In an effort to address Covid missteps, CDC plans an ‘ambitious’ overhaul

The Centers for Disease Control and Prevention, an agency that has had its reputation battered by a series of missteps in the Covid-19 pandemic, and a slow response to the monkeypox outbreak, will undergo an “ambitious” overhaul, Director Rochelle Walensky announced Wednesday.

In an email to staff, Walensky said the renewal effort will focus on making the agency more nimble and responsive to needs that arise in health emergencies. The priority will be to gather data that can be used to rapidly dispense public health guidance, rather than craft scientific papers.

Walensky also said the agency needs to acknowledge the flaws of its response to Covid-19. Those mistakes date to the earliest days of the pandemic, when a test designed by CDC scientists to detect the new disease failed to work on the ground — leaving the country blind to how quickly the SARS-CoV-2 virus was transmitting at a critical juncture when aggressive measures could have slowed Covid’s spread.

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That error happened on Walensky’s predecessor’s watch. But the agency has continued to struggle since her arrival at the beginning of the Biden administration, notably with confusing messaging about how long people who have been infected need to isolate to try to prevent onward transmission.

“For 75 years, CDC and public health have been preparing for Covid-19, and in our big moment, our performance did not reliably meet expectations,” Walensky said in the email, sent to the agency’s 11,000-person staff.  “My goal is a new, public health action-oriented culture at CDC that emphasizes accountability, collaboration, communication, and timeliness.”

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Though Walensky’s statement focused on her intention to reform the culture of the CDC, she said there would be structural changes as well. To that end, she announced she has appointed Mary Wakefield, who served as an acting deputy secretary of Health and Human Services near the end of the second term of the Obama administration, to lead a team to help implement the reform. Wakefield’s first day at the agency was Monday.

The changes Walensky plans to make will help the agency focus on what she sees as its top priorities: preparedness and response, equity, global health, laboratory science and data modernization.

The announcement comes on the heels of a review of the agency’s response to Covid that Walensky commissioned in the spring. Jim Macrae, associate administrator for primary health care at the Health Resources and Services Administration — part of HHS — was tasked in early April with doing a swift assessment of the CDC’s performance during the pandemic. To date, Walensky has only received an oral briefing on Macrae’s findings, which have not been publicly disclosed.

Macrae and Wakefield previously worked together at HRSA, where she served as administrator from 2009 to 2015.

Macrae’s evaluation was reportedly based on interviews with 120 CDC staff members and key external figures and is said to reflect a consensus on how the CDC should communicate with the public going forward.

It is said to have focused on the need to share scientific data faster and to translate the science the agency generates into practical policies that are easy to comprehend. It also reportedly calls on CDC to strengthen its capacity to respond to public health emergencies — a key responsibility of the agency.

In response to Macrae’s findings, Walensky is creating a new executive council that will report to her, along with a new equity office.

Some of the improvements Walensky signaled she would like to make will require new authorities from Congress — a fact she acknowledged in her statement. The agency’s capacity to rapidly craft data-based guidance in disease outbreaks, for example, is wholly reliant on jurisdictions around the country agreeing to share data with the CDC. She suggested she will ask Congress to mandate data sharing with CDC.

They’ll also take money — and there’s a looming question of whether Congress will increase the agency’s budget as needed to build out its workforce and bolster its technical capabilities.