‘No quick fixes’: Walensky’s push for change at CDC meets reality
In an interview with POLITICO, Walensky said it is critical for the CDC to communicate with Americans more quickly — even when it doesn’t know everything. “In a pandemic, you don’t have time to wait. You have to take action to help people,” said Walenksy, who has faced her own communications problems during the crisis. “We haven’t been able to be as nimble as we’ve needed to be.”
If she fails, the CDC risks repeating the mistakes it made during the pandemic, in which millions did not have the clear, real-time information they wanted to protect themselves from a virus that has killed more than a million Americans. Public trust in the agency has plummeted over the last three years; a further decline would mean even fewer people are listening to the government when another deadly Covid-19 wave hits, or a dangerous new disease emerges.
Previous CDC directors have also tried to improve the patchwork and antiquated system of disease data collection and reporting that relies on a chronically underfunded and understaffed national public health workforce. But Covid-19 thrust these liabilities into the spotlight, spurring widespread demand for change that could help Walenksy overcome some of the major hurdles in front of her.
“There are real structural problems in states that don’t have the data. … There are structural problems in CDC’s ability to get data from states and [health] facilities,” former CDC director Tom Frieden told POLITICO. The challenge, he said, is “big, and it is not easy to solve. … There are no quick fixes here.”
At the same time, Walensky is confronting internal pushback. Cutting down on long internal reviews before making scientific findings or data public has been met with skepticism from some veteran scientists in the agency, who worry about sharing data too soon, according to two agency staff members who requested anonymity to speak freely about CDC matters.
Walensky said she is trying to steer the agency toward the “sweet spot” between its old way of publishing its findings, which can take weeks or months, and ensuring that the science going out to the public is safe and reliable.
“We want to make sure we get the answer right, but when we know the answer, we shouldn’t wait to convey it to others,” she said. “I think people within the agency recognize the need for change.”
Walensky needs help to realize her vision. She has asked Congress for support in expanding the agency’s authority to collect better public health data and for more funding to help build up and train the depleted public health workforce.
“We continue to need congressional assistance,” said Walensky. The agency needs it to modernize the nation’s public health data infrastructure, she said, as well as “for the workforce, and quite honestly, we need it for the intersection of the two. We need data analysts working in public health.”
Given lawmakers’ appetite for putting more money into public health, help isn’t likely to be on the way anytime soon. Instead, some lawmakers are calling for greater oversight of the agency after its Covid-19 response and failure to contain the monkeypox outbreak more quickly, even advocating for the agency’s mandate to be curtailed.
During a September Senate hearing on the federal monkeypox response, Sen. Bill Cassidy (R-LA) said he didn’t see why Congress should give the agency more money when it had, by its own admission, been underperforming.“It’s going to be hard for me to support more appropriations until we have a better relationship — a more trusting relationship, and more transparent relationship — between the agency and Congress,” he said.
‘Some people may still resist’
This spring, Walensky ordered a review of the CDC’s Covid-19 response and its operations. More than 150 CDC staff and partners were interviewed, and the thrust of the feedback was clear: the CDC needs to adapt if it wants to perform better in public health emergencies and hang onto its place as the world’s premier public health agency.
The director announced a subsequent spate of reforms in August, including speeding up data delivery, making public health guidance easier to understand, building up its communications team, strengthening the CDC’s national laboratory system and shifting internal incentives for staff away from publishing in scientific journals and toward making practical policy recommendations.
A lot of that work is underway, Walensky told POLITICO, including the push to improve public health data and get it out faster.
Concerns in the administration and among public health experts that the agency is too slow to publish critical data have dogged the agency throughout the pandemic. It often took days — sometimes weeks — for the CDC to publish infection rates and deaths.
That’s partly because the system that the CDC relies on to collect state and local health data is outdated and unreliable. Dozens of states still collect lab results via fax machine and snail mail, delaying the time it takes public health officials to log the information into the electronic data system and send it to the federal government.
While that process has improved for Covid-19, some data is still outdated, said Eric Topol, founder of the Scripps Research Translational Institute. “Right now, if you were to look at the most recent data for hospitalizations and deaths, it’s at least two months or three months behind,” Topol said. “And these are essential data.”
