Comment The nation’s top public health official acknowledged Wednesday that the Centers for Disease Control and Prevention has failed to respond effectively to the coronavirus pandemic and pledged sweeping changes, including faster release of scientific findings and clearer guidelines. CDC Director Rochelle Walensky told senior leaders she had embraced a long-awaited overhaul of the CDC’s culture based on an internal review that called for a more nimble and better-trained workforce and changing incentives to reward action over publication, among other things. “For 75 years, CDC and public health have been preparing for COVID-19, and in our big moment, our performance has fallen reliably short of expectations,” she said in a statement. “My goal is a new action-oriented public health culture at CDC that emphasizes accountability, collaboration, communication and timeliness. “ Walensky appointed Mary Wakefield, a former deputy health secretary in the Obama administration, to lead the effort, which she warned “will take time and commitment at all levels of the agency.” Recommendations shared on Wednesday morning, first to senior staff and then to the entire Atlanta-based agency, which employs about 13,000 people, according to a senior CDC official who provided details but was not authorized to speak officially. Several changes are already underway. “Work on basically everything else starts today,” the official said. Walensky briefed White House and Health and Human Services officials last week on plans to modernize the agency. “They are supportive,” the official said. Since the coronavirus pandemic began 2½ years ago, the once-studied agency has come under intense fire for its response, from initial delays in developing a coronavirus test, to strict eligibility limits to get tested, to mistakes often attributed to Trump administration involvement. But even under the Biden administration, which appointed Walensky director, guidance and decision-making on masking, isolation and quarantine, and booster doses have been repeatedly seen as slow, opaque and confusing. A consistent criticism has been the service’s failure to be flexible, especially with real-time data analysis and release. How CDC data problems left the US behind in the delta variant White House officials have also been frustrated with the CDC and other health agencies over their response to monkeypox, with patients, doctors and even some administration officials asking why it has been so difficult to speed up testing and treatment. Outside experts on Wednesday said they supported Walensky’s proposal. The CDC director “did a very good job of diagnosing the problems” at her agency, said Scott Gottlieb, who led the Food and Drug Administration under Donald Trump and blamed CDC bureaucracy in “Uncontrolled Spread,” a book he wrote on the US coronavirus response. . “The CDC is a very academic organization — and I think Dr. Walensky recognized that when she says they need to change the reward structure so people are not rewarded for publications but for functional execution,” Gottlieb said. He also praised Walensky for promising a new communications approach, adding that her plans to simplify the CDC’s language and release data more quickly will better reach people confused by the agency’s guidance. “They have to learn how to give information about the bottom line,” Gottlieb said. Caitlin Rivers, a senior scholar at the Johns Hopkins Center for Health Security who helped launch the CDC’s new forecasting initiative, said she supported the plan and called on the agency to go even further. “The Preparedness and Response Center is a wonderful resource at CDC. I think they could stand to be brought in sooner [an outbreak]because they have so much experience to share,” Rivers said. The recommendations for change come from an internal review of the CDC’s structure, systems and processes that Walensky ordered this year. It was led by Jim Macrae, a senior official at the Health Resources and Services Administration, part of the Department of Health and Human Services. Macrae interviewed 120 people inside and outside the agency from mid-April to early June, the senior CDC official said. Wakefield will create an executive staff board of the agency that will monitor progress and report directly to Walensky. A briefing paper shared with the Washington Post outlines some of the CDC’s most pressing problems and proposed solutions. Certain measures, such as new authority for injunction Reporting data, hiring people faster, and offering competitive wages to hire and retain top people will require action from Congress. Others are internal changes Walensky might make, such as having the offices of science and laboratory sciences report directly to her, two key departments that would be at the forefront of a public health crisis. And some will require negotiations with unions. The document raised several issues, including the CDC’s lack of agility during public health emergencies. “It takes a long time for the CDC to release its data and science for decision-making,” he said. Agency officials acknowledge this problem and blame it on the CDC’s incentive structure for promotions, which prioritizes publication in agency reports and scientific journals, which delays publication of public health findings, especially in emergencies. “This whole idea where people are saying, ‘we don’t want to arrest ourselves and release this information before we can do an MMWR should be ashamed,’” said one official who requested anonymity to speak candidly about the practice of retaining data until published in the agency’s weekly morbidity and mortality report. “It’s not right. And part of that has to do with the incentive structure within the CDC for promotion.” One solution being considered, the briefing paper said, is to create an online mechanism for “submission before publication” for faster public health responses. Another is simply to share material that can work faster. For example, service employees do not intend to do so wait to release a survey the CDC is conducting among gay men to determine if they have changed their behavior because of the spread Monkey pox, the senior CDC official said. Wakefield will be responsible for changing CDC’s culture by “prioritizing and incentivizing action and public health impact over the number of scientific publications,” the briefing document says. “Generating data for action (not data for publication).” The senior official acknowledged that such a culture change might force some at the CDC to leave, adding, “There will be some people … who would prefer to work in a more academic institution and feel that this is not the right fit.” The changes also include efforts to bring clarity to the CDC’s guidance documents, which “are confusing and overwhelming,” the document says, highlighting one of the most common complaints from consumers. Recommendations include communicating in plain language, reducing the number and length of guidance documents, including scientific rationales, and using frequently asked questions that can be updated in real time. To reinforce training and avoid burnout, Walensky is considering requiring at least a six-month rotation for employees who lead emergency response. During the pandemic, some senior executives were exhausted from deployments lasting more than six months. It has also been difficult to persuade officials to take time off from normal duties to do a tour of duty leading to dealing with the coronavirus or monkeypox. “Leave your position, where you publish documents, to lead [an outbreak response]that is not being rewarded right now,” the senior CDC official said. The agency also plans to create a one-stop shop to help outside groups “navigate the agency and get timely information,” the document says. In addition, it will create a new equity office that will operate across the organization, including recruiting and retaining employees from diverse backgrounds.
