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Reform the CDC—Before Another Pandemic Hits

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eye on the news

Reform the CDC—Before Another Pandemic Hits

A bigger budget and more “expert review” will only insulate the agency from change. December 2, 2022
Politics and law
Health Care
Covid-19

Following the CDC’s incontestable failure to protect Americans from Covid, President Joe Biden has proposed a 21 percent increase in the agency’s budget. If CDC bureaucrats had any concerns that painful reforms were coming, or that their leader, Rochelle Walensky, might be replaced, this proposal surely has put their minds at ease. Nor did two recent expert examinations of the nation’s Covid response by highly regarded, independent institutions do anything to worry them by way of publicizing the CDC’s negligence in failing to prepare for the kind of global pandemic that, by 2018, experts were already saying was inevitable.

Nearly everyone knows that the CDC’s colossal failures led to the needless deaths of tens of thousands of people from Covid. The agency’s highhanded mandates imposed additional costs by needlessly shutting down the economy, which caused unrecoverable income losses to businesses and families and a major rise in mental-health problems. Adding to the damage, millions of students were deprived of a year or more of in-person learning.

Americans will be paying a long time for the CDC’s panicked decision to treat a low-fatality virus as sufficient reason to shut down commerce, motivated partly by the government’s growing impulse to treat individual freedom as a threat to authority. In light of this debacle, President Biden’s decision to reward the CDC by showering it with resources seems incomprehensible.

In the world of Washington, however, sending more money to a broken agency is standard procedure. Politicians’ default response is to keep the federal institutional infrastructure unchanged unless a groundswell for reform develops. No such movement has emerged in public health.

Consider that the CDC is the source of billions of dollars in grants that support thousands of public-health professionals, agency contractors, faculty in the nation’s public-health schools, and, through funding agreements, other federal and state entities, including local health departments. The CDC is also one of the largest funders of the World Health Organization (WHO), the UN agency that suppressed critical information about what happened in Wuhan to mollify the Chinese government. If the U.S. were to attempt a serious reform of the CDC, it might also insist on redefining its relationship with the WHO.

When Walensky publicly apologized for the agency’s failures last August, she effectively bought amnesty for the CDC. At the time, she promised a report on her intended managerial reforms. That report has yet to materialize. And now that the White House has announced an increase to the agency’s budget, the need for such a potentially discomforting overhaul has disappeared. It seems we are watching a species of Kabuki theater, evolved for Washington’s political and media environment. Its purpose? To avoid working on problems that no one in the government knows how to fix.

Taking cues from this script, two institutions with presumed authority in matters related to health policy have now undertaken independent studies of the federal response to the pandemic. Not surprisingly, each reads like Hamlet without the prince. Neither takes more than passing notice of the CDC’s gridlocked management culture, the weakening of its once-unflinching commitment to science, or its newfound readiness to play in the world of partisan politics. Recall that Walensky provided pseudoscientific cover for the nation’s largest teachers’ union when it insisted that schools be closed indefinitely.

The first of these two studies, a 542-page report prepared by the National Academies of Sciences (NAS), “Emerging Stronger After COVID-19,” elides its examination of how the epidemic was managed with the larger context of how the nation’s health-care system can be reimagined or “strengthened.” Written by dozens of credentialed Washington experts, the report barely references the CDC’s shortcomings.

The second report, by the Commonwealth Fund, also the product of a group of seasoned health-policy hands, skirts any mention of specifics regarding CDC failures in controlling the spread of the virus. Instead, “Meeting America’s Public Health Challenge” copies the NAS report by avoiding any meaningful discussion of CDC reform, focusing instead on rethinking the nation’s health-care system.

The primary conclusion of both reports is that Congress failed to appropriate sufficient funds for the CDC, and that, once it remedies this flaw, it should make the resulting funding increases somehow immune from future budget reductions. This echoes the widely held belief in Washington that, if only the CDC had had a bigger budget, it could have done its job. Politicians and bureaucrats always see agency failure through the lens of insufficient funding. Playing the long game, they know that larger appropriations will strengthen the reciprocal decision-making customs that they maintain with Washington’s rentier class—regulatory lawyers and lobbyists.