The drive to publish science faster — and communicate its limitations — was put to an early test during the unexpected U.S. monkeypox outbreak. As the outbreak expanded rapidly this summer, the CDC started to share information from surveys and studies earlier than it would have under its previous processes.
A CDC study that looked at how well the little-known monkeypox vaccine Jynneos was working was an early test of the new workplace philosophy. While the study showed Jynneos may be preventing infection, it did not reflect how individuals’ behavioral changes — or other factors like testing, age or underlying health conditions — might have played into that outcome.
It was not a “perfect vaccine effectiveness study,” Walensky admitted. But, she said, “It was the best we were going to get over some period of time, and it was some indication that these vaccines were working. We wanted to acknowledge the limitations of the methods that we had and give out the data that we had so that people could see how the vaccines were performing.”
The approach has made some longtime staffers uncomfortable. Veteran scientists in the agency have expressed concern about changing the publication process, in part because they worry about promoting scientific analysis and data that could change after it’s out, according to the two CDC staffers.
The scientists have raised their concerns to Walensky in small working group meetings dedicated to solving the data issues, the staffers said.
Resistance is going to be part of any meaningful change inside a sprawling agency, a senior CDC official acknowledged, speaking on condition of anonymity to freely discuss the reform agenda.
“Certainly, some people may still resist some change,” the official said. But, they added, “We’re not compromising the quality of our science. We remain committed to scientific integrity. We just have to look at, ‘How do we modernize to be the new CDC?’”
Sharing data faster also carries a risk outside the embattled agency. Americans may get public health information sooner, but they also have to stay tuned in case that information proves to be different or wrong, a condition that has the potential to exacerbate the mistrust millions of Americans have developed of federal health officials during the pandemic.
“When you’re dealing with all the complexities of pathogens and human populations, the likelihood that you’re going to be wrong sometimes is pretty high,” said Kathleen Hall Jamieson, director of the Annenberg Public Policy Center at the University of Pennsylvania.
“Right now we’re in an environment in which too many people hear that any scientific statement must be conclusive, final and eternally true, when science never is,” she said. “They’re susceptible to people saying, ‘See? they got it wrong. They’re either incompetent, or malevolent.’”
‘Pedal to the metal’
Rehabilitating the CDC’s image in large swathes of America won’t be easy. In a survey published by the Pew Research Center in July, only 29 percent of Republicans or Republican-leaning individuals said public health officials, such as those at the CDC, were doing a good job responding to the pandemic, compared to 72 percent of Democrats. An April poll from YouGov found only a quarter of Americans agreed the agency was “trustworthy.”
Walensky herself has come under fire for the way she communicated with Americans at different points during the pandemic. Critics say she has issued confusing health guidance, not held enough press briefings and not put forward enough of the agency’s career scientists to explain the science to the public.
Anand Parekh, chief medical adviser at the Bipartisan Policy Center in Washington, said he is optimistic about the steps Walensky is taking to reform the agency, and they are all headed “in the right direction.” But, he added, “I think those who are more skeptical of the CDC probably don’t think that this is going to amount to much.”
The agency’s trajectory may be further complicated by the next Congress, which could pull the CDC director into oversight hearings and amplify calls for broader change to how the agency functions.
The current version of the PREVENT Pandemics Act, introduced in March by Sen. Patty Murray (D-Wash.), calls for Senate confirmation of the CDC director and requires the director to submit a strategic plan to Congress every four years. Other legislation wants to redefine the agency’s entire role in government: Sen. Rand Paul’s (R-Ky.) Limiting CDC to Disease Control Act would strip it of its authority to regulate the spread of communicable diseases.
Against this backdrop, convincing Congress to expand the CDC’s authorities to get better and faster data from states is a long shot, Frieden said.
“I’m afraid that in the current political context, that’s pretty unlikely to happen,” he said. “So they’re stuck with not being able to get the kind of data from states that they optimally should get,” said Frieden.
That will continue to make the agency’s job difficult, particularly in an administration that observers say wants to move faster than the speed of public health.
“We will put the pedal to the metal for as long as we can under my leadership,” Walensky said. “My hope is I will leave them in a place where everyone recognizes that this needs to move.”
