Intended for healthcare professionals


US CDC announces major changes after criticism of its responses to covid-19 and monkeypox

BMJ 2022; 378 doi: (Published 23 August 2022) Cite this as: BMJ 2022;378:o2074
  1. Janice Hopkins Tanne
  1. New York

The US national public health agency, the Centers for Disease Control and Prevention (CDC), will make major changes to its structure and systems in the light of a review of its emergency response to the covid-19 pandemic.

Announcing the changes on 17 August, Rochelle Walensky, CDC director, admitted that the agency had failed in its responses to covid-19 and monkeypox. She said that the proposed changes would strengthen and speed the CDC’s response to public health threats and improve its communications.

“For 75 years CDC and public health have been preparing for covid-19, and in our big moments, our performance did not reliably meet expectations,” she said. “As a long time admirer of this agency and a champion for public health, I want us all to do better, and it starts with CDC leading the way.”1

The CDC has been criticised for releasing a flawed test early in the covid-19 pandemic that delayed accurate reporting of cases; confusing advice about social distancing, masking, and vaccinations; and poor communications. Scott Gottlieb, former head of the Food and Drug Administration, also criticised the CDC’s response to the monkeypox outbreak for being slow and having problems with testing and vaccination.2

Walensky, a Harvard professor and head of infectious diseases at Massachusetts General Hospital, was appointed CDC director by President Joe Biden and took office with his inauguration in January 2021. She announced the changes to the CDC in a video to its 11 000 staff, most of whom are still working remotely, after commissioning a review of its pandemic response in April. The review—led by James Macrae, a senior official in the Department of Health and Human Services, the CDC’s parent government department—has yet to be published.

“Data for action”

Walensky said, “My goal is a new, public health action oriented culture at CDC that emphasises accountability, collaboration, communication, and timeliness.” She appointed Mary Wakefield, a former deputy secretary at the Department of Health and Human Services, to head a new executive council to implement the changes.

The CDC will now place less emphasis on employees’ records of published scientific papers and more emphasis on quicker responses to public health issues, such as preprints. Walensky called it “data for action” rather than “data for publication.”3

Georges Benjamin, executive director of the American Public Health Association, commented, “CDC is a great organisation, but it has always functioned like a big academic health system and not an emergency response entity. And the world has changed a lot.”4

The CDC will also revamp its communications with the public, its guidance statements (of which it issued several thousand during the pandemic), and its website, which has been described as confusing and difficult to navigate. The aim is to make information clear and concise and to use plain English, so that information will be easier to understand and can be issued more quickly.

In one major change, the CDC’s science and laboratory sciences divisions will report directly to Walensky. These divisions play essential roles in investigating and tracking public health threats such as covid-19 and monkeypox.

The CDC will also create an equity office to make sure that its workforce is representative of the US population and better communicates public health information to all groups, as well as an office of intergovernmental affairs to help other federal agencies and state health departments work with the agency.

Walensky will ask Congress for new powers, including a requirement for state health agencies and counties to share their data with the CDC, as such sharing is currently voluntary. She will also ask for more flexibility in funding, as Congress currently designates funds for specific programmes, making it difficult for the agency to have money available to cope with a sudden public health emergency.5

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