It’s right there in the name: the U.S. Centers for Disease Control and Prevention is supposed to prevent outbreaks of infectious diseases — or, failing that, control them.
But the Atlanta-based CDC by its own admission screwed up the initial response to the Covid-19 pandemic back in early 2020. And now there’s a growing sense of worry among epidemiologists that the agency is screwing up the responses to outbreaks of monkeypox and polio, too.
“I’m sorry to say that the public, as well as a number of public-health professionals, have lost confidence in the agency’s ability to manage early identification and management of one, no less three outbreaks, at the same time,” says Irwin Redlener, the founding director of Columbia University’s National Center for Disaster Preparedness.
“The CDC has been the crown jewel of national public-health agencies, a reputation it has long deserved and enjoyed,” Redlener adds. “That said, it has unfortunately been on a reputational slide for years.”
Redlener and other experts cited a long list of failures by the CDC. For one, a lack of urgency when a new disease appears — or an old one resurfaces. Also, sloppy planning for the rollouts of vaccines.
And perhaps most seriously, poor communication with the public about the true risks they face as the world reels under multiple disease outbreaks connected to deforestation, the illicit spread in wild animals, and a slippage in vaccinations as more and more people fall prey to online misinformation.
“The agency urgently needs an overhaul in virtually everything, from how it acquires and processes data to how it develops and communicates policy,” Redlener says. “Even the internal culture of the agency needs an urgent reset.”
If there’s a silver lining in the dark clouds gathering over the CDC, it’s that the agency knows it has a problem. Last week Rochelle Walensky, the CDC director, told the agency’s 11,000 employees the CDC needed a top-to-bottom rethinking. “To be frank, we are responsible for some pretty dramatic, pretty public mistakes, from testing to data to communications,” Walensky said.
Whether the CDC can fix itself in time to prevent the triple threat of Covid, monkeypox, and polio from escalating into an out-of-control, three-way pandemic — well, that remains to be seen. The CDC didn’t immediately respond to a request for comment.
It’s no secret that, during the final year of Donald Trump’s presidency, the CDC was under tremendous pressure to downplay the severity of the Covid pandemic. And the pressure got worse as the pandemic did. Trump more than most presidents politicized the agency.
But Anthony Alberg, a University of South Carolina epidemiologist, says the CDC’s problems pre-date Covid. “Before the pandemic, the CDC had been gradually drifting away from placing public-health response as its number-one priority and building everything around this vital core mission.”
“During the Covid-19 pandemic, and presently amidst multiple public health crises, we see the negative impacts this has had on CDC’s performance,” Alberg adds.
The first big failure came in March 2020. Covid was spreading rapidly across the globe and, with no vaccines or proven therapies to prevent or treat the disease, countries had no choice but to lock down their populations and shut down their economies.
What the world needed most at that moment was accurate information. That meant testing. While the World Health Organization in Geneva moved swiftly to ship test kits to poorer countries and wealthier countries such as China and South Korea quickly expanded their own production of tests, the United States fell far behind.
It was the CDC’s fault. The agency had designed a PCR test kit that it intended to provide to state and local health departments. But the kit included a faulty reagent, making it unusable in most cases. Worse, the CDC initially rejected requests from local and state health departments and private labs to develop and use their own tests.
So for a critical few weeks early in the pandemic, the United States was in the dark. Yes, Covid was spreading — that much was evident from all the people falling sick. But the CDC and state and local authorities couldn’t accurately track the virus’s transmission or tally up the total number of infections.
It was a major screw-up — and it wasn’t the last. More recently, the CDC has come under fire for presenting Covid data in a way that’s misleading to the general public. The design of the CDC’s website makes the Covid pandemic seem much less serious than it really is.
First the CDC botched Covid. Then it botched monkeypox, a virus that causes a rash — and in a very small percentage of cases, death — and arrived in the United States from West Africa, perhaps via Europe, apparently sometime this spring.
The current monkeypox outbreak, 41,000 cases and growing, is the first major outbreak outside of West and Central Africa — where the disease is endemic — since 2003. It was a test for the CDC, but not an especially difficult one compared to Covid. SARS-CoV-2, the virus that causes Covid, “is much more contagious than other infections,” says Stephanie James, the head of a viral testing lab at Regis University in Colorado.
The pox, after all, usually spreads through close physical contact. It’s not apparent that it’s airborne, like the novel coronavirus is. This limits the pox’s spread. Moreover, existing smallpox vaccines seem to work against the similar monkeypox virus. There was no need for a rushed, multi-billion-dollar vax-development effort to address a monkeypox outbreak.
