Three years into the COVID-19 pandemic, the Centers for Disease Control and Prevention’s flaws have never been more public or politicized, and the agency’s director wants to seize this moment to overhaul the agency, making it more nimble and responsive to public health emergencies.
But there’s one major problem — she needs Congress’ help. And she is losing key allies.
CDC Director Rochelle Walensky argues that in order to make her agency more effective, it needs expanded authorities and capabilities. But congressional Republicans say they want more oversight.
Walensky said she’s amenable to such oversight and will testify whenever called. But she also wants to prove to lawmakers the importance of long-term public health funding.
This is the agency’s moment to “rebrand,” Walensky told CQ Roll Call in an interview last week.
GOP members in both the House and Senate are loath to provide the agency with more funding after several years of redirecting emergency funds to prop up pandemic efforts.
They say the agency mismanaged the vaccine rollout, masking guidelines and return-to-school policies, among other things. The CDC has admitted mistakes but argues it did the best it could under unprecedented circumstances.
In the House, the new Republican majority plans to subject Walensky to a barrage of scrutiny not previously seen from Democrats. Across the Capitol, the departure of Sen. Richard M. Burr of North Carolina, the lead Republican on the key Senate Health, Education, Labor and Pensions Committee, leaves the agency without a key Republican champion.
A CDC overhaul, announced in August, aims to revamp the large agency and streamline communication. It’s a long-term effort, and the agency has brought in new staff to begin implementing the changes.
But the mission is daunting: The United States is 80,000 public health workers in deficit, has crumbling public health laboratory infrastructure and poor data-sharing capabilities, Walensky said.
The agency has had to repeatedly ask Congress for emergency pandemic funding, and Congress is increasingly reluctant to fulfill those requests. Most recently, the Biden administration asked for $10 billion more for short-term needs — the fourth request the administration has made this year alone. Like the prior three requests, there’s little momentum in Congress to fulfill that ask.
Walensky said she doesn’t want to keep asking Congress for emergency funding. Instead, she argues, Congress should commit to steady annual public health funding.
“The fascinating thing about public health is that what works, it shouldn’t be part of your everyday dialogue. And that is a hard way to get funded,” Walensky said.
At its core, the CDC is an agency charged with protecting American public health and tracking the spread of diseases. But now, as the agency looks to reorganize and correct mistakes made during the COVID-19 pandemic, it’s unlikely to shed its reputation as a political agency, experts say.
“It’s a real uphill battle. And, you know, there’s the internal culture, and then there’s a lot of external factors that are just, frankly, beyond CDC’s control,” Jen Kates, senior vice president at the Kaiser Family Foundation, said.
Big reputation
The agency’s troubles preceded the Biden administration. Former President Donald Trump’s laser focus on the public health agency, and occasional public chastising of scientists, planted a seed of mistrust in the agency.
But public trust in the CDC continued to decline between December 2020 and April 2022, according to polling from the Kaiser Family Foundation.
Walensky knows regaining that trust will take work.
“A lot of what I feel like the work of moving forward is to demonstrate where we are in the science, where we are in delivering to the American people and redeveloping that trust,” Walensky said
Before the pandemic, the CDC enjoyed relatively high levels of support among the American public, but the challenges that stemmed from the pandemic could impact its long-term credibility, said J. Stephen Morrison, senior vice president at the Center for Strategic and International Studies, a national security-focused think tank. Morrison is currently researching the CDC reorganization effort.
Many Republicans in the House and Senate say that trust has been completely eroded, but Walensky is searching for allies. She’s been making weekly — sometimes twice-weekly — trips from the agency’s Atlanta headquarters to Washington to try to win over lawmakers.
“They’ve lost a lot of trust with the American people that they need to come clean,” said Kentucky Sen. Rand Paul, a prominent Republican on the HELP Committee and reliable adversary of Walensky’s. “And the bottom line is people need to have some answers.”
Incoming HELP ranking Republican Bill Cassidy, R-La., is less critical than Paul. He questions some of the agency’s internal workings, like its remote work policy, but said his goal is to help the agency succeed.
“I’m very amenable to working with CDC. But there has to be more accountability, more than ‘trust us,'” Cassidy said.
Testing the waters
The CDC needs Congress’ help — and money — to fix some internal issues, especially when it comes to collecting data, Walensky said.
She points to the U.S. response to mpox, formerly known as monkeypox, as evidence. The U.S. reported its first case of mpox on May 17 and the agency had its vaccination strategy in place by June 28, but it took until Sept. 1 for the agency to access data on how the vaccination had been administered.
That’s because the agency had to work individually with the legal offices from 61 states and jurisdictions before collecting vaccine data.
“Nine weeks. We were allocating a scarce resource without seeing who was getting it. That’s too long,” Walensky said.
The agency has had similar issues collecting data on COVID-19, Ebola and wastewater surveillance, which can be used to track disease.
“It’s not lost on me that [saying], ‘Oh, the CDC needs to mandate all the data coming to CDC’ — that’s probably not going to, you know, be a winning plan,” she said.
Congress has already provided the agency a total of $1.1 billion to update its data capabilities since the start of the pandemic, via two different COVID-19 relief bills.
Cassidy knows the agency wants more money to update its data streams and says he will work with them to get it done. But he said the agency needs to first demonstrate what it’s been doing with the money it’s already been given to improve its information systems.
“There needs to be a little bit of transparency with what they’ve done. … I mean, if you want more capabilities, you should be able to open up your books and say, “This is what we’re doing,” Cassidy said.
The Select Subcommittee on the Coronavirus Crisis’ final report recommends that the CDC modernize its public health data systems using the funds it has already received, noting that the agency’s “long-standing challenges” with the management of public health data have slowed down decision-making.
Lawmakers are considering two bills that could change how the CDC handles data. One includes data-sharing incentives, and the other expands the agency’s ability to collect data.
Industry is not in favor of giving the agency more authority to collect data.
“The CDC has repeatedly proven that it is incapable of handling a national database run by public health bureaucrats,” the Health Innovation Alliance, an advocacy group that represents organizations like CVS and Amazon, said in a statement. “Everyone agrees the CDC needs serious reforms. Unfortunately, doubling down with more resources and more control is not the answer.”
But as Walensky looks to the next Congress, she remains undeterred.
“This is going to take work. There’s no question. I think that there’s a fundamental difference between asking for money and asking for authorities. Authority is political will, right?” Walensky said.
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