Both reports also line up with six other findings that, uncontested, are likely to become a recurring leitmotif in future studies of the U.S. Covid response. The first has already become a canard following past crises: nearly every retrospective examination of significant government failures has concluded by calling for a larger and more powerful agency to coordinate all the relevant government programs. For example, last July, Secretary of Health and Human Services (HHS) Xavier Becerra “elevated” the Office of the Assistant Secretary for Preparedness and Response (ASPR) from a staff division in HHS to the more powerful and senior status of an administration. The operational result of this name change is that the newly empowered agency has responsibility for managing all relevant entities, including the CDC, in health-related national emergencies.

Second, both reports avoid the question of credible statistics regarding deaths directly caused by Covid. While far too many Americans died, a fact that can’t be disputed, we also know that faulty PCR testing led agencies to overstate the number of infections and that ad hoc payment methods devised by Medicare, Medicaid, and private payers motivated hospitals to exaggerate the numbers of Covid admissions, relevant patient days, and deaths. Without unbiased statistical baselines, we can never judge the effectiveness of interventions, including various preventive and therapeutic approaches, intended to slow the disease and save lives.

Unfortunately, many epidemiologists and clinicians continue to study these matters using observational data rather than large-scale population data augmented with randomized controlled trials. Until such studies exist, we will not have a clear picture of the efficacy of Covid vaccinations.

Given that the NAS and Commonwealth reports adopt an incurious attitude to existing statistical evidence, it is all the more troubling that, in at least two instances, the CDC withheld critical data on how the virus was spreading, denying experienced virologists and epidemiologists working outside of government the ability to offer alternative views on how to combat the pandemic.

Third, both reports fail to point out that for all the rhetorical posturing about the need for a “whole of nation” approach to stopping Covid, the CDC actively resisted relying on private-sector resources that could have greatly improved the agency’s response time and the effectiveness of its interventions. Early in the pandemic, when the CDC had no test to determine whether individuals were infected, the agency initially refused to work with major diagnostic testing firms to develop a strategy. The CDC should have recognized and remedied this anti-private-sector bias.

Fourth, both reports suggest that if universal health insurance had been in place, controlling the virus somehow would have been easier and more effective. With no cause-effect argument offered, the reports appear to ask readers to accept this proposition as self-evident. There is no evidence, however, that a publicly financed universal insurance system—Medicare For All, for instance—would have had any ameliorating effect on the severity of Covid.

Merging the disciplines of public health and clinical medicine provides the two reports’ fifth common conclusion. Overturning hundreds of years of practice and theoretical foundations, the reports would have clinical medicine “pivot” to become subordinate to public health. Fundamental epistemological and practical matters separate these disciplines, however. Naively to propose such a merger is to ignore the grave risks of robbing medical professionals of their mandate to prioritize the needs of individual patients, whose unique and often acute conditions require interventions tailored to their immediate clinical circumstances.

Public health, as a body of knowledge distinct from that of interventional medicine, exists to prevent and contain communicable diseases that threaten whole populations. The argument that physicians should become foot soldiers in the practice of public health reflects the newly fashionable idea of “social determinants of health,” which emphasizes disparities in race and income as the primary cause of differences in individual health status. According to this logic, until disease and injury can be cured at the societal level, clinical interventions are of lesser importance. It is axiomatic that this position negates individual agency for maintaining one’s own health.

The final common conclusion of the reports is a concern for reestablishing trust in the nation’s public-health enterprise, damaged by what the Commonwealth report calls “the corrosive effects of misinformation and disinformation.” Ironically, neither report recognizes that the federal government repeatedly promulgated pandemic guidance unsupported by scientific evidence. Indeed, the CDC, aided by the readiness of the Food and Drug Administration (FDA) to abandon its established vaccine-safety protocols, sowed more doubt in the public than did any nefarious purveyor of “medical misinformation.”

Public-health experts must raise the alarm about the false narratives purveyed in these reports. If the current regime at the CDC, the National Institutes of Health, and the FDA can dodge accountability for their missteps in 2020, then they will likely make the same mistakes in the next pandemic. The American public needs to hear the full story of the federal government’s failures during Covid so that it can discover better solutions than just spending more money.

Photo by Nathan Posner/Anadolu Agency via Getty Images

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