An effective monkeypox strategy was obvious. Disseminate information on pox symptoms to doctors, clinics and community leaders. Test for infections. Isolate and vaccinate the infected (the vaccines also work as therapies, post-infection). Vaccinate people who came in contact with the infected in order to cut off the pathogen’s transmission pathways.
It’s Public Health 101. But the CDC scored, at best, a “C,” says Jeffrey Klausner, a UCLA epidemiologist.
First, the CDC dragged its heels informing doctors and clinicians about pox symptoms, leading to many instances where pox infections got misdiagnosed as herpes or another common sexually-transmitted disease. Misdiagnosis allowed the virus to spread, unchecked, for weeks.
After finally addressing the diagnosis problem this summer, the CDC struggled with the next challenge: testing. Pox surveillance in these critical early months has been “quite limited and insufficient,” Klausner says.
Perhaps most gallingly, the CDC failed to maintain its stash of hundreds of millions of smallpox vaccine doses residing in 12 secret locations overseen by the Strategic National Stockpile. When the CDC began pulling doses out of storage, it noticed that around 20 million of them had expired. That slowed the distribution of jabs to pox hotspots such as New York City.
Broadly speaking, the CDC is taking the right steps to contain monkeypox. But it takes each step a little too late, and stumbles. Slow and sloppy against an outbreak that’s doubling in scale every 10 days, the CDC’s performance on the pox “could and should be much, much, much better,” Klausner said.
As if overlapping Covid and monkeypox outbreaks weren’t bad enough, polio has reappeared in the United States for the first time in a generation.
On July 18, the New York State health department told the CDC it had detected the poliovirus, which can cause paralysis or death in a small percentage of cases, in a young adult from Rockland County, near New York City. State testers subsequently detected the poliovirus in sewage in Rockland and neighboring Orange County — evidence of transmission in the local community.
Overall, around 90 percent of Americans are vaccinated against polio. But just 60 percent of Rockland residents are. That unvaccinated third is exactly what the virus needs for community spread.
Polio is “one of the most feared diseases in the U.S.,” according to the CDC. So you’d be safe in assuming the agency is doing everything it can to detect the virus — not just in New York, but across the United States.
You’d be wrong. For a month since that first polio case, the CDC has clung to its testing monopoly. Only the CDC and certain states are equipped to monitor for the poliovirus. And despite a clamor of requests from private and university labs, the CDC has yet to release the testing materials and protocols these labs would need to join a national polio surveillance effort.
“They don’t want others doing surveillance,” Vincent Racaniello, a professor in the Department of Microbiology and Immunology at Columbia University, tweeted in reference to the CDC. “Sounds like their early attempt to control PCR testing of SARS-CoV-2, which did not work out well.”
There’s been some talk of the CDC finally opening up polio surveillance to include non-government labs, says Christopher Mason, a biophysicist at Weill Cornell Medicine in New York.
That might be a small, tentative sign that, after years of failures and Walensky’s recent self-criticism, the CDC is finally beginning to reform its testing, communications and vaccine-management processes. “The CDC leadership now recognizes these and other shortcomings and will be working to correct them,” Alberg said.
But Ali Mokdad, a professor of health metrics sciences at the University of Washington Institute for Health, says real and lasting change at the CDC requires new leadership. “You cannot reform if the same team is still in charge.”
CDC director Walensky is a respected scientist, but that doesn’t make her an effective manager, Redlener says. “I like and respect Director Walensky, but it’s fair to ask if a highly credentialed infectious disease expert has the chops and specific experience to manage the rough and tumble of protecting the nation from another serious public-health crisis.”
Klausner said it’s time to go farther. It’s not enough to shake up the CDC’s leadership and reorganize the agency. A whole new agency, one with greater authority, should take over many of the CDC’s duties — and then some, Klausner said.
“We have to remember that as an organization focused on public health science and training of future health officials, the CDC has little authority for direct action,” Klausner pointed out. “The CDC is more like a school of criminal justice than the FBI.”
“What we need is an organization empowered to take action and deploy resources, such as countermeasures in the national stockpile, and direct delivery of testing services or vaccines,” Klausner adds. This new health agency should be “staffed and funded for operations like other federal agencies, such as FEMA or the U.S. military.”
But it’s a heavy political lift to stand up a brand-new major federal agency with potentially tens of thousands of employees and billions of dollars in annual funding — and there’s no sign Congress or the administration of Pres. Joe Biden is even considering such a move.
For now, Americans are stuck with the CDC as the lead agency for public health. It’s an arrangement more and more epidemiologists regret as the agency struggles to contain overlapping viral outbreaks.