CDC Can Do Better: Five Former Directors on Room for Improvement

One of the CDC’s most pressing needs is data modernization, former CDC directors acknowledged during a panel at Harvard on Tuesday.

“I always felt a little embarrassed every night when I came home and watched the nightly news. … I always thought it was bothersome that the data the nation used to track the epidemic was from a medical school rather than CDC,” said Robert Redfield, MD, who led the agency during when the COVID-19 pandemic started.

Redfield, who was referring to the Johns Hopkins COVID-19 tracker, said increased funding might allow the agency to have real-time data. He cited an example of having to use 2015 data during a 2018 briefing on the opioid epidemic.

“I thought I was going to be leading the premier public health agency in the world,” he said. “And what you’re telling me is, I’m a medical historian.”

Redfield and four other former CDC directors spoke during a virtual panel titled “CDC at the Crossroads” hosted by Harvard’s T.H. Chan School of Public Health. The panel came just one day after current CDC Director Rochelle Walensky, MD, announced plans to hire an outside party to conduct a month-long review of the agency in an effort to improve its performance.

The former directors — their discussion moderated by Rick Berke, the co-founder and executive editor of STAT — focused on how to make the CDC more effective, following a pandemic that has revealed its inadequacies. They also debated how to restore trust in an institution that’s traditionally been held up as an example for the world.

“It may very well be an appropriate time to think about, are we really organized in a way to continue what has become a marathon?” asked Julie Gerberding, MD, MPH, who led the agency from 2002 to 2009. Gerberding is now chief patient officer and executive vice president of population health and sustainability at Merck.

Most panelists said that when they began their terms, they were surprised at the lack of resources for the agency and by the fickle nature of funding, which could surge during an emergency but would not be consistent enough to prevent one.

“I was shocked to see how under-resourced the agency was,” said Redfield, who is now a senior medical advisor at PERSOWN.

“I personally believe that our national health security is much more impacted by the capacity of our public health system in this nation than it is by North Korea or Iran, China, or Russia,” Redfield said, making a comparison to the federal military budget. “And yet, we don’t invest proportionally to that.”

Bill Foege, MD, MPH, agency director from 1977 to 1983, agreed. “The resources are always so inadequate, except when we have an emergency. [After a crisis], you think — but it doesn’t come true — you think it’s going to change,” he said. “We’re always a beggar.”

Berke also asked the panelists if the CDC’s effort to appear apolitical, and its presence in Atlanta rather than in Washington D.C., had cost it influence.

Most of the panelists said the location can’t change, but acknowledged the difficulty of leading an institution that’s both accused of being too political and not political enough. Bill Roper, MD, MPH, agency leader from 1990 to 1993, even acknowledged that the notion of the CDC being apolitical was naive.

Roper and Redfield suggested the COVID-19 task force had weakened CDC’s authority and confused the messaging. Redfield also hinted at his frustration with NIAID Director Anthony Fauci, MD, who is Biden’s chief medical advisor.

Redfield argued that the CDC director should be Senate-confirmed. This, Roper added, would lend more credibility to the position. On the other hand, this could drive more division and politicization, Tom Frieden, MD, MPH, agency director from 2009 to 2017, and now president and CEO of Resolve to Save Lives, argued via a pre-recorded segment.

Redfield favored a longer fixed term for the CDC director, resembling the director of the FBI. FBI directors serve 10-year terms while CDC directors are limited to five, but can be re-appointed by the HHS secretary, he said.

Panelists also addressed the erosion of trust in the CDC. Gerberding said the key was to communicate clearly that CDC guidance is temporary and can always change. Roper said it’s time to reinforce that the CDC is a scientific agency.

“The fact that things are off in crazy directions, if I can be blunt about it, it is not CDC’s fault,” he said. “It’s the political system. And so that can’t be solved by even the wisest people that Dr. Walensky invites in.”

Things got personal for Redfield, whose time at the helm of the agency was made controversial due to the Trump administration’s response to the pandemic. Redfield came down hard on what he said was public criticism from Foege and others during his term, and vowed never to criticise Walensky publicly.

“I was actually very disappointed in Bill and his decision to publicly criticize me fairly aggressively,” he said. Foege had sent him a letter encouraging him to take a stronger stand against former president Trump. The letter was leaked to the press, and Foege stood by his criticism in the aftermath. Foege maintained the letter was meant to be a private exchange with Redfield.

“Every time that I go through an airport now, I trigger the metal detector because of all the shrapnel that’s in my back. Even though I spent 20-years plus in the military I never got any shrapnel, including in Pakistan, Afghanistan,” Redfield said.