Everybody is frustrated with this pandemic: tired-to-the-bone, worried and angry. So it is no wonder that people want someone to blame. Every agency — local, state, and national -- and country’s government has made mistakes over the past two years.
It is no surprise that criticism is focusing on CDC: it is the agency charged with preventing disease, and they have not prevented this one. It is very easy to find fault with CDC — testing, masking, returning to school, vaccination mandates and vaccine distribution. But we should remember CDC is our Atlanta treasure and the people who work there are what make it – they are our neighbors, friends, families and us. Let’s not pile on and jump to judgment.
Naturally, there is the most criticism directed at the director of CDC. The current director Dr. Rochelle Walensky is more than well-qualified for the job. Massachusetts General Hospital in Boston is one of the best hospitals in the world. The doctors there are very smart, and the smartest of them are usually to be found in the division of infectious diseases. Rochelle Walensky was the director of that division, and she excelled in both clinical care and research. She is compassionate, very articulate and supportive of her CDC colleagues.
It is very easy to criticize the director, and there has been a lot of criticism of her. It comes from politicians on the right and the left, from Dr. Fauci and the surgeon general, from the media, from some CDC staff and staff of other HHS agencies. And it comes from former leaders of CDC who suggest that they know how to do the job better.
Credit: contributed
Credit: contributed
I (Mark) used to think of the director of CDC as my dream job. I had trained in infectious diseases, epidemiology, psychiatry and public policy and worked at CDC for 20 years. I had worked closely with WHO, UNICEF, and the World Bank and had led one of the largest nonprofit organizations in the country. I also considered myself a half-decent communicator. But I could not do a good job as CDC director now.
This is a job that is impossible to do well now. The problem is not with the person, but with the systems. The first problem is with the information and analysis system that CDC uses to collect information, analyze it, make decisions and communicate that information. The informatics infrastructure is old and out of date. It is too slow and too incomplete to track a virus that changes and spreads quickly. The culture of public health — as well as the capacity of public health — is used to having decades to collect information, improve its performance and try to reach its goals. In fact, public health has been working on Health Objectives for the Nation that started with objectives for 1990, then 2000, 2010, and 2020.
Business moves much more quickly, setting goals not for the decade, but for the quarter. But we are in a war with a very devious enemy that is always changing and always moving. To win this battle we need real-time knowledge of where our enemy is and what it is doing. To beat this enemy, we need to work more like the military in battle. Faster and smarter.
And we need to work better across state lines and forge ties between the CDC, NIH and FDA. We can start by getting the directors of each of these organizations to work together. When collaboration starts — and continues — at the top, it is much more likely to succeed.
The other big problem is with our system for integrating science with politics. Public health is public and inherently political. It serves everyone and is paid for by governments. Politicians should not interfere with the rigorous scientific collection, analysis and communication of evidence.
The science and evidence should be used to form policies. This is when we must involve both the scientists and the politicians. During the Trump administration there were many documented instances where administration officials altered or censored scientific data. That was wrong, and it had disastrous consequences. In an overreaction to that meddling in the evidence, scientists, politicians and pundits have said that this administration should let CDC operate unfettered – to let CDC make policies based on science alone. That too is not helpful.
Leaders must make decisions using the best possible data and evidence. We need a system that can integrate science with politics, that can get these two parts to work effectively together. We don’t yet have that.
It is especially important to get both parts working together on policy related to this epidemic because the next elections may be won or lost based on how the public rates the performance of the politicians currently in office. The policies we use to guide us — at community, state and national levels — are important to all of us and we need to fix these systemic problems as quickly as we can.
As a country, we are getting more impatient with this pandemic. We all want someone to blame. But when we are looking for a scapegoat, let’s make sure we pick the right one. The director of CDC is working very hard to get the information we need and share that with the public. The problem is not with her. She and CDC deserve our support and they should be allowed to build the information system we need to go to war with this coronavirus.
Politicians need to find constructive ways to work with scientists and the science to develop the very best policies they can develop – policies that will continue to change as science and situations evolve.
If we need to find a scapegoat, let’s be sure to find the right one: the SARS-CoV-2 virus.
And if we focus on our real enemy, we can figure out what we really need, and with adequate resources we can:
1.) Develop a plan for dealing with this virus that is going to be around for a long time and for the new threats that will surely be emerging;
2.) Develop new vaccines and get them into the people all over the world who need them;
3.) Build a better system for tracking this and future threats — our enemies — and gathering, analyzing, disseminating and applying that information quickly and in real time;
4.) Develop an adequate supply and appropriate distribution of masks and tests;
5.) Create an effective process for integrating science and political priorities to generate the best policies for the country.
We have more than enough to do. Time to stop blaming and get to work.
Dr. Mark Rosenberg is a physician-scientist trained in infectious diseases, psychiatry and public health who served as the founding director of CDC’s National Center for Injury Prevention and Control and as assistant surgeon general. Rochelle Walensky’s husband is his very distant 4th cousin twice-removed by marriage, but Dr. Rosenberg has never met either Dr. Walensky or her husband.
Julie Rosenberg, MPH, is an associate director at Ariadne Labs and deputy director of the Global Health Delivery Project at Harvard. She is a graduate student in public health leadership at Georgia Southern University. She is Dr. Rosenberg’s daughter.
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