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.
Trump is doing to America what he did to the United States Football League 35 years ago. He was a team owner. He made the uninformed, unintelligent decision to move the league to play in the fall, without a TV contract, in direct competition with the National Football League, then pushed the USFL to sue the NFL, which drove the league to its corporate death. He has a way of arrogating power to himself, then destroying the organization he has power over. He did it to his casinos. He’s been doing it to the Republican Party. He’s doing it to us now.
I agree with you about our country’s critical and ongoing need for CDC’s expertise and data based analyses of disease trends, spread, and intervention.
However, the accountability for absence of diagnostic testing belongs squarely with the Trump administration. As the Washington Post documents, (https://www.washingtonpost.com/investigations/2020/04/03/coronavirus-cdc-test-kits-public-health-labs/?arc404=true&utm_campaign=wp_news_alert_revere_special_report&utm_medium=email&utm_source=alert&wpisrc=al_special_report__alert-hse–alert-national&wpmk=1 ) , the lack of the million CLINICAL DIAGNOSTIC tests needed by hospitals and health care facilities is the result of the administration failing to convene the FDA and the private sector to address the overly restrictive Emergency Use Authorization–which should have happened shortly after January 31 when Azar declared a health emergency. Leadership by HHS, a Pandemic Planning Unit, even the NSC could have incented or mandated development, production, and distribution of those tests.
Public health use requires a limited number of tests, used strategically. It is a problem that the initial tests CDC released for public health functions had an inadequate negative control reagent. Public health testing facilities had in place the quality assurance testing to recognize the problem and have worked to correct it. That public health test issue is independent of the availability of the MILLION tests needed for the country’s clinical diagnostic testing.
Just today, the CDC put out 2 Facebook messages that were clearly directed for political purposes. It was incredibly disheartening to see that one of the most respected agencies in the country (maybe even the world) is now being used for political reasons to help Trump cover-up his missteps and get himself reelected.
With IG’s being fired and Whistle-blowers understandably afraid to say anything, I have lost hope the CDC can recover until after we have a new President.
Have you considered that the CDC will be “fired” if they take up Trumps’ spot at the microphone ? Or that tests were DICTATED to have to be “made in America”? Have you forgotten how angry Redfield was when Trump uttered denouncing BS on Covid-19 severity at the CDC lab in golf outfit and cap? The hands of the CDC and all valuable professionals are bound by Trump’s twist ties. His muzzling is as destructive as the virus.
I think I had the virus in February. I was in a store stand by asiaian women who had been on vacation. Later I had 101 fever, Chills, threw up, had sore throat and was too weak to cook meals. I snacked whenever I felt like eating. Had a sore throat and cough. Stayed in had groceries delivered and stood across the romm and had driver put them in floor by door. Coul I have had the virus. Had trouble breathing until I put my sleep machine on. How can I found out that if it was what I had or flue?
Celia…i had it also in Feb ….lasted 6 weeks. Didn’t put me down but was irritating.
Thousands of us here have had it early on before all this fear propaganda and have made it thru with flying colors. Why they want the economy and small businesses destroyed is another matter of discussion.
I suspect Fauci, Redfield, Brix, Adams and other leaders are walking a fine line between stating the truth to the public and being fired for contradicting Trump too directly. Federal health leaders are constrained by Trump — unless they are willing to make a final statement and resign.
Resigning is a poor option, since any replacement is likely to be more deferential to Trump and therefore aggravate the situation.
The electorate failed to judge Trump objectively. So did the Electoral College. So did the Republican Senate in the impeachment trial. We won’t have a sound, steady and coherent Federal response to the pandemic so long as Trump remains in office.
Trump has already demonstrated that he can get a person (e.g. FBI Andrew McCabe) fired days before their retirement, taking away their pension. I can’t imagine the level of stress and frustration from career civil servants in the CDC who really want to do a good job, but have to deal with the Toddler.
I hope this was sent directly to the CDC and to every senator, congressperson, and governor. Should probably be sent to the White House although I doubt that it will have any impact.
Finally it’s been said publicly (if not yet widely acknowledged or aired on national media) that this has been a very low and tragic time for the CDC. As an EIS officer 1967-9, I am astounded by the shameful disappearing act of the CDC, for which Trump/his crew and the CDC leadership bear enormous responsibility. This performance is living and will be remembered in infamy. Thank you.
Redfield may be an accomplished researcher and clinician but he is severely lacking in charisma, which is desperately needed when communicating important information. He comes across as a trump lackey, and kind of a penguin type character as he stands on the podium representing the CDC.. mouth slightly agape as he stares at our inept president.
insightful article! The CDC’s handling of the pandemic reminds me of the two NASA Space Shuttle crashes which included technical failures but were ultimately caused by politicization of the space program and, in the 2nd one, bureaucratic failure produced by a toxic organizational culture (CYA before safety).
To any impartial observer there have been glaring flags about the CDC response right from the beginning. Countries that successfully controlled the outbreak like China and Korea mandated wearing medical-grade masks in public and provided them – for 2 1/2 months the CDC advised American specifically NOT to wear them. Orwellian advice to say the least.
Also during that time the CDC”s primary messaging was an ambiguous warning that only people with health risks or over-65’s need to undertake precautions like social distancing. Looks like an agency in need of systemic reform. It all begins with accountability – who is taking responsibility and resigning or being fired for the obvious federal lapses and mistakes? So far not one person.