Public health wins are quiet — the child born healthy, the loved one still safe, the crisis averted, the economy strong. Public health losses, like the nation’s failure to develop an early and accessible diagnostic test for novel coronavirus, are loud.
The Centers for Disease Control and Prevention, what has been the nation’s — and arguably the world’s — preeminent public health agency, must shake off its recent failures, steel itself for what is to come, and display the leadership and competence it possesses. We need the CDC to do the kind of essential work it has done in the past, and are pulling for it to do so now against Covid-19.
In the mid-2000s, Congress appropriated more than $1.6 billion to modernize the CDC campus in Atlanta. Local business leaders, including Bernie Marcus, the conservative co-founder of Home Depot, as well as CEOs from UPS, Delta Airlines, the Southern Company, and Cox Enterprises, advocated for this modernization because they saw the economic risk of infectious disease and understood that, when the time came, the CDC would need the capacity to respond, communicate, and lead.
The CDC and political leaders of that time understood that in moments of public health crisis, accurate and precise communication is paramount. In addition to building new labs, the modernization included construction of both an emergency operations center and a global communications center.
Over the next 20 years, the time came often: anthrax, West Nile, severe acute respiratory syndrome (SARS), Middle East respiratory syndrome (MERS), multi-drug resistant tuberculosis, H1N1 influenza, Ebola, and others. The CDC not only set the standard for what a national public health agency does, but it trained others to carry out that mission around the world. Several generations of the world’s disease detectives have been trained in the CDC’s Epidemic Intelligence Service. These alumni now populate public health agencies around the world.
Quietly and effectively, the CDC projected American competence and leadership.
Around the world, public health agencies across Asia, Africa, and Europe are called “CDC,” despite the fact that the acronym may be meaningless in the home language. As one journalist recently remarked, that happened because the U.S. CDC is the gold standard.
That stands in sharp contrast to the failures of the CDC in the face of Covid-19, from the inability to facilitate widespread testing diagnostics to fostering miscommunication to failed advocacy within the states and at the highest levels to value and listen to trusted and credible scientific and health experts. These public health failures and losses are loud — and consequential.
Georgia Gov. Brian Kemp and New York City Mayor Bill de Blasio are political opposites, but they share a lack of understanding timely science in their decision-making. Both claimed not to know that the novel coronavirus can be spread by asymptomatic people, nearly two months after Anthony Fauci, the nation’s top infectious disease researcher, stated it as beyond doubt in a White House press conference.
Kemp’s statements are particularly perplexing given that the CDC is in his state. Yet his ignorance on this subject is more understandable when we recognize that the CDC has almost disappeared from the national conversation. Or as a reporter with special expertise in infectious disease said to the CDC’s director, Robert Redfield, “You’re invisible now, sir. Your agency is invisible.”
We cannot afford for the CDC to be invisible in the public health crisis of our times. Even if physical distancing works beyond our wildest expectations — even though subsequent backlash wrongly states that it was an overreaction — we will need the contact tracing, epidemiology, disease surveillance, guidance on public health and clinical care, and the leadership of the CDC to ensure we can control the virus until treatments and vaccines are widely available.
There is no question that the credibility of the CDC has been damaged by the last 90 days, and particularly by the increasingly discordant claims that no mistakes have been made. The American people are savvy. We recognize the reality that good, smart, hard-working people can make mistakes. But we cannot continue to trust when reality is denied and communication is inadequate.
The scientific community and the American people will rally to the CDC if they see the calm, rational, and visible leadership they have seen in the past, in movies, and in the namesakes of other nations’ CDCs around the world. Visible leadership by the CDC in speaking the truth about public health can drive public opinion, making it easier for the Governor of Georgia and the Mayor of New York City to include science in their decision-making. More importantly, it can encourage individuals and families to make science-based decisions, and save lives.
Redfield is an accomplished researcher and clinician, and the professional CDC leadership is a national treasure. These leaders direct an agency that has, in the past, demonstrated its competence again and again. This is their moment and they can deliver.
Remember who you are, CDC. The public health win against Covid-19 will be loud. But we need your help to get there.
Sudip Parikh is chief executive officer of the American Association for the Advancement of Science and executive publisher of the Science family of journals.