How CDC can restore public trust in the wake of health crises like hantavirus
For decades, the U.S. Centers for Disease Control and Prevention has served as the nation’s most vital institution for safeguarding public health and security.
Operating at the intersection of scientific excellence, real-time surveillance and rapid response and communication, no other agency in the world matches its expertise in detecting and containing dangerous diseases before they become national crises.
Today, that capacity — and the public’s health — is at grave risk.
In the aftermath of COVID-19, the agency has been steadily hollowed out — its funding constrained, its scientific workforce depleted and its data, public health and research functions weakened. With that, trust within the agency and beyond has eroded.
Its global reach, once a cornerstone of American health security, has been sharply curtailed following the U.S. withdrawal from the World Health Organization.
CDC’s staff cuts and withdrawal from WHO have contributed to the slow, fractured and delayed response to the current hantavirus outbreak. It took a full week after WHO alerted the world for the CDC to launch a response.
Instead of accurate, transparent risk assessments, the acting CDC director gave false reassurances. This lack of transparency erodes trust more than saying, “We just don’t know yet, but we will share everything we know as soon as we learn it.”
At the same time, Health and Human Services Secretary Robert F. Kennedy Jr. has exerted unprecedented political pressure, eroding the agency’s independence.
Against this backdrop, President Donald Trump nominated Dr. Erica Schwartz as the next CDC director.
Highly qualified as a former deputy surgeon general and U.S. Coast Guard leader and with degrees in medicine, public health and law, Schwartz now carries a profound responsibility to restore the agency’s scientific integrity and rebuild public trust.
To succeed, she should pledge to adopt these nine principles of leadership articulated by Dr. William Foege, a revered former CDC director.
1. Commit to the highest standards of science
The CDC’s effectiveness and reputation depend on scientific integrity. Schwartz must secure public assurances from Kennedy and the White House that CDC recommendations, publications and communications will be grounded in the highest standards of evidence, analysis and peer review.
The current signs are troubling. Most recently, Kennedy blocked publication of a peer-reviewed research study that demonstrates the effectiveness of COVID-19 vaccines in the CDC’s “MMWR,” the agency’s flagship journal.
Last year, he fired every member of the Advisory Committee on Immunization Practices and installed handpicked “experts” who more closely align with his agenda.
In recent Senate hearings, the secretary refused to commit to following the director’s recommendation on vaccinations. Kennedy plans a similar overhaul of the U.S. Preventative Services Task Force.
Scientific judgment must reside solely with CDC’s professional staff, free from political interference and safeguarded by transparent processes for publication and dissent. Given ongoing political pressure, these protections must be structural, not dependent on temporary goodwill.
This is not to say that politicians don’t have a role in public health policy. They have a very important role to play.
Scientists need to deliver gold-standard science to the appropriate political actors — in Congress, the administration and at state, tribal and local levels — so they can work together to develop the best evidence-based policies.
During confirmation hearings for the new CDC director, the Senate must make clear that political consultation is needed, but political corruption of the science will not be tolerated.
2. Know the truth and tell the truth
Pandemic-era CDC communications on school closures and masking eroded public trust. Restoration requires transparent, disciplined and relatable communication — in terms that different communities understand.
As Foege observed, knowing the truth requires seeking first to understand. This necessitates listening to diverse viewpoints and lived experiences with an open mind.
From that foundation, the director must insist on clarity: informing the public of what is known, what is uncertain and how gaps will be closed.
In crises, evolving evidence is inevitable, but confusion is not.
Credibility rests on being forthright and intellectually honest, especially when the message is difficult.
3. Build and sustain coalitions
The CDC maintains critical relationships with state, local and tribal health authorities on the front lines.
While the CDC provides funding and technical assistance, these partnerships have been weakened by budget cuts and legal battles.
The next director must actively rebuild and strengthen these relationships — treating them as co-creators rather than just implementers.
Trust grows through authentic, sustained collaboration across communities, tribes, states and global health institutions, including the WHO.
4. Embrace humility in the face of uncertainty
The COVID-19 pandemic proved that science evolves.
Leaders who project absolute certainty in the face of shifting evidence will erode their own credibility when recommendations change — as seen with the aerosolized spread of SARS-CoV-2 or wearing masks.
The next CDC director must model intellectual humility, making decisions based on the best available science while openly acknowledging uncertainty and adapting as knowledge advances.
This is not weakness but a hallmark of scientific leadership.
5. Institutionalize learning and improvement
While the CDC has faced external pressures, it must also be visibly self-correcting.
The CDC could implement its own continuous improvement processes. This means embedding rigorous evaluation into all guidance and communications and being transparent about past missteps.
The director should create mechanisms for continuous learning from the populations served; seeing improvement strengthens trust.
