After a nearly yearlong review of the CDC’s pandemic response, Rochelle Walensky prepares to shake up its operations and culture.
(Bloomberg) — Centers for Disease Control and Prevention chief Rochelle Walensky is preparing to roll out sweeping changes at the agency after it endured a barrage of criticism for its delayed and inconsistent response to the pandemic.
The CDC director will require all employees to be ready to deploy to combat national health crises, marking a drastic shift from a fragmented volunteer system that hampered its Covid-19 response, according to Walensky and other top CDC leadership who previewed a series of measures the agency will implement to better prepare for emergencies. Others include elimination of management layers, elevation of laboratory sciences and the possible formation of a CDC unit dedicated to coronaviruses within its immunizations and respiratory disease arm.
Walensky took the helm at the beginning of President Joe Biden’s term with promises to revitalize an agency embattled by criticism from Democrats and Republicans alike for producing flawed Covid-19 tests, inconsistent messaging on how the infection spreads and other issues. In April, she launched a multi-pronged review that unearthed deep concerns about the CDC’s responsiveness to health emergencies.
“We really have to demonstrate that we’re action-oriented,” Walensky said in an exclusive interview at the agency’s Atlanta headquarters. “I don’t want to repeat old mistakes.”
Ready to Respond
The findings led Walensky to announce plans in August for a top-to-bottom overhaul of the CDC, including improving data collection, laboratory practices and public communication. CDC has long been known for top-notch science that’s been able to identify the social and geographical roots of disease, along with the pathogens responsible. She set out to move the CDC away from what’s seen as an academic orientation that’s long been part of the agency’s culture toward a workforce geared to response.
Lawmakers, think tanks and state and local health groups have said that change is needed. Meanwhile, Republicans who took control of the House of Representatives in November are threatening a probe of the agency’s pandemic response; Walensky says she’s prepared to testify.
“The expectation of the CDC is to do great science — but it’s not just that, it’s to run a state-of-the-art, best-possible reaction to novel epidemics and pandemics,” said Tom Inglesby, director of the Johns Hopkins Center for Health Security at the Bloomberg School of Public Health. “You need people skilled at running infectious-disease crises, and they’re not highly skilled at operating an emergency response.” (The Johns Hopkins Bloomberg School of Public Health is supported by Michael R. Bloomberg, founder of Bloomberg LP and Bloomberg Philanthropies.)
Inglesby is also the co-chair of a Center for Strategic and International Studies working group preparing its own recommendations for strengthening the CDC.
From the beginning of the pandemic in early 2020, the CDC struggled to identify workers who were well-suited to take part in the emergency response, said Henry Walke, director of the agency’s Center for Preparedness and Response. In an interview at CDC’s Emergency Operations Center in Atlanta, Walke described a laborious process of searching for epidemiologists, laboratory scientists and other experts willing to temporarily leave their positions and put those skills towards combating Covid. At the the outbreak’s peak, the CDC was able to redirect 25% of its workforce to focus on the pandemic—but finding personnel took time, he said.
Through Walensky’s overhaul, called the CDC Moving Forward project, the agency will “move away from a volunteer workforce to a mandatory one where we’ll just deploy people” to work on emergencies, Walke said. The agency will offer new trainings, encourage managers to allow their staff to participate in crisis-response and consider participation in annual performance reviews.
“What we need to do is make sure every CDC staffer actually considers response a critical element of their job,” he said.
Walensky, former chief of Harvard-affiliated Massachusetts General Hospital’s infectious disease division, is also campaigning for more flexibility in how it collects data from states and spends its $10.7 billion budget. It now includes more than 150 detailed line-items for specific diseases that can’t be shifted to other priorities, even in an emergency. She also plans to request additional funds for improved public health infrastructure, data modernization and lab capacity.
“We need congressional help to be nimble,” she said.
Staff Lost
The CDC now has fewer than 300 employees dedicated to the Covid response, and as part of the overhaul, Walensky has asked the National Center for Immunization and Respiratory Diseases to find a permanent home for efforts to counter the coronavirus. But even that may be tough to staff, said Jose Romero, who leads the unit.
“CDC has lost a lot of people in the last two years,” Romero said, “Some retired, some have had enough.”
Walensky sympathized with the travails of agency workers who have been under terrific strain throughout the pandemic, and said she hopes the reorganization will help alleviate some of it. She’s formed dozens of teams focused on implementing the new policies and determining whether they’re successful, and created a virtual suggestion box for anonymous employee feedback.
“We’ve had a rough go over the last several years,” said Walensky. She hopes to strike “a delicate balance of moving fast enough such that we’re taking action,” she said, “but not moving so fast that you pull the legs out from under people.”
She’s soliciting feedback on the agency-wide reorganization and made herself available to state and federal officials, who have their own demands. Anne Zink, chief medical officer for Alaska and the president of the Association of State and Territorial Health Officials, said the agency has had many faces during the pandemic.
“They’ve been incredibly helpful and useful and they’ve been incredibly frustrating and infuriating.” said Zink, who has provided input on how the agency should improve. “We want to be a part of making plans with the CDC.”
For Walensky’s plan to succeed, much hinges on external support and buy-in — particularly from Congress. If that falters, Walensky said she’ll trudge ahead with the resources she has.
“Change is uncomfortable,” she said. “Sometimes it’s harder in a politically charged environment, but our job is to deliver health in a bipartisan way.”
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