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As political leaders discuss relaxing social distancing restrictions and opening up the economy again, a majority of Americans are concerned about whether it is safe to do so. They have fundamental questions about how the nation is doing, what will happen after it opens up, whether we will be able to keep people safe, and could we have to shut down again.

As we struggle our way through this, an essential element is missing: strong, effective leadership from the Centers for Disease Control and Prevention, the premier public health agency in the world.

Since the beginning of the Covid-19 pandemic, the CDC has been inexplicably absent, and Americans are suffering and dying for it.

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The CDC has long been the steady, trusted source for high-quality national data and evidence-based guidance. But not this time, when its voice is needed the most.

While individual states oversee their public health departments, provision of health care, and actually implement policies and programs, the CDC has always provided the intellectual leadership, technical expertise, the expert guidance that states rely on to do their work. This federal agency coordinates efforts across states so they can learn from one another. And the CDC standardizes data and methods so we can get a true national picture of what is happening.

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Want to know how many tuberculosis cases there were in the U.S. last year? Ask the CDC. Want to know about health-care-associated infections? Ask the CDC. It knows.

But ask how many Covid-19 tests have been done, and the CDC’s doesn’t have an answer. Want a daily update on how many people are getting hospitalized for Covid-19? The CDC isn’t tracking it. Want to know if social distancing is making a difference? The CDC doesn’t know.

During this pandemic, when accurate, timely, nationwide information is the lifeblood of our response, the CDC has largely disappeared.

The performance of the world’s leading public health agency has been surprising, and by that I mean surprisingly disappointing. When the outbreak began, the CDC decided to forgo using the World Health Organization’s testing kit for Covid-19 and build its own. The test it shipped out to states was faulty, creating problems that stretched for weeks and slowed response as states waited for replacement tests.

During this critical time, early hot spots like Washington state and New York City were unable to test for the virus. During the inexplicable number of weeks it took to figure out what went wrong, we could have easily adopted the WHO test, which was developed in Germany and is being successfully used in 126 countries around the world. This setback in testing — driven by defects in the CDC’s Covid-19 test and other bottlenecks and regulatory hurdles — is a major contributor to our national lockdown and the fact that thousands of Americans have needlessly died of this virus.

Beyond its testing failure, the CDC has been slow and its response inadequate in another area where it has always excelled: evidence-based guidance. Throughout this pandemic, it has been slow in coming, confusing, and not necessarily evidence-based.

The agency was slow to suggest that we should end large gatherings. As masks for health care workers became scarce, it recommended that health care workers wear bandanas and scarves with zero evidence that these would protect workers from the virus. Investigative reporting has uncovered unclear and disorganized communication to state public health agencies. And the CDC’s restrictive early testing guidelines did not necessarily align with what was understood about disease symptoms and risks at the time.

Americans rely on the CDC for evidence-based guidance. We have not received it.

Effective leadership from the CDC starts with immediately collecting standardized data and updating it regularly — including weekends. Yet for four weeks, the CDC took weekends off from reporting any data on the pandemic until overwhelming criticism forced it to change course. Daily CDC briefings would help the American public understand the data: Not only do we need to know the number of infections, tests, hospitalizations, deaths, and ICU cases, we need CDC experts to put these numbers in context, explain trends and outliers, and keep us grounded in science. Daily updates from the CDC would allow all of us to better understand how we are doing, whether we are likely to run out of hospital capacity and when, what the bottlenecks are on testing, and how we get ahead of this outbreak.

It would be easy for the CDC to do this, but it hasn’t.

Most states are already reporting some of this information every day, though often in haphazard and incomplete ways. The CDC’s natural role is working with states to standardize data collection and reporting it in a way that would make timely, important information publicly available.

It should also commit to providing guidance based solely on evidence, not speculation. If we run out of masks, the CDC should state clearly that going without masks is harmful (as the evidence suggests), not that we should wear makeshift bandanas (for which there is no evidence). Committing to evidence-based guidance would be easy, since it is what the CDC has historically done. And it would be immensely helpful at this moment.

During any public health crisis — especially the largest one of our generation — the nation’s top public health agency needs to provide leadership. That’s what the American people expect and deserve. But so far the CDC has been absent from the fray, and its absence is being felt.

This must be a painful time for the many extraordinary career scientists who continue to work at the agency. But it’s a painful moment for the American people, too, and with deadly consequences. Real CDC leadership — clear, science-based guidance, effective coordination of states, and public transparency of data — is absolutely essential for confronting and getting clear of this crisis.

The CDC was once the world’s greatest public health agency. We need that CDC back, and we need it now.

Ashish K. Jha, M.D., is director of the Harvard Global Health Institute and professor of global health at the Harvard T.H. Chan School of Public Health.

  • There’s a lot of good things in this article, but I have one thing to add and also one critique.

    First, it may be worth mentioning that constitutional issues prevent the CDC from compelling states to provide data, although there are some workarounds the CDC could be using, such as the CLC Cooperative Agreement.
    https://chris-said.io/2020/04/14/fragmented-data-pipelines/

    Now on to the critique: I’m not sure I agree with the author’s insistence that all CDC guidance be evidence-based, where “evidence-based” seems to be narrowly limited to clinical trials. Obviously clinical trials are ideal, but in a fast moving pandemic I see no problem with making recommendations based on Bayesian prios (i.e. common sense), even if some of them may end up being wrong. To take his cloth masks example, it’s totally reasonable to think they might help reduce spread (from, not to, the wearer), even without clinical trials.

  • I agree that what happened to the CDC is very sad, but like this article notes they deserve a share of the blame. Beyond their faulty test kit that has been well documented, their limited testing guidelines were truly unforgivable. When the outbreak was unquestionably killing people in Italy the CDC steadfastly clung to their “ only test people from China or known contacts of confirmed positives” for way way way way to long and state DPHs followed their guidelines with disasterous results. We could not test patients flying back to US from Milan with fevers and dry cough according to the CDC guidelines at the time. If the CDC wants to restore itself there needs to be a proper accounting of how decisions like this and the bandanas guidance that are truly inexplicable, they cannot simply be swept under the rug with hollow platitudes “ like it didn’t go as smoothly as we would have liked”

  • CDC started getting political during Bush’s final years, and continued to slide under Obama. It is now the FEMA of public health. CDC’s complicity and bungling in the Pandemic trainwreck is just more evidence that it is not independent and not trustworthy. NIH is the only health agency that can be trusted because it is led by proven experts, and Congress has done a fair job of protecting it from WH manipulation.

  • Problem with government no one in the last 20 years has never been held accountable or fired ; in the private sector they are shown the door before lunchtime, until that changes it will only get worst daily

  • I couldn’t agree more. Their recommendation of wearing bandanas and scarves in lieu of medical-grade masks was jaw-dropping. The testing debacle deserves a full investigation to assure it doesn’t happen again. It appears they have been side-lined and muzzled by the current administration. They need a Dr. Fauci at the helm.

  • The key word here is WAS. The CDC has failed miserably with Lyme disease, why would anyone think they were going to succeed with COVID 19? Something is seriously wrong with the CDC.

  • This commentary is absolutely correct. CDC’s leadership in the US has been declining for years. It has failed to stand up for what must be done and let political expediency rule the day. Redfield and it’s other administrators have no backbones.

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