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‘It’s an amazing place’: CDC director Rochelle Walensky explains how she hopes to reform her battered agency | Science

Rochelle Walensky got into a hot mess when she took over as head of the US Centers for Disease Control and Prevention (CDC) in January 2021.

Then head of infectious diseases at Massachusetts General Hospital, Walensky was a clinician and researcher who specialized in cost-effectiveness studies and supervised fewer than 80 physicians. She took over an agency with a $15 billion annual budget, nearly 11,000 employees and a world-renowned reputation that had been damaged by its haphazard and inconsistent response to the COVID-19 pandemic. Part of the problem lay at the feet of incumbent former President Donald Trump’s administration, which had restricted the CDC’s ability to communicate with the public, changed its scientific reports and pressured it to follow advice which sometimes went against the scientific evidence.

But the pandemic also exposed cracks in the CDC’s structure that had little to do with politics. The agency has struggled to keep up with the rapid pace of the crisis. While most scientists had switched to preprints to publish COVID-19 data, CDC researchers often published in the agency’s own journal. Morbidity and Mortality Weekly Report (MMWR), which requires multiple permission levels before publishing. The CDC also botched development and distribution of COVID-19 tests, sending faulty diagnosis to state labs; issued unclear guidelines on prevention efforts such as social distancing and vaccines; and was unable to fight misinformation being spread on social media.

In April, Walensky announced two agency reviews. We look back on the CDC’s COVID-19 response to analyze its failures; the other assesses agency organizations, systems, processes and policies. Last week, after seeing the preliminary results of those exams, Walensky addressed the entire CDC staff in a video that didn’t mince words. “To be frank, we’re responsible for some pretty dramatic and pretty public errors, from testing to data to communications,” Walensky said. “This is our defining moment. We have to pivot.”

Science spoke with Walensky about the reviews, none of which have been finalized, and his vision for CDC reform. The interview has been edited for brevity and clarity.

Q: In September 2020, former CDC Director William Foege wrote a searing letter to then-CDC Director Robert Redfield claiming that the CDC had been “a colossal failure” in its response to COVID-19. 19 and lamenting that the agency went from “tarnished gold.” brass.” He urged Redfield to send a letter to employees setting out the facts in an attempt to boost morale.

Are your public statements about identified shortcomings in the reviews your attempt to help restore morale within the CDC and own up to its mistakes?

A: I intervened in it. You are absolutely right. I’m not sure last week’s headlines have lifted morale within the agency. I mean, the headlines said, “We botched the answer.”

But I wasn’t necessarily motivated by [Foege’s] letter.

I was always an avid consumer, a champion, and a cheerleader for CDC before I came here. The CDC people are amazing. They have subject matter expertise and have been able to withstand so many different things. And yet, there were so many structures, incentives, alignments and priorities that it was difficult for them to do so. [during the pandemic]. So my job after a year and a half in this agency was to better understand things from the inside, to say: Let’s look at what went well and what didn’t go well, with COVID -19 and outside of COVID. And then correct the course.

Q: That’s basically what Foege was recommending: tell your employees the facts, own them, and apologize for the mistakes.

A: The question, however, is whether the people themselves were responsible or whether many elements of the structure around them did not allow them to act as quickly as possible and did not allow them to set priorities. I think it’s a bit of both.

Q: You are a prioritization specialist. This is what profitability studies are for.

A: That’s absolutely correct.

Q: What are you going to prioritize? You could say overnight: CDC employees, you can submit preprints and wait no longer. MMWR. Are you ready to do this?

A: I don’t know if I can do it in no time. But it’s something we’re looking at: how come we get our data faster? I’ve published enough articles to know that, as painful as the review process is, the articles are usually better after. So I don’t necessarily want to get rid of it. But there is the case, especially in public health, where we have to make the data public if we are confident enough that it is clean enough, because we have to take that step imminently.

But CDC has changed. Last week we put the Internet Survey of American Men monkeypox data on our website, and the document is not out yet. The question is, what is the best way to do this? There are many different ways. But the clearance process at the CDC for published stuff is too slow.

Q: The main criticism of the CDC is that it has been crippled by its own caution and reluctance over and over again. Testing was an infamous sloppy early in COVID-19, and the CDC’s handling of monkeypox testing has also been criticized.

A: As a leader, I now have to come to terms with what happened with COVID testing. And we worked a lot on testing. We now have an infectious disease review board so that any test that comes out of the CDC is reviewed. We have worked a lot on quality assurance.

What happened with monkeypox is different. We gave it a try. We had published primer data [used in the polymerase chain reaction assay] online as soon as the first cases of monkeypox were reported. Within days of the first two cases, we were on the phone with commercial labs, which we felt was the fastest way to ramp up as much testing as possible across the country. We got rid of manual processing and automated it.

There were difficulties in accessing laboratory resources, I will not deny that. And there was an education that had to take place. We’ve been accused of not testing widely enough, widely enough: “Why can’t I just walk through the door?” People don’t necessarily recognize that you need a rash to get tested.

Q: One issue that many people point out is the relationship between the CDC and the states and local public health units. Some, for example, have defiantly ignored CDC recommendations on masking and the COVID-19 vaccine. How do you approach this?

A: We need to prioritize our partnerships. I had regional calls with each of the states. I am often on the phone with the Association of State and Territorial Health Officials (ASTHO). I actually told ASTHO, some of you I hear some of you don’t. I wanted to meet them so they would feel free to contact me if something was wrong.

As you probably know, we have to be guests in the States. We can’t just show up and say we want to be here. What we really want to do is tell how can we be most helpful to you.

Q: Are there any concrete plans that you’ve based on the draft reviews you’ve seen? Do you plan to lay off or reorganize the staff?

A: For most of its history, the CDC has talked to public health partners and scientists, not the American public. Most people haven’t gone to the CDC’s website to see what the pre-COVID school guidelines were. So we need to become more versatile in how we speak to the American public. Historically, we haven’t been challenged by social media and misinformation. How do we do all these things?

Second, we will realign the incentives for staff so that we are moving towards promoting people to take actions that benefit public health. How do we realign our communications to speak to the American public?

I have not lost sight that changing the boxes of a flowchart will not do anything by itself. We have not devoted sufficient time, energy and resources to our public health infrastructure, core staffing capabilities, data modernization and laboratory infrastructure. And that’s the investment that I think we really need to make.

Q: How are you going to convince the right people, especially young people, to join the CDC in the future given what it has been through in recent years?

A: It’s such an easy sell. It’s such an amazing organization of people who are up all night, whose names you’ll never know, because they benefit health all over the country and really all over the world. I just spoke to someone yesterday who was retiring. She said, “I can’t believe they’re paying me to do this job.” And so if you’re so into science, epidemiology, and health missions, I’d be happy to talk to you because I think it’s an amazing place and full of just amazing people.