“My goal is a new action-oriented public health culture at CDC that emphasizes accountability, collaboration, communication, and timeliness. I look forward to working with the incredible people at CDC and our partners to realize the full potential of the agency to benefit the health and well-being of all Americans,” Walensky said in a statement Wednesday. Staff were informed of the plans by email. More than 12,000 people work at the agency, which is headquartered in Atlanta. The changes will aim to improve the culture and restore public trust following the agency’s acknowledged missteps in its response to the Covid-19 pandemic. The reforms follow a period of review and introspection at the CDC. In April, Walensky announced that Jim Macrae, administrator at the US Department of Health and Human Services, would lead a month-long review of the agency’s Covid-19 response efforts. At the same time, she assigned three of her deputies to scrutinize the businesses and propose strategic changes. Walensky meets with staff groups in person as employees return to their offices after months of remote work. The new marching orders come after significant stumbling across the agency in response to the Covid-19 pandemic. The US had little capacity to test for infection in the early months of the pandemic, largely because the agency released a flawed test to public health laboratories. This kept the nation blind, for months, to the extent of the virus’ spread.
The agency has also been criticized throughout the pandemic for issuing public health guidance that some have seen as confusing and ineffective. Many also felt that they were not moving fast enough to respond. “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,” Walensky acknowledged in her statement. Walensky will bring former HHS Deputy Secretary Mary Wakefield to the CDC to oversee the reorganization. Among the key moves announced today, the Division of Laboratory Science and the Office of Science will now report directly to the CDC director, a change aimed at making them more accountable and speeding the results of their work to the public. The agency will also create a new office of intergovernmental affairs — a hub where state health departments and other federal agencies interact with the CDC. Walensky will convene an executive board that will set the agency’s priorities, monitor its progress and weigh budget decisions. The agency will launch a new equity office that aims to increase diversity both in CDC’s workforce and add that lens to its public health activities. CDC also plans to create a new online mechanism for delivering science before publication and will revamp its website, streamlining and simplifying its guidance to the public and health care providers. Walensky also plans to ask Congress to give the agency new powers, including mandating that jurisdictions share their data. Currently, the CDC depends on states and counties to do this voluntarily. It will also call for new flexibilities in the agency’s funding. Right now, when Congress appropriates money for the CDC, it must be spent on specific programs. This has created more than 150 individual budget lines that fund the organization. This can be a problem when a public health emergency occurs. In 2014, when the Ebola outbreak began, Dr. Tom Frieden, who was then director of the CDC, had to borrow money from other parts of the federal government to respond. “We literally had no money for airfare and per diem to send staff into the field,” said Frieden, who interviewed Macrae for his review.
“I had, literally, 20 times more flexible dollars as New York City’s health commissioner than I did as director of the CDC,” Frieden said in an interview with CNN. Frieden now heads the nonprofit organization Resolve to Save Lives. Some of these changes have already begun, including the reorganization of the organization’s communications functions.
Earlier this year, the CDC filled a long-standing vacancy when it hired Kevin Griffis, a veteran of public affairs at the Department of Health and Human Services and Planned Parenthood, to lead its communications efforts. Along with communicating CDC health information, part of his job is to manage “risk communication and reputational issues for the organization,” according to the CDC website. The agency has not had a communications officer for four years, according to a senior official with knowledge of the changes, who was not authorized to speak to reporters. A final draft of Macrae’s assessment is expected to be published on Wednesday. Key recommendations will include: • Share scientific findings and data faster • Do a better job of translating science into practical, understandable policy • Prioritize public health communications • De-emphasize publication of scientific findings for career advancement • New training for agency staff so multiple people can take on the same role in public health emergencies