CDC ‘Should Be Leading the Way’ in Pandemic Decisions, Says Former Director

Two weeks ago, the Trump administration ordered hospitals to start reporting their coronavirus data to a private contractor through the Health and Human Services Department, instead of the Centers for Disease Control and Prevention. The decision is one piece of the government’s response to the pandemic that concerns former federal officials, state health officials, doctors, lawmakers and data experts. 

Administration officials have said the move is meant to streamline the data collection process and better assist the White House coronavirus task force; however, historically the CDC has been in charge of collecting public health data, as The New York Times reported earlier this month. The changeover also followed reports about the alleged stifling of science at the agency and sideling by the White House. 

“As America begins the formidable task of getting our kids back to school and all of us back to work safely amid a pandemic that is only getting worse, public health experts face two opponents: COVID-19, but also political leaders and others attempting to undermine the [CDC],” wrote Dr. Tom Frieden and three other former CDC directors in The Washington Post on July 14. 

Frieden was CDC director for almost the entire Obama administration and now is president and CEO of the Resolve to Save Lives, an initiative of the global public health organization Vital Strategies. Government Executive interviewed Frieden via email earlier this week about the switch in coronavirus data reporting protocol and what actions he would take if he were still in charge of the CDC.

GE: What are the challenges and/or benefits of HHS, not the CDC, managing coronavirus data now? 

Frieden: We’ll have to wait and see how the new approach works. HHS has said it will be better, and let’s hope it is. They have mandated reports in order for hospitals to receive remdesivir, which they chose not to do when the system was reporting to CDC, so we should see increased reporting. 

However, CDC’s [National Healthcare Safety Network] is not just a health care reporting system, it’s a program to support hospitals and improve performance. HHS’ abrupt change seems to have brought some glitches. The HHS site is not being updated regularly; it should be updated daily, but the most recent update was nearly a week ago (July 23). There are also inconsistencies with data. From other data sources, we know that 29 states are seeing increased hospitalizations, and this critical indicator is missing from the HHS Protect Data Hub. 

GE: Historically, have there been issues in the way the CDC collects and reports data on infectious diseases? 

Frieden: Data about notifiable diseases and conditions are collected by each jurisdiction through their disease surveillance programs and then reported to states and to the CDC, where it is compiled and analyzed. Because states and other jurisdictions collect and report data somewhat differently, CDC sometimes needs to make adjustments so that all data are comparable.

There can also be delays in reporting, which means that some data are provisional until verified and finalized. Improvements in technology and data exchange standards have reduced these limitations, but more progress is needed.

GE: If you were still CDC director, what would you propose to do? 

Frieden: CDC must have a seat at the table and at the podium; the agency’s world-class scientists and subject matter experts should be leading the way in making our nation’s public health decisions and then communicating them. All communications must be clear, correct and relevant to both the public and to lawmakers. 

I’d also clarify how recommendations evolve based on new information, something that has generally been poorly understood. In case of an error, I’d strive to admit and correct it as quickly as possible. And I’d avoid politicization of public health to the greatest extent possible; viruses don’t respect borders and are not aligned with political parties or ideologies. The virus is our common enemy, and all have to work together—and stay physically apart—to fight it effectively.