A shake-up at the CDC is intended to make it a more nimble organization
Thursday, August 18, 2022
NPR's Leila Fadel speaks with Dr. Ali Khan, public health expert at the University of Nebraska Medical Center and a former CDC official, about the effects of an announced CDC reorganization.
LEILA FADEL, HOST:
Over the course of the COVID-19 pandemic, we've become accustomed to hearing recommendations that sound like this.
(SOUNDBITE OF MONTAGE)
UNIDENTIFIED PERSON #1: Today, CDC is releasing updated guidance for K-12 schools.
UNIDENTIFIED PERSON #2: We've done a reevaluation.
UNIDENTIFIED PERSON #3: Now we have new science that is just happening from our outbreak investigations that has demonstrated that...
UNIDENTIFIED PERSON #4: But we are at CDC updating our guidance for the particular settings in light of the newer science.
FADEL: For more than two years, the science shifted, the guidance changed, and now the head of the Centers for Disease Control and Prevention wants to reorganize the CDC to do better. Dr. Rochelle Walensky calls it a reset, saying her agency was responsible for pretty dramatic and pretty public mistakes in response to COVID-19. Dr. Ali Khan is dean of the University of Nebraska Medical Center Department of Public Health. He's also a former director of the CDC's Office of Public Health Preparedness and Response. Welcome back to the program, Dr. Khan.
ALI KHAN: Always a pleasure, Leila.
FADEL: So I want to start with this announcement. I mean, a lot of Americans lost trust in the CDC over its response to the pandemic, the constantly changing guidance, a perception that the CDC was bending to political pressure from the Trump White House. What's your reaction to this announcement?
KHAN: I think that assessment of yours is spot on, and the first step in solving a problem is actually admitting you have a problem. So it's really critically important that the CDC director admitted to the American people and has, importantly, the rank and file of the agency, that they made numerous mistakes during the botched COVID response, including the fact that people didn't go to CDC to get data on how many cases there were in the United States, which is their raison d'etre. She left obviously unsaid that CDC's woes weren't just, you know, due to partisanship. So we do know that's an issue. But for the rank and file and for the American people, CDC itself needs to reform.
FADEL: Let's do a quick summary of the ways in which you believe the CDC might have failed during the pandemic.
KHAN: Sure. And Dr. Walensky was very transparent about this. So you talked about, without a doubt, botched communications. They could have done much better in communications. But it starts right at the beginning, using the wrong response model - this was not a influenza disease; this was more like the original SARS-1 - not having enough testing, the wrong case definition, a wrong test that initially went out, not compiling the data, making it available to individuals. So those are some of the things that - and the messaging obviously has continued, but some of the mistakes that were made by the agency.
FADEL: Now, you say this is a big step, recognizing there's a problem, but what are your concerns maybe with this reset? Is this the solution?
KHAN: It's not the complete solution. So there's lots to like about the reset - the focus on better sharing of early information, better communications - it's hard for me to believe that for years, CDC hasn't had a person in charge of communications - and the clear recognition that data is the core of what public health does, and a request for more mandates around data sharing and obviously flexibility in using dollars. But I think this misses the mark on a couple of places. One is, I think, the recognition of the underlying culture of CDC. So, you know, CDC, you know, prides itself on saving polio vaccination in 1955 from a nimble - you know, nimble, fast response when people got infected from an inactivated polio vaccine. So when I hear about creating a culture of nimble response, I think no, that is the inherent culture of CDC. What's happened to it over the last couple of administrations that they've lost that culture? So, you know, response to measles, anthrax, natural disasters, global emergencies like SARS - CDC got all those right, so what's wrong now? What were the leadership issues that put them in this position?
So I think it misses the mark on that, and I think it misses the mark on less focus on publications without recognizing that CDC is a science creation entity, unlike many other federal entities. And the reason people trust CDC and respect CDC is because of their best science. And I think it gets framed like - framed as too academic, too many publications, but the too many publications is because CDC creates science, and that's why you trust CDC, and we can't get away from that. And then finally, too much focus on reorganization - when I was at CDC, I underwent three separate organizations based on whatever the director's pet project happens to be. And I'm not sure they'd necessarily lead to more, you know, operational administrative efficiencies, to be honest with you. And what we don't want to do is create a FEMA for public health emergencies. We still need that excellent science-based organization that is CDC.
FADEL: You know, we can't talk about the CDC and public health officials without talking about the politicized environment in which they're working, where public health officials have gotten death threats over public guidance, over masking and testing. So I've got to ask, how much of this organization is in response to politicized criticism and how much it reflects real problems inside the agency?
KHAN: This reflects real problems inside the agency. And so it's important - why I started off by saying it's important to the rank and file to say an amazing workforce - some of the best scientists worldwide in public health - but there are issues that need to be solved at the agency. And an internal review, which is essentially what this is, is not going to talk about the politicization and the difficulties, not just at CDC, but local and state health departments. And I think we still need a truly external review like we did, for example, during the original 9/11 events that looks broadly across the federal government. I do not want to compartmentalize the difficulties - national difficulties with the public health response to what the challenges were just at CDC. And I think we need to look at this broadly across every agency, across the government and say, how do we do better to be ready for the next pandemic?
FADEL: In the little time we have left, a big question - how can the CDC become more effective in its public health responses going forward?
KHAN: I believe CDC can become more effective by going back to its roots, which is about a rapid, nimble response at trying to identify how it's become so bureaucratic and how to address that bureaucracy where anybody at CDC can identify a problem, bring it to the fore for the CDC director and the leadership and say, this is what's wrong. This is what we need to do to move forward. And that'll get us back to the CDC we all know and respect.
FADEL: Dr. Ali Khan of University of Nebraska Medical Center, a former director of the CDC's Office of Public Health Preparedness and Response - Dr. Khan, thank you.
KHAN: It's a pleasure. Transcript provided by NPR, Copyright NPR.View this story on npr.org
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