WASHINGTON – Dr. Rochelle P. Walensky, director of the Centers for Disease Control and Prevention, on Wednesday issued a scathing rebuke of her agency’s handling of the coronavirus pandemic, saying it had not responded quickly enough and that had to be reviewed.
“To be frank, we are responsible for some pretty dramatic and public failures, from testing to data to communications,” he said in a video distributed to the agency’s approximately 11,000 employees.
Dr. Walensky said the CDC’s future depended on whether it could absorb the lessons of the past few years, during which much of the public lost confidence in the agency’s ability to handle a pandemic that has killed more than 1 million Americans. “This is our turning point. We have to pivot,” he said.
His admission of the agency’s failures came after he received the findings of a review he ordered in April amid scathing criticism of the CDC’s performance. The report itself was not published; an agency official said it wasn’t finished yet, but it will be made public soon.
Dr. Walensky laid out her core conclusion from the review in stark terms: CDC needs to refocus on public health needs, respond much more quickly to emergencies and disease outbreaks, and provide information so that the ordinary people and state and local health authorities can understand and use.
In an interview Monday, Dr. Walensky stressed that hundreds of Americans were still dying every day from the coronavirus and that while the country has yet to see deaths from the outbreak of a new disease, monkeypox, has presented some of the same challenges. for the agency.
The CDC has been criticized for years for being too academic and insular. The coronavirus pandemic made those failures visible, with even some of the agency’s staunchest defenders criticizing its response as inept.
It remains unclear whether Dr. Walensky, an infectious disease expert whom President Biden picked to lead the agency in December 2020, can bring about the changes many believe are needed.
“Can it? I don’t know. Should it absolutely be done? Yes. Is it just a reorganization that is needed? I don’t think so,” Dr. Jennifer Nuzzo, epidemiologist and director of the Pandemic Center at the School of Public Health at Brown University.
Others said it was difficult to judge Dr. Walensky’s moves without more information, including the report he commissioned. The review was led by James Macrae, who has held senior positions at the Department of Health and Human Services, which oversees the CDC. He interviewed about 120 people inside and outside the agency.
Read more about the coronavirus pandemic
“I’m just saying we’re strengthening this and that, the devil is in the details here,” said Dr. Howard Markel, a professor of the history of medicine at the University of Michigan who has advised the CDC.
The agency has been under fire since the start of the coronavirus pandemic two and a half years ago. He bowed to political pressure from the Trump White House to alter key public health guidelines or withhold them from the public, decisions that cost him a measure of public trust that experts say he has yet to regain. He also made his own serious mistakes, including deploying a flawed Covid-19 test that slowed the nation’s efforts to slow the spread of the virus.
Although it has strengthened since Dr. Walensky took over about 18 months ago, the CDC has continued to fall short.
Its public orientation has often been confusing, even to public health experts. The leaders of his Covid team rotate so frequently that other top federal health officials have sometimes been unsure who is in charge. And important data were sometimes released too late to inform federal decisions, including studies of breakthrough infections that could have influenced a federal recommendation to authorize a round of booster shots.
Regardless of who ran the agency, “an honest and unbiased reading of our recent history will yield the same conclusion,” Dr. Walensky told employees. “It’s time for CDC to change.”
He described in general terms how he hopes to transform operations by emphasizing public health needs, particularly with faster response to emergencies such as infectious disease outbreaks. One of their top priorities is to deliver clear and concise messages about threats to public health, in plain language that can be understood without wading through the bulky pages of a website.
“I think for a long time, the CDC has underestimated the importance of communicating directly with the public with information that the public can use,” said Dr. Richard E. Besser, who served as acting director of the ‘agency during the Obama administration.
Dr. David Dowdy, an epidemiologist at the Johns Hopkins Bloomberg School of Public Health, said messages for the general public need to be “very clear, very simple, very direct,” not framed for scientists. “I think the culture is changing, but we need it to change faster,” he said.
Other planned changes are more bureaucratic, but could have a big impact. A new executive team will be created to set priorities and make decisions about how to spend the agency’s $12 billion annual budget “with a bias toward public health impact,” according to a media briefing. Now two scientific divisions will report directly to Dr. Walensky’s office, a move that appears to be aimed at speeding up data delivery. Mary Wakefield, a former deputy health secretary in the Obama administration, was appointed to lead the reforms.
Dr. Walensky hopes to reduce review time for urgently needed studies by emphasizing the production of “data for action” rather than “data for publication,” the briefing paper said.
In an interview, Dr. Walensky said that while “some of the data is messy and some of the data takes time, I tried really hard to get the data out when we had it.”
The agency plans to modify its promotion system to reward employees’ efforts to impact public health and focus less on the number of scientific papers published.
“This is not going to change anything overnight. But in the long run it will have a huge impact,” said Kyle McGowan, who served as the agency’s chief of staff during the Trump administration and criticized fiercely the administration’s interference in CDC decision-making after he left the agency.
Dr. Walensky also plans to create a stronger cadre of officials to respond to public health crises by training more staff and requiring those officials to stay in their posts for at least six months. Previously, officials tasked with responding to the pandemic often left after a few months, a system that helped mitigate burnout but also sowed confusion.
Dr. Walensky stressed that she would not let the burden of responding to a public health threat fall on just a few people. “This is an agency-wide priority to respond when we are called,” he said.
“We’ve had the same people deploy over and over,” said Mr. McGowan. “What they need is more people to deploy longer.”
Many of the CDC’s experts are accustomed to conducting highly focused research that undergoes lengthy reviews, and are uncomfortable with the kind of urgent action needed to address public health threats.
That kind of research is still critical, many experts say. “Having experience in these rare diseases is very valuable. And it becomes valuable sometimes when you really don’t know,” said Dr. Mitchell Wolfe, who left the CDC in June after serving as medical director.
“I think monkeypox is a great example. A year ago people would have asked why you have a monkeypox expert,” he said.
And some of the CDC’s problems are beyond its control: Much of its funding is tied to work on specific diseases and cannot be shifted to address public health threats. The agency also lacks legal authority to compel state and local health departments to hand over public health data.
The pandemic itself is another impediment. The agency’s massive compound outside Atlanta is mostly empty, while employees, including Dr. Walensky, work remotely.
“The actions that are being taken seem to me to be actions that make sense and would make CDC a more effective public health agency,” said Dr. Besser, the CDC’s former acting director.
But he said it was hard to see how Dr. Walensky could implement wholesale changes when she only sees most of her staff remotely. “I don’t know how you motivate and inspire cultural change when people are not together,” he said.
Sheryl Gay Stolberg contributed reporting.