6. Respect culture and community context
Public health guidance that ignores cultural realities breeds skepticism. The next director must ensure that recommendations are informed by lived experiences of diverse communities.
This includes engaging trusted local voices and tailoring messaging. It means not doing things to communities or for communities, but doing things with them.
For example, measles outbreaks in religious communities highlight the need for ongoing engagement with community and spiritual leaders to build the cooperation necessary to prevent emergencies.
7. Strengthen internal leadership and rebuild the workforce
Public trust requires the agency to be internally trustworthy. Employees must feel supported and empowered within a culture where scientific debate is respected.
A true leader will support U.S. Public Health Service personnel, giving them authority to evaluate evidence within their areas of expertise.
Crucially, the agency must reverse the exodus of experienced scientists through intentional recruitment and retention strategies, alongside renewed investment in the national public health system.
An organization — and a national public health system — that is adequately staffed is essential to restoring confidence.
8. Mobilize political and public will — without compromising independence
The director must be adept at collaborating with, as well as securing resources from, policymakers while fiercely protecting the agency’s scientific integrity.
This requires translating science into actionable policy. Trust depends on the perception — and the reality — that decisions about how best to serve the health of the country are driven by science. Policies must be grounded in evidence but crafted in collaboration with the political actors.
This assumes goodwill and a genuine belief in science and public health across the political divide. There should not be partisan bickering between Democrats and Republicans, or red and blue states. There is nothing inherently political, yet the bipartisan support for science and evidence has broken down and must be rebuilt.
9. Advance health equity as a core mission
The current administration’s rejection of diversity, equity and inclusion initiatives has led to the defunding of research into health disparities.
Yet these disparities are central to the CDC’s mission. The mission of public health is to serve the entire population, and that can’t be done if the system is intentionally blind to the disproportionate suffering of key U.S. populations, including based on race, ethnicity and gender.
A robust public health agency has dual responsibilities: It must strive to improve health outcomes for every American, while ensuring that the benefits of science accrue equitably to the most disadvantaged.
This requires infusing equity into every aspect of the agency’s work: data collection, program design and delivery, resource allocation and evaluation. Communities that have historically been underserved must see themselves as partners and beneficiaries of CDC initiatives.
These nine principles define a leader who is scientifically rigorous, transparent, culturally grounded, organizationally effective and committed to equity.
This is a high bar, but one this agency, the country and the world demand.
However, no director can succeed without support from the president and HHS secretary.
When political leaders denigrate the agency and its staff, when policies change from day to day, when Americans see the director is not free to speak the truth, trust is eroded.
When the public suffers through preventable disease outbreaks, injuries and chronic diseases and widening health gaps between the privileged and the less advantaged, trust in the agency is undermined.
Framework for moving forward
Schwartz, or any nominee, should work closely with the secretary to develop a shared and transparent framework of trust and collaboration before taking office. We suggest that they begin with written assurances that they will:
- Work together toward a mutual, overriding goal of protecting and promoting the health of the American people; sharing their strategy for reaching that goal; supporting clear communication channels to support their collaboration and communicate the outcomes to the public; designating staff and resources to support this work; and managing this process efficiently and effectively
- Support high-caliber science: The HHS secretary must grant the director the power to drive the scientific agenda and oversee advisory committees like the Advisory Committee on Immunization Practices.
- Restore domestic and international partnerships: This includes re-funding and amplifying tribal, state and local health departments. While the administration may not choose to rejoin the WHO, it must immediately resume close scientific collaboration and data sharing with global experts.
- Ensure fiscal stability: Cease abrupt clawbacks of funds that damage agency stability and partners’ trust. The CDC requires adequate, reliable funding to carry out its mission.
The CDC remains the world’s premier public health institution, staffed by extraordinarily capable and committed professionals. Its staff requires leadership that aligns expertise with a clarity of purpose.
Trust will only be rebuilt through disciplined adherence to these principles, decision by decision, over months and years. If this framework is embodied, the agency will not only regain trust, it will reaffirm its role as the global leader in protecting human health.
The American public deserves a CDC that is driven by science, not partisan politics. Our lives depend on it.
Dr. Mark L. Rosenberg served as U.S. assistant surgeon general and was the founding director of the Centers for Disease Control and Prevention’s National Center for Injury Prevention and Control. He is president emeritus of the Task Force for Global Health.
Julie Rosenberg, who holds doctoral and master’s degrees in public health, is deputy director of the Global Health Delivery Project at Harvard University, where she works to expand access to evidence-based practices by equipping healthcare leaders and clinicians worldwide with the tools and strategies to deliver better care.
Lawrence O. Gostin is a distinguished university professor at Georgetown University, where he directs the WHO Center on Global Health Law.
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