Report: The CDC is in ‘Peril,’ But Here’s How to Fix it

The nation’s public health agency currently “faces a moment of peril” as it works to restructure after issues raised during the COVID-19 pandemic, according to a new report that suggested the agency establish a greater presence in the nation’s capital and make hiring reforms, among other changes. 

Dr. Rochelle Walensky, director of the Centers for Disease Control and Prevention, outlined in August how she seeks to change the culture and operations at her agency to improve timeliness, collaboration, communication and accountability after it underwent a review earlier in the year. This came after the agency faced criticisms for various aspects of its response to the COVID-19 pandemic response under the Trump and Biden administrations. Additionally, the fiscal 2023 government spending package that President Biden signed on December 29 gave the CDC a funding bump, increased investments in public health infrastructure and made the director a Senate confirmed position. 

But still, the agency has a long way to go, according to a new report from a bipartisan working group launched by the Center for Strategic and International Studies, which acknowledges that much of the power to actually make changes at the CDC comes from the White House, Health and Human Services Department and Congress. 

“Today, CDC faces a moment of peril,” the report stated. “Over the course of the pandemic, it has suffered a rapid, dramatic decline in public support across many demographics and groups.” This peril “does not occur in a silo,” the report noted, as “it unfolds amid a broad attitudinal swing in America toward higher skepticism of science, the federal government, and U.S. health-centered institutions.” 

Having CDC’s headquarters in Atlanta and only a small presence in D.C. is a “major disadvantage,” the working group found. About 73.6% of CDC employees are based in Georgia, according to the most recently available data from the Office of Personnel Management. 

“Further, CDC does not possess a cadre of decision makers who are comfortable and trained to work in international and national security decision-making with the White House and other departments and agencies,” said the report. “Such core staff will be essential if CDC is to become more rapid, nimble, and effective and aligned with broader federal agencies.” 

Tom Inglesby, director of the Johns Hopkins Center for Health Security at the Bloomberg School of Public Health, and J. Stephen Morrison, senior vice president and director of the CSIS Global Health Policy Center, wrote the report and it was endorsed by 40 members of the working group. The working group––which included former government officials (and specifically a former CDC director) and a member of Congress––had just shy of 40 members who signed onto a broad consensus on the findings and recommendations and served as representatives of their organizations. 

Another area of reform the working group recommended was human capital. 

Taking the lead from the U.S. Agency for International Development and the Federal Emergency Management Agency, “Congress should permit CDC to change hiring practices to allow faster hires in crisis and more flexibility to move people in the field, including through noncompetitive hiring of temporary staff during an outbreak response,” said the report. “This should also include seamless ways to onboard these staff to CDC as each response winds down, in order to increase the number of people at the agency with experience successfully responding to outbreaks.” 

The working group noted that the agency is establishing a new career incentive system to award work in outbreak response and not just academic publication achievements. 

“That does not mean that the agency should abandon the rewards and pathway to promotion for academic and scientific excellence as one route for moving forward in the agency,” the report said. “However, it needs new, equally strong pathways for advancement that reward operational speed, experience, and accomplishment alongside subject matter expertise.” 

Other recommendations include clarifying and reaffirming the CDC’s main mission; strengthening the CDC’s global mission; reforming the agency’s guidance development process; launching a high-level dialogue with congressional and executive branch leaders to plan for the agency’s future; improving the quality and speed of its data collection; and giving the CDC more flexibility with its budget.

The CDC did not respond for comment on the report. 

Susan Brooks, co-chair of the CSIS Commission on Strengthening America’s Health Security who was a member of the working group and previously served in Congress, said at a CSIS event on Tuesday that the goal now is to share the report with members of Congress. She noted that this year the Pandemic and All-Hazards Preparedness Reauthorization Act needs to be approved. 

While much of the authority to make changes at the CDC rests with Congress, another panelist and member of the working group issued a word of caution later during the event. 

“Frankly, I don’t think Congress, and especially Republicans, are going to be eager to put new wine in what’s perceived to be an old and broken bottle,” said Gary Edson, president of the Covid Collaborative, an assembly of diverse experts on public health, education and the economy, who previously served as deputy national security advisor and deputy national economic advisor to President George W. Bush. “I think now it’s up to the CDC to step up and [it] needs to first hone the failures of its own making.” These failures include the testing debacle early in the pandemic and issues producing swift and clear guidance, which is why the report calls for the high-level dialogue, Edson said.

“By the same token if congressional investigations are nothing more than a witch hunt that’s not going to make Americans any safer either,” he added.