can’t create a workforce. You have to upskill the workforce,” she said. “We need to train it. We need to make public health an attractive workforce to enter.”

CDC under scrutiny

Over the past two years, state public health offices have worked to build data teams, specifically. When the pandemic began, health offices were inundated with new lab reports and cases to track. The volume of results that flowed into the public health offices overwhelmed even the biggest and most well-funded teams. As a result, states failed to accurately detect and contain Covid-19, ending contact-tracing efforts before the end of the first year.

In recent months, the CDC has come under fire from lawmakers on Capitol Hill, and within the administration, for its data, primarily the gaps that still exist two years into the pandemic. The agency has struggled to report accurate vaccination, hospitalization and case information due in part to delayed reporting from overburdened state health agencies. In a Senate HELP Committee hearing last week, Walensky said the agency was six weeks behind in compiling and analyzing state Covid-19 data.

“Historically, the CDC has this reputation of making sure every every I is dotted, every T is crossed before a decision is made — that the data has to be perfect before they’re able to get it out. We don’t have that luxury in this pandemic,” Walensky said. “And when you wait for those perfect data to make a decision, it’s too late. We need to sometimes make decisions in the context of areas where the science is gray